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Petersen M, Coenen M, DeCarli C, De Luca A, van der Lelij E, Barkhof F, Benke T, Chen CPLH, Dal-Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Fletcher EF, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, Maillard PM, McCreary CR, Papma JM, Pijnenburg YAL, Schmidt R, Smith EE, Steketee RME, van den Berg E, van der Flier WM, Venkatraghavan V, Venketasubramanian N, Vernooij MW, Wolters FJ, Xu X, Horn A, Patil KR, Eickhoff SB, Thomalla G, Biesbroek JM, Biessels GJ, Cheng B. Enhancing Cognitive Performance Prediction through White Matter Hyperintensity Connectivity Assessment: A Multicenter Lesion Network Mapping Analysis of 3,485 Memory Clinic Patients. medRxiv 2024:2024.03.28.24305007. [PMID: 38586023 PMCID: PMC10996741 DOI: 10.1101/2024.03.28.24305007] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction White matter hyperintensities of presumed vascular origin (WMH) are associated with cognitive impairment and are a key imaging marker in evaluating cognitive health. However, WMH volume alone does not fully account for the extent of cognitive deficits and the mechanisms linking WMH to these deficits remain unclear. We propose that lesion network mapping (LNM), enables to infer if brain networks are connected to lesions, and could be a promising technique for enhancing our understanding of the role of WMH in cognitive disorders. Our study employed this approach to test the following hypotheses: (1) LNM-informed markers surpass WMH volumes in predicting cognitive performance, and (2) WMH contributing to cognitive impairment map to specific brain networks. Methods & results We analyzed cross-sectional data of 3,485 patients from 10 memory clinic cohorts within the Meta VCI Map Consortium, using harmonized test results in 4 cognitive domains and WMH segmentations. WMH segmentations were registered to a standard space and mapped onto existing normative structural and functional brain connectome data. We employed LNM to quantify WMH connectivity across 480 atlas-based gray and white matter regions of interest (ROI), resulting in ROI-level structural and functional LNM scores. The capacity of total and regional WMH volumes and LNM scores in predicting cognitive function was compared using ridge regression models in a nested cross-validation. LNM scores predicted performance in three cognitive domains (attention and executive function, information processing speed, and verbal memory) significantly better than WMH volumes. LNM scores did not improve prediction for language functions. ROI-level analysis revealed that higher LNM scores, representing greater disruptive effects of WMH on regional connectivity, in gray and white matter regions of the dorsal and ventral attention networks were associated with lower cognitive performance. Conclusion Measures of WMH-related brain network connectivity significantly improve the prediction of current cognitive performance in memory clinic patients compared to WMH volume as a traditional imaging marker of cerebrovascular disease. This highlights the crucial role of network effects, particularly in attentionrelated brain regions, improving our understanding of vascular contributions to cognitive impairment. Moving forward, refining WMH information with connectivity data could contribute to patient-tailored therapeutic interventions and facilitate the identification of subgroups at risk of cognitive disorders.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirthe Coenen
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Alberto De Luca
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, Division Imaging and Oncology, UMC Utrecht
| | | | | | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Christopher P. L. H. Chen
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Lieza G. Exalto
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Saima Hilal
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Huiberdina L. Koek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andrea B. Maier
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Cheryl R. McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janne M. Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Eric E. Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M. E. Steketee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Vikram Venkatraghavan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W. Vernooij
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J. Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xin Xu
- Memory, Aging and Cognition Center, National University Health System, Singapore
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology with Experimental Neurology, 10117 Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Kaustubh R. Patil
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Simon B. Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Matthijs Biesbroek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Geert Jan Biessels
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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O'Callahan K, Sitters S, Petersen M. 'You make the call': Improving radiology staff scheduling with AI-generated self-rostering in a medical imaging department. Radiography (Lond) 2024; 30:862-868. [PMID: 38582024 DOI: 10.1016/j.radi.2024.03.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION New Zealand's shortage of medical imaging technicians has intensified due to factors like illness, the pandemic, and an ageing workforce. Addressing staff retention issues requires attention to intrinsic factors like workplace satisfaction and work-life balance. Self-rostering has proven effective in healthcare by enhancing work-life balance, job satisfaction, and retention, but it has not been implemented widely in radiology. This study aimed to explore the perceptions, benefits, and challenges of implementing AI-generated self-rostering in a radiology department through simulated trials. METHODS This study simulated an AI-generated roster in a regional New Zealand radiology department, engaging 23 staff members. A mixed-methods approach included surveys and discussion groups. Community-based participatory action methodology guided discussion groups and informed modifications. RESULTS The AI-generated self-rostering method demonstrated success by meeting a high percentage of shift preferences while fulfilling service demands. Participants perceived potential benefits in work-life balance and autonomy, though uncertainties persisted regarding implementation and fairness. Despite staff reservations, we found that an AI-generated self-rostering system may be fairer than manual self-rostering, while saving radiology staff time and cost. CONCLUSION AI-generated self-rostering offers an innovative solution to an old problem. This self-rostering system provides a fair way for staff to have a say in the shifts they do, which increases feelings of work-life balance and autonomy. In this simulation, AI-generated self-rostering was well received, and most staff were receptive to moving to pilot the programme. IMPLICATIONS FOR PRACTICE Self-rostering could be a potential solution to staff retention issues in radiology; we recommend a pilot study is implemented. When switching to self-rostering, departments should consider implementing one-on-one support systems to assist staff with entering preferences. Education is essential to encourage staff understanding and cooperation.
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Affiliation(s)
- K O'Callahan
- Department of Medical Imaging, Unitec Institute of Technology, 5-7 Ratanui St, Henderson, Auckland, New Zealand.
| | - S Sitters
- Department of Medical Imaging, Unitec Institute of Technology, 5-7 Ratanui St, Henderson, Auckland, New Zealand.
| | - M Petersen
- Department of Medical Imaging, Unitec Institute of Technology, 5-7 Ratanui St, Henderson, Auckland, New Zealand.
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Bhattacharya D, Becker BT, Behrendt F, Beyersdorff D, Petersen E, Petersen M, Cheng B, Eggert D, Betz C, Schlaefer A, Hoffmann AS. Computer-Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation. Laryngoscope 2024. [PMID: 38520698 DOI: 10.1002/lary.31413] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Computer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts. METHODS This study uses Hamburg City Health Study (HCHS) a large, prospective, long-term, population-based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C-reactive protein, allergies). RESULTS The evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy. CONCLUSION The study demonstrates a 3D CNN's ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Debayan Bhattacharya
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Tobias Becker
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Finn Behrendt
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
| | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elina Petersen
- Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dennis Eggert
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Schlaefer
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
| | - Anna Sophie Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Petersen M, Hoffstaedter F, Nägele FL, Mayer C, Schell M, Rimmele DL, Zyriax BC, Zeller T, Kühn S, Gallinat J, Fiehler J, Twerenbold R, Omidvarnia A, Patil KR, Eickhoff SB, Thomalla G, Cheng B. A latent clinical-anatomical dimension relating metabolic syndrome to brain structure and cognition. eLife 2024; 12:RP93246. [PMID: 38512127 PMCID: PMC10957178 DOI: 10.7554/elife.93246] [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] [Indexed: 03/22/2024] Open
Abstract
The link between metabolic syndrome (MetS) and neurodegenerative as well as cerebrovascular conditions holds substantial implications for brain health in at-risk populations. This study elucidates the complex relationship between MetS and brain health by conducting a comprehensive examination of cardiometabolic risk factors, brain morphology, and cognitive function in 40,087 individuals. Multivariate, data-driven statistics identified a latent dimension linking more severe MetS to widespread brain morphological abnormalities, accounting for up to 71% of shared variance in the data. This dimension was replicable across sub-samples. In a mediation analysis, we could demonstrate that MetS-related brain morphological abnormalities mediated the link between MetS severity and cognitive performance in multiple domains. Employing imaging transcriptomics and connectomics, our results also suggest that MetS-related morphological abnormalities are linked to the regional cellular composition and macroscopic brain network organization. By leveraging extensive, multi-domain data combined with a dimensional stratification approach, our analysis provides profound insights into the association of MetS and brain health. These findings can inform effective therapeutic and risk mitigation strategies aimed at maintaining brain integrity.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Felix Hoffstaedter
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University DüsseldorfDüsseldorfGermany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center JülichJülichGermany
| | - Felix L Nägele
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - D Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Birgit-Christiane Zyriax
- Midwifery Science-Health Services Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-EppendorfHamburgGermany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular CenterHamburgGermany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/LuebeckHamburgGermany
- University Center of Cardiovascular Science, University Heart and Vascular CenterHamburgGermany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular CenterHamburgGermany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/LuebeckHamburgGermany
- University Center of Cardiovascular Science, University Heart and Vascular CenterHamburgGermany
- Epidemiological Study Center, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Amir Omidvarnia
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University DüsseldorfDüsseldorfGermany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center JülichJülichGermany
| | - Kaustubh R Patil
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University DüsseldorfDüsseldorfGermany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center JülichJülichGermany
| | - Simon B Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University DüsseldorfDüsseldorfGermany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center JülichJülichGermany
| | - Goetz Thomalla
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-EppendorfHamburgGermany
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Schulz M, Petersen M, Cheng B, Thomalla G. Association of structural connectivity with functional brain network segregation in a middle-aged to elderly population. Front Aging Neurosci 2024; 16:1291162. [PMID: 38371399 PMCID: PMC10870644 DOI: 10.3389/fnagi.2024.1291162] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction The deterioration of white matter pathways is one of the hallmarks of the ageing brain. In theory, this decrease in structural integrity leads to disconnection between regions of brain networks and thus to altered functional connectivity and a decrease in cognitive abilities. However, in many studies, associations between structural and functional connectivity are rather weak or not observed at all. System segregation, defined as the extent of partitioning between different resting state networks has increasingly gained attention in recent years as a new metric for functional changes in the aging brain. Yet there is a shortage of previous reports describing the association of structural integrity and functional segregation. Methods Therefore, we used a large a large sample of 2,657 participants from the Hamburg City Health Study, a prospective population-based study including participants aged 46-78 years from the metropolitan region Hamburg, Germany. We reconstructed structural and functional connectomes to analyze whether there is an association between age-related differences in structural connectivity and functional segregation, and whether this association is stronger than between structural connectivity and functional connectivity. In a second step, we investigated the relationship between functional segregation and executive cognitive function and tested whether this association is stronger than that between functional connectivity and executive cognitive function. Results We found a significant age-independent association between decreasing structural connectivity and decreasing functional segregation across the brain. In addition, decreasing functional segregation showed an association with decreasing executive cognitive function. On the contrary, no such association was observed between functional connectivity and structural connectivity or executive function. Discussion These results indicate that the segregation metric is a more sensitive biomarker of cognitive ageing than functional connectivity at the global level and offers a unique and more complementary network-based explanation.
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Affiliation(s)
- Maximilian Schulz
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bhattacharya D, Behrendt F, Becker BT, Beyersdorff D, Petersen E, Petersen M, Cheng B, Eggert D, Betz C, Hoffmann AS, Schlaefer A. Multiple instance ensembling for paranasal anomaly classification in the maxillary sinus. Int J Comput Assist Radiol Surg 2024; 19:223-231. [PMID: 37479942 PMCID: PMC10838850 DOI: 10.1007/s11548-023-02990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/27/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Paranasal anomalies are commonly discovered during routine radiological screenings and can present with a wide range of morphological features. This diversity can make it difficult for convolutional neural networks (CNNs) to accurately classify these anomalies, especially when working with limited datasets. Additionally, current approaches to paranasal anomaly classification are constrained to identifying a single anomaly at a time. These challenges necessitate the need for further research and development in this area. METHODS We investigate the feasibility of using a 3D convolutional neural network (CNN) to classify healthy maxillary sinuses (MS) and MS with polyps or cysts. The task of accurately localizing the relevant MS volume within larger head and neck Magnetic Resonance Imaging (MRI) scans can be difficult, but we develop a strategy which includes the use of a novel sampling technique that not only effectively localizes the relevant MS volume, but also increases the size of the training dataset and improves classification results. Additionally, we employ a Multiple Instance Ensembling (MIE) prediction method to further boost classification performance. RESULTS With sampling and MIE, we observe that there is consistent improvement in classification performance of all 3D ResNet and 3D DenseNet architecture with an average AUPRC percentage increase of 21.86 ± 11.92% and 4.27 ± 5.04% by sampling and 28.86 ± 12.80% and 9.85 ± 4.02% by sampling and MIE, respectively. CONCLUSION Sampling and MIE can be effective techniques to improve the generalizability of CNNs for paranasal anomaly classification. We demonstrate the feasibility of classifying anomalies in the MS. We propose a data enlarging strategy through sampling alongside a novel MIE strategy that proves to be beneficial for paranasal anomaly classification in the MS.
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Affiliation(s)
- Debayan Bhattacharya
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Finn Behrendt
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
| | - Benjamin Tobias Becker
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elina Petersen
- Population Health Research Department, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Clinic and Polyclinic for Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Clinic and Polyclinic for Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dennis Eggert
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Sophie Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Schlaefer
- Institute of Medical Technology and Intelligent Systems, Technische Universitaet Hamburg, Hamburg, Germany
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Petersen M, Hoffstaedter F, Nägele FL, Mayer C, Schell M, Rimmele DL, Zyriax BC, Zeller T, Kühn S, Gallinat J, Fiehler J, Twerenbold R, Omidvarnia A, Patil KR, Eickhoff SB, Thomalla G, Cheng B. A latent clinical-anatomical dimension relating metabolic syndrome to brain structure and cognition. bioRxiv 2023:2023.02.22.529531. [PMID: 36865285 PMCID: PMC9980040 DOI: 10.1101/2023.02.22.529531] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The link between metabolic syndrome (MetS) and neurodegenerative as well cerebrovascular conditions holds substantial implications for brain health in at-risk populations. This study elucidates the complex relationship between MetS and brain health by conducting a comprehensive examination of cardiometabolic risk factors, cortical morphology, and cognitive function in 40,087 individuals. Multivariate, data-driven statistics identified a latent dimension linking more severe MetS to widespread brain morphological abnormalities, accounting for up to 71% of shared variance in the data. This dimension was replicable across sub-samples. In a mediation analysis we could demonstrate that MetS-related brain morphological abnormalities mediated the link between MetS severity and cognitive performance in multiple domains. Employing imaging transcriptomics and connectomics, our results also suggest that MetS-related morphological abnormalities are linked to the regional cellular composition and macroscopic brain network organization. By leveraging extensive, multi-domain data combined with a dimensional stratification approach, our analysis provides profound insights into the association of MetS and brain health. These findings can inform effective therapeutic and risk mitigation strategies aimed at maintaining brain integrity.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Felix Hoffstaedter
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Ju lich, Wilhelm-Johnen-Straße, 52425 Ju lich, Germany
| | - Felix L. Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - D. Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science-Health Services Research and Prevention, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center, Martinistraße 52, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Martinistraße 52, 20251 Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, Martinistraße 52, 20251 Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, Martinistraße 52, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Martinistraße 52, 20251 Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, Martinistraße 52, 20251 Hamburg, Germany
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Amir Omidvarnia
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Ju lich, Wilhelm-Johnen-Straße, 52425 Ju lich, Germany
| | - Kaustubh R. Patil
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Ju lich, Wilhelm-Johnen-Straße, 52425 Ju lich, Germany
| | - Simon B. Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Ju lich, Wilhelm-Johnen-Straße, 52425 Ju lich, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
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Petersen M, Bogren A, Hunt G. Ambiguous Encounters: Young women's expectations and experiences with intoxicated sexual relations in Danish nightlife. Young 2023; 31:517-535. [PMID: 38250707 PMCID: PMC10798808 DOI: 10.1177/11033088231179550] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This article is based on 28 in-depth interviews with young women (18–25) about their experiences with intoxicated sexual encounters in Danish nightlife. Little research has examined the role intoxication plays in the processes of consensual and non-consensual sex. Using theories of intoxication and sexual scripts, this article focuses on how alcohol is used and perceived by these young women as a potential way of modifying behaviours and norms in their sexual encounters; how they characterize sexual consent and how they navigate intoxicated behaviour that can result in inappropriate, transgressive or victimizing situations. While the women talk about pleasurable and regrettable experiences, many described situations took on a much more ambiguous, fluid and nuanced role. The study points to the lack of knowledge on how ambiguity may play an active role in managing processes of sexual consent in intoxicated settings, especially for the youngest age groups.
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Affiliation(s)
| | - A Bogren
- School of Social Sciences, Södertörn University, Sweden
| | - G Hunt
- CRF, Aarhus University, Denmark
- Institute for Scientific Analysis, Alameda, CA., USA
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Mayer C, Walther C, Borof K, Nägele FL, Petersen M, Schell M, Gerloff C, Kühn S, Heydecke G, Beikler T, Cheng B, Thomalla G, Aarabi G. Association between periodontal disease and microstructural brain alterations in the Hamburg City Health Study. J Clin Periodontol 2023. [PMID: 37263624 DOI: 10.1111/jcpe.13828] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
AIM The aim of the PAROBRAIN study was to examine the association of periodontal health with microstructural white matter integrity and cerebral small vessel disease (CSVD) in the Hamburg City Health Study, a large population-based cohort with dental examination and brain magnetic resonance imaging (MRI). MATERIALS AND METHODS Periodontal health was determined by measuring clinical attachment loss (CAL) and plaque index. Additionally, the decayed/missing/filled teeth (DMFT) index was quantified. 3D-FLAIR and 3D-T1-weighted images were used for white matter hyperintensity (WMH) segmentation. Diffusion-weighted MRI was used to quantify peak width of skeletonized mean diffusivity (PSMD). RESULTS Data from 2030 participants were included in the analysis. Median age was 65 years, with 43% female participants. After adjusting for age and sex, an increase in WMH load was significantly associated with more CAL, higher plaque index and higher DMFT index. PSMD was significantly associated with the plaque index and DMFT. Additional adjustment for education and cardiovascular risk factors revealed a significant association of PSMD with plaque index (p < .001) and DMFT (p < .01), whereas effects of WMH load were attenuated (p > .05). CONCLUSIONS These findings suggest an adverse effect of periodontal health on CSVD and white matter integrity. Further research is necessary to examine whether early treatment of periodontal disease can prevent microstructural brain damage.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Borof
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix L Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Petersen M, Nägele FL, Mayer C, Schell M, Petersen E, Kühn S, Gallinat J, Fiehler J, Pasternak O, Matschke J, Glatzel M, Twerenbold R, Gerloff C, Thomalla G, Cheng B. Brain imaging and neuropsychological assessment of individuals recovered from a mild to moderate SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2023; 120:e2217232120. [PMID: 37220275 DOI: 10.1073/pnas.2217232120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/23/2023] [Indexed: 05/25/2023] Open
Abstract
As severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections have been shown to affect the central nervous system, the investigation of associated alterations of brain structure and neuropsychological sequelae is crucial to help address future health care needs. Therefore, we performed a comprehensive neuroimaging and neuropsychological assessment of 223 nonvaccinated individuals recovered from a mild to moderate SARS-CoV-2 infection (100 female/123 male, age [years], mean ± SD, 55.54 ± 7.07; median 9.7 mo after infection) in comparison with 223 matched controls (93 female/130 male, 55.74 ± 6.60) within the framework of the Hamburg City Health Study. Primary study outcomes were advanced diffusion MRI measures of white matter microstructure, cortical thickness, white matter hyperintensity load, and neuropsychological test scores. Among all 11 MRI markers tested, significant differences were found in global measures of mean diffusivity (MD) and extracellular free water which were elevated in the white matter of post-SARS-CoV-2 individuals compared to matched controls (free water: 0.148 ± 0.018 vs. 0.142 ± 0.017, P < 0.001; MD [10-3 mm2/s]: 0.747 ± 0.021 vs. 0.740 ± 0.020, P < 0.001). Group classification accuracy based on diffusion imaging markers was up to 80%. Neuropsychological test scores did not significantly differ between groups. Collectively, our findings suggest that subtle changes in white matter extracellular water content last beyond the acute infection with SARS-CoV-2. However, in our sample, a mild to moderate SARS-CoV-2 infection was not associated with neuropsychological deficits, significant changes in cortical structure, or vascular lesions several months after recovery. External validation of our findings and longitudinal follow-up investigations are needed.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Felix Leonard Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Elina Petersen
- Department of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251 Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 202115 Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 202 Boston, MA
| | - Jakob Matschke
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251 Gemany
| | - Markus Glatzel
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251 Gemany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251 Hamburg, Germany
- German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Luebeck, 20251 Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, 202115 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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11
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Rimmele DL, Petersen EL, Schlemm E, Kessner SS, Petersen M, Mayer C, Cheng B, Zeller T, Waldeyer C, Behrendt CA, Gerloff C, Thomalla G. Association of Carotid Plaque and Flow Velocity With White Matter Integrity in a Middle-aged to Elderly Population. Neurology 2022; 99:e2699-e2707. [PMID: 36123124 DOI: 10.1212/wnl.0000000000201297] [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] [Received: 05/31/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is uncertain whether there is an association of carotid plaques (CPs) and flow velocities with peak width mean diffusivity (PSMD) and white matter hyperintensities (WMH) independent of shared risk factors. We aimed to study this association controlling for biomarkers of inflammation and cardiac dysfunction and typical cardiovascular risk factors and spatial distribution. METHODS We included participants from the population-based Hamburg City Health Study, recruiting citizens between 45 and 74 years of age. Medical history was obtained from structured interviews and extended laboratory tests, physical examinations, MRI of the head, echocardiography, and abdominal and carotid ultrasound were performed. We performed multivariable regression analysis with PSMD and periventricular, deep, and total volume of WMH (pWMH, dWMH, tWMH) as dependent variables. PSMD was calculated as the difference between the 95th and 5th percentiles of MD values on the white skeleton in standard space. Volumes of WMH were determined by the application of a manually trained k-nearest neighbor segmentation algorithm. WMH measured within a distance of 1 cm from the surface of the lateral ventricles were defined as pWMH and above 1 cm as dWMH. RESULTS Two thousand six hundred twenty-three participants were included. The median age was 65 years, and 56% were women. Their median tWMH was 946 mm3(IQR:419, 2,164), PSMD 2.24 mm2/s × 10-4 (IQR: 2.04, 2.47), peak systolic velocity (PSV) of internal carotid arteries 0.70m/second (IQR:0.60, 0.81), and 35% had CPs. Adjusted for age, sex, high-sensitive CRP, NT-proBNP, and commonly measured cardiovascular risk and systemic hemodynamic factors, both CPs (B = 0.15; CI: 0.04, 0.26; p = 0.006) and low PSV (B = -0.49; CI: -0.87, -0.11; p = 0.012) were significantly associated with a higher tWMH and PSMD. Low PSV (B = -0.48; CI: -0.87, -0.1; p = 0.013) was associated with pWMH and the presence of CP with pWMH (B = 0.15; CI: 0.04, 0.26; p = 0.008) and dWMH (B = 0.42; CI: 0.11, 0.74; p < 0.009). DISCUSSION Low PSV and CP are associated with WMH and PSMD independent of cardiovascular risk factors and biomarkers of inflammation and cardiac dysfunction. This points toward pathophysiologic pathways underlying both large and small vessel disease beyond the common cardiovascular risk profile. TRIAL REGISTRATION INFORMATION The trial was submitted at clinicaltrials.gov, under NCT03934957 on January 4, 2019. The first participant was enrolled in February 2016.
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Affiliation(s)
- David Leander Rimmele
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany.
| | - Elina Larissa Petersen
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Eckhard Schlemm
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Simon S Kessner
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Marvin Petersen
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Carola Mayer
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Bastian Cheng
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Tanja Zeller
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christoph Waldeyer
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christian-Alexander Behrendt
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Christian Gerloff
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
| | - Götz Thomalla
- From the Department of Neurology (D.L.R., E.S., S.S.K., M.P., C.M., B.C., C.G., G.T.) and Epidemiological Study Center (E.L.P.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Cardiology (T.Z., C.W.) and Vascular Medicine (C.-A.B.), University Heart and Vascular Center UKE Hamburg; and German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck (T.Z., C.W.), Germany
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Schlemm E, Frey BM, Mayer C, Petersen M, Fiehler J, Hanning U, Kühn S, Twerenbold R, Gallinat J, Gerloff C, Thomalla G, Cheng B. Equalization of Brain State Occupancy Accompanies Cognitive Impairment in Cerebral Small Vessel Disease. Biol Psychiatry 2022; 92:592-602. [PMID: 35691727 DOI: 10.1016/j.biopsych.2022.03.019] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive impairment is a hallmark of cerebral small vessel disease (cSVD). Functional magnetic resonance imaging has highlighted connections between patterns of brain activity and variability in behavior. We aimed to characterize the associations between imaging markers of cSVD, dynamic connectivity, and cognitive impairment. METHODS We obtained magnetic resonance imaging and clinical data from the population-based Hamburg City Health Study. cSVD was quantified by white matter hyperintensities and peak-width of skeletonized mean diffusivity (PSMD). Resting-state blood oxygen level-dependent signals were clustered into discrete brain states, for which fractional occupancies (%) and dwell times (seconds) were computed. Cognition in multiple domains was assessed using validated tests. Regression analysis was used to quantify associations between white matter damage, spatial coactivation patterns, and cognitive function. RESULTS Data were available for 979 participants (ages 45-74 years, median white matter hyperintensity volume 0.96 mL). Clustering identified five brain states with the most time spent in states characterized by activation (+) or suppression (-) of the default mode network (DMN) (fractional occupancy: DMN+ = 25.1 ± 7.2%, DMN- = 25.5 ± 7.2%). Every 4.7-fold increase in white matter hyperintensity volume was associated with a 0.95-times reduction of the odds of occupying DMN+ or DMN-. Time spent in DMN-related brain states was associated with executive function. CONCLUSIONS Associations between white matter damage, whole-brain spatial coactivation patterns, and cognition suggest equalization of time spent in different brain states as a marker for cSVD-associated cognitive decline. Reduced gradients between brain states in association with brain damage and cognitive impairment reflect the dedifferentiation hypothesis of neurocognitive aging in a network-theoretical context.
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Affiliation(s)
- Eckhard Schlemm
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Benedikt M Frey
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Redmond A, Bullough G, Gray A, Bruen T, van der Merwe M, Foley S, Schallert M, Cook K, Petersen M, Pleshkan V, Gill M. The Development of Nutritional Literacy Curriculum with Practical Application on Middle School Students. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Mayer C, Nägele FL, Petersen M, Frey BM, Hanning U, Pasternak O, Petersen E, Gerloff C, Thomalla G, Cheng B. Free-water diffusion MRI detects structural alterations surrounding white matter hyperintensities in the early stage of cerebral small vessel disease. J Cereb Blood Flow Metab 2022; 42:1707-1718. [PMID: 35410517 PMCID: PMC9441727 DOI: 10.1177/0271678x221093579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In cerebral small vessel disease (CSVD), both white matter hyperintensities (WMH) of presumed vascular origin and the normal-appearing white matter (NAWM) contain microstructural brain alterations on diffusion-weighted MRI (DWI). Contamination of DWI-derived metrics by extracellular free-water can be corrected with free-water (FW) imaging. We investigated the alterations in FW and FW-corrected fractional anisotropy (FA-t) in WMH and surrounding tissue and their association with cerebrovascular risk factors. We analysed 1,000 MRI datasets from the Hamburg City Health Study. DWI was used to generate FW and FA-t maps. WMH masks were segmented on FLAIR and T1-weighted MRI and dilated repeatedly to create 8 NAWM masks representing increasing distance from WMH. Linear models were applied to compare FW and FA-t across WMH and NAWM masks and in association with cerebrovascular risk. Median age was 64 ± 14 years. FW and FA-t were altered 8 mm and 12 mm beyond WMH, respectively. Smoking was significantly associated with FW in NAWM (p = 0.008) and FA-t in WMH (p = 0.008) and in NAWM (p = 0.003) while diabetes and hypertension were not. Further research is necessary to examine whether FW and FA-t alterations in NAWM are predictors for developing WMH.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix L Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Elina Petersen
- Clinical for Cardiology, University Heart and Vascular Center, Germany.,Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Petersen EL, Goßling A, Adam G, Aepfelbacher M, Behrendt CA, Cavus E, Cheng B, Fischer N, Gallinat J, Kühn S, Gerloff C, Koch-Gromus U, Härter M, Hanning U, Huber TB, Kluge S, Knobloch JK, Kuta P, Schmidt-Lauber C, Lütgehetmann M, Magnussen C, Mayer C, Muellerleile K, Münch J, Nägele FL, Petersen M, Renné T, Riedl KA, Rimmele DL, Schäfer I, Schulz H, Tahir E, Waschki B, Wenzel JP, Zeller T, Ziegler A, Thomalla G, Twerenbold R, Blankenberg S. Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection: The Hamburg City Health Study COVID programme. Eur Heart J 2022; 43:1124-1137. [PMID: 34999762 PMCID: PMC8755397 DOI: 10.1093/eurheartj/ehab914] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 01/09/2023] Open
Abstract
AIMS Long-term sequelae may occur after SARS-CoV-2 infection. We comprehensively assessed organ-specific functions in individuals after mild to moderate SARS-CoV-2 infection compared with controls from the general population. METHODS AND RESULTS Four hundred and forty-three mainly non-hospitalized individuals were examined in median 9.6 months after the first positive SARS-CoV-2 test and matched for age, sex, and education with 1328 controls from a population-based German cohort. We assessed pulmonary, cardiac, vascular, renal, and neurological status, as well as patient-related outcomes. Bodyplethysmography documented mildly lower total lung volume (regression coefficient -3.24, adjusted P = 0.014) and higher specific airway resistance (regression coefficient 8.11, adjusted P = 0.001) after SARS-CoV-2 infection. Cardiac assessment revealed slightly lower measures of left (regression coefficient for left ventricular ejection fraction on transthoracic echocardiography -0.93, adjusted P = 0.015) and right ventricular function and higher concentrations of cardiac biomarkers (factor 1.14 for high-sensitivity troponin, 1.41 for N-terminal pro-B-type natriuretic peptide, adjusted P ≤ 0.01) in post-SARS-CoV-2 patients compared with matched controls, but no significant differences in cardiac magnetic resonance imaging findings. Sonographically non-compressible femoral veins, suggesting deep vein thrombosis, were substantially more frequent after SARS-CoV-2 infection (odds ratio 2.68, adjusted P < 0.001). Glomerular filtration rate (regression coefficient -2.35, adjusted P = 0.019) was lower in post-SARS-CoV-2 cases. Relative brain volume, prevalence of cerebral microbleeds, and infarct residuals were similar, while the mean cortical thickness was higher in post-SARS-CoV-2 cases. Cognitive function was not impaired. Similarly, patient-related outcomes did not differ. CONCLUSION Subjects who apparently recovered from mild to moderate SARS-CoV-2 infection show signs of subclinical multi-organ affection related to pulmonary, cardiac, thrombotic, and renal function without signs of structural brain damage, neurocognitive, or quality-of-life impairment. Respective screening may guide further patient management.
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Affiliation(s)
- Elina Larissa Petersen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Fischer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch-Gromus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B. Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes K. Knobloch
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Kuta
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | | | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Julia Münch
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Felix Leonard Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Renné
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, Mainz, Germany
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Katharina Alina Riedl
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - David Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ines Schäfer
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Waschki
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Hospital Itzehoe, Pneumology, Itzehoe, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
| | - Tanja Zeller
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, Hamburg, Germany
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Cardio-CARE, Medizincampus Davos, Davos, Switzerland
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
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17
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Schulz M, Mayer C, Schlemm E, Frey BM, Malherbe C, Petersen M, Gallinat J, Kühn S, Fiehler J, Hanning U, Twerenbold R, Gerloff C, Cheng B, Thomalla G. Association of Age and Structural Brain Changes With Functional Connectivity and Executive Function in a Middle-Aged to Older Population-Based Cohort. Front Aging Neurosci 2022; 14:782738. [PMID: 35283749 PMCID: PMC8916110 DOI: 10.3389/fnagi.2022.782738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023] Open
Abstract
Aging is accompanied by structural brain changes that are thought to underlie cognitive decline and dementia. Yet little is known regarding the association between increasing age, structural brain damage, and alterations of functional brain connectivity. The aim of this study was to evaluate whether cortical thickness and white matter damage as markers of age-related structural brain changes are associated with alterations in functional connectivity in non-demented healthy middle-aged to older adults. Therefore, we reconstructed functional connectomes from resting-state functional magnetic resonance imaging (MRI) (rsfMRI) data of 976 subjects from the Hamburg City Health Study, a prospective population-based study including participants aged 45-74 years from the metropolitan region Hamburg, Germany. We performed multiple linear regressions to examine the association of age, cortical thickness, and white matter damage quantified by the peak width of skeletonized mean diffusivity (PSMD) from diffusion tensor imaging on whole-brain network connectivity and four predefined resting state networks (default mode, dorsal, salience, and control network). In a second step, we extracted subnetworks with age-related decreased functional connectivity from these networks and conducted a mediation analysis to test whether the effect of age on these networks is mediated by decreased cortical thickness or PSMD. We observed an independent association of higher age with decreased functional connectivity, while there was no significant association of functional connectivity with cortical thickness or PSMD. Mediation analysis identified cortical thickness as a partial mediator between age and default subnetwork connectivity and functional connectivity within the default subnetwork as a partial mediator between age and executive cognitive function. These results indicate that, on a global scale, functional connectivity is not determined by structural damage in healthy middle-aged to older adults. There is a weak association of higher age with decreased functional connectivity which, for specific subnetworks, appears to be mediated by cortical thickness.
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Affiliation(s)
- Maximilian Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt M. Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Malherbe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Neuroradiological Diagnostics and Intervention, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Center of Cardiovascular Science, Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Thorpe C, DeWees T, Bhangoo R, Petersen M, Chang J, Hartsell W, Sinesi C, Rwigema J, Keole S, Gondi V, Vargas C. Randomized Phase III Study of Moderately Hypofractionated Radiation Therapy With or Without Androgen Suppression for Intermediate Risk Adenocarcinoma of the Prostate: Analysis of Quality of Life and Toxicity, PCG GU 003. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.932] [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: 11/16/2022]
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19
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Bhangoo R, DeWees T, Thorpe C, Petersen M, Hartsell W, Chang J, Sinesi C, Mishra M, Mohammed N, McGee L, Keole S, Sweeney P, Gondi V, Vargas C. Updated Toxicity and Quality-of-Life Outcomes From a Randomized Phase III Trial of Extreme Hypofractionated vs. Standard Fractionated Proton Therapy for Low-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Cheng B, Petersen M, Schulz R, Boenstrup M, Krawinkel L, Gerloff C, Thomalla G. White matter degeneration revealed by fiber-specific analysis relates to recovery of hand function after stroke. Hum Brain Mapp 2021; 42:5423-5432. [PMID: 34407244 PMCID: PMC8519864 DOI: 10.1002/hbm.25632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/13/2022] Open
Abstract
Recent developments of higher‐order diffusion‐weighted imaging models have enabled the estimation of specific white matter fiber populations within a voxel, addressing limitations of traditional imaging markers of white matter integrity. We applied fixel based analysis (FBA) to investigate the evolution of fiber‐specific white matter changes in a prospective study of stroke patients and upper limb motor deficit over 1 year after stroke. We studied differences in fiber density and macrostructural changes in fiber cross‐section. Motor function was assessed by grip strength. We conducted a whole‐brain analysis of fixel metrics and predefined corticospinal tract (CST) region of interest in relation to changes in motor functions. In 30 stroke patients (mean age 62.3 years, SD ±16.9; median NIHSS 4, IQR 2–5), whole‐brain FBA revealed progressing loss of fiber density and cross‐section in the ipsilesional corticospinal tract and long‐range fiber tracts such as the superior longitudinal fascicle and trans‐callosal tracts extending towards contralesional white matter tracts. Lower FBA metrics measured at the brainstem section of the CST 1 month after stroke were significantly associated with lower grip strength 3 months (p = .009, adjusted R2 = 0.259) and 1 year (T4: p < .001, adj. R2 = 0.515) after stroke. Compared to FA, FBA metrics showed a comparably strong association with grip strength at later time points. Using FBA, we demonstrate progressive fiber‐specific white matter loss after stroke and association with functional motor outcome. Our results promote the application of fiber‐specific analysis to detect secondary neurodegeneration after stroke in relation to clinical recovery.
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Affiliation(s)
- Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Boenstrup
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Lutz Krawinkel
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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21
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Mayer C, Frey BM, Schlemm E, Petersen M, Engelke K, Hanning U, Jagodzinski A, Borof K, Fiehler J, Gerloff C, Thomalla G, Cheng B. Linking cortical atrophy to white matter hyperintensities of presumed vascular origin. J Cereb Blood Flow Metab 2021; 41:1682-1691. [PMID: 33259747 PMCID: PMC8221767 DOI: 10.1177/0271678x20974170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the relationship between white matter hyperintensities (WMH) and cortical neurodegeneration in cerebral small vessel disease (CSVD) by investigating whether cortical thickness is a remote effect of WMH through structural fiber tract connectivity in a population at increased risk of CSVD. We measured cortical thickness on T1-weighted images and segmented WMH on FLAIR images in 930 participants of a population-based cohort study at baseline. DWI-derived whole-brain probabilistic tractography was used to define WMH connectivity to cortical regions. Linear mixed-effects models were applied to analyze the relationship between cortical thickness and connectivity to WMH. Factors associated with cortical thickness (age, sex, hemisphere, region, individual differences in cortical thickness) were added as covariates. Median age was 64 [IQR 46-76] years. Visual inspection of surface maps revealed distinct connectivity patterns of cortical regions to WMH. WMH connectivity to the cortex was associated with reduced cortical thickness (p = 0.009) after controlling for covariates. This association was found for periventricular WMH (p = 0.001) only. Our results indicate an association between WMH and cortical thickness via connecting fiber tracts. The results imply a mechanism of secondary neurodegeneration in cortical regions distant, yet connected to subcortical vascular lesions, which appears to be driven by periventricular WMH.
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Affiliation(s)
- Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristin Engelke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Jagodzinski
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Katrin Borof
- Epidemiological Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Gianfrancesco M, LI J, Evans M, Petersen M, Schmajuk G, Yazdany J. OP0117 REAL-WORLD EFFECTIVENESS OF TNFI VERSUS NON-TNFI BIOLOGICS ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE ACR’S RISE REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Our understanding of how medications such as biologic disease modifying anti-rheumatic drugs and targeted small molecules (b/tsDMARDs) influence disease activity in RA is based largely on randomized controlled trials (RCTs). However, most U.S. trials in RA are limited by small sample sizes and have often excluded patients who are older, male, and from racial/ethnic minorities. Whether effectiveness of b/tsDMARDs varies in these populations has largely been unexplored.Objectives:We aimed to examine differences in longitudinal RA disease activity by demographic and clinical characteristics using a novel electronic health record data source of rheumatology providers across the U.S. We simulated various treatment assignments of b/tsDMARDs that have been examined in RCTs: namely, TNF-inhibitors (TNFi) and non-TNFi.Methods:We included 16,448 individuals from the ACR’s RISE registry with ≥ 2 RA diagnoses (ICD-9: 714.0) ≥ 30 days apart, who had at least 2 recorded clinical disease activity index (CDAI) scores and no historical b/tsDMARD use documented in RISE. b/tsDMARD use and CDAI scores were assessed at each quarter; covariates included sex, race (white, Black, Asian, other), ethnicity (Hispanic/non-Hispanic), age, smoking, obesity, area deprivation index, other DMARD use, RF status, anti-CCP status, and practice type. Longitudinal targeted maximum likelihood estimation estimated the average treatment effect (ATE) of cumulative TNFi vs. non-TNFi use over a 12-month period on CDAI score among the entire population and across various subgroups based on demographic and clinical characteristics, accounting for censoring and time-varying confounding.Results:Approximately 75% of patients were female with a mean age of 65.1 (+/- 13.7) years. Sixty percent of patients were white, 8% black, 2% Asian, and 30% other/mixed or unknown race; 6% were Hispanic. The mean CDAI score at baseline was 11.3 (+/- 10.7). For the overall population, there was no significant difference in disease activity between TNFi and non-TNFi at 12 months (ATE= 0.85, 95% CI -0.26, 1.96; Table 1). Stratified analyses found higher disease activity for TNFi compared to non-TNFi among patients of Black and Asian race, non-Hispanic ethnicity, and female sex. Among Black race patients, TNFi use was associated with a 6.08 point higher CDAI score compared to non-TNFi use (95% CI 1.99, 10.17). In contrast, in Hispanic/Latino ethnicity patients, TNFi use was associated with a lower CDAI score compared to non-TNFi use (ATE= -2.64, 95% CI -3.99, -1.30).Table 1.Average treatment effect (ATE) of cumulative TNFi vs. non-TNFi use at 12-months on CDAI score in patients with RATNFiNon-TNFiATE (95% CI)Overall (n=16,448)8.847.990.85 (-0.26, 1.96)Race White (n=9,814)8.246.811.42 (0.03, 2.81)* Black (n=1,358)13.917.836.08 (1.99, 10.17)* Asian (n=301)6.542.743.80 (2.93, 4.67)*Ethnicity Non-Hispanic (n=14,216)8.927.631.29 (0.08, 2.51)* Hispanic (n=938)5.698.33-2.64 (-3.99, -1.30)*Sex Female (n=12,527)8.987.471.51 (0.31, 2.72)* Male (n=3,921)8.579.49-0.92 (-3.42, 1.58)*P<0.05Conclusion:Results from this RCT simulation study suggest that non-TNFi may have an important role as first-line agents in the treatment of Black and Asian patients, but not Hispanic patients. These novel findings fill gaps where RCTs have not been conducted, highlight the need for inclusion of diverse populations in future trials, and have the potential to lead to a more personalized approach to rheumatologic care.References:Disclosure of Interests:Milena Gianfrancesco: None declared, Jing Li: None declared, Michael Evans: None declared, Maya Petersen: None declared, Gabriela Schmajuk: None declared, Jinoos Yazdany Consultant of: Eli Lilly and Astra Zeneca, unrelated to this project., Grant/research support from: Gilead, unrelated to this project.
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Barlinn J, Winzer S, Worthmann H, Urbanek C, Häusler KG, Günther A, Erdur H, Görtler M, Busetto L, Wojciechowski C, Schmitt J, Shah Y, Büchele B, Sokolowski P, Kraya T, Merkelbach S, Rosengarten B, Stangenberg-Gliss K, Weber J, Schlachetzki F, Abu-Mugheisib M, Petersen M, Schwartz A, Palm F, Jowaed A, Volbers B, Zickler P, Remi J, Bardutzky J, Bösel J, Audebert HJ, Hubert GJ, Gumbinger C. [Telemedicine in stroke-pertinent to stroke care in Germany]. Nervenarzt 2021; 92:593-601. [PMID: 34046722 PMCID: PMC8184549 DOI: 10.1007/s00115-021-01137-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution. METHODS The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks. RESULTS Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states. CONCLUSION Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.
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Affiliation(s)
- J Barlinn
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - S Winzer
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - H Worthmann
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Urbanek
- Klinik für Neurologie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland
| | - K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - H Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Görtler
- Klinik für Neurologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - L Busetto
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Wojciechowski
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Y Shah
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - B Büchele
- Klinik für Neurologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - P Sokolowski
- Klinik für Neurologie und neurologische Intensivmedizin, Fachkrankenhaus Hubertusburg, Hubertusburg, Deutschland
| | - T Kraya
- Klinik für Neurologie, Klinikum St.Georg Leipzig, Leipzig, Deutschland
| | - S Merkelbach
- Klinik für Neurologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland
| | - B Rosengarten
- Klinik für Neurologie, Klinikum Chemnitz, Chemnitz, Deutschland
| | - K Stangenberg-Gliss
- Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - J Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Schlachetzki
- Klinik für Neurologie, Universität Regensburg, Regensburg, Deutschland
| | - M Abu-Mugheisib
- Klinik für Neurologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - M Petersen
- Klinik für Neurologie, Klinikum Osnabrück, Osnabrück, Deutschland
| | - A Schwartz
- Klinik für Neurologie, Klinikum Region Hannover, Hannover, Deutschland
| | - F Palm
- Klinik für Neurologie, Helios Klinikum Schleswig, Schleswig, Deutschland
| | - A Jowaed
- Klinik für Neurologie, Westküstenkliniken Heide, Heide, Deutschland
| | - B Volbers
- Klinik für Neurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Zickler
- Klinik für Neurologie und Klinische Neurophysiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Remi
- Klinik für Neurologie, Klinikum der LMU München-Großhadern, München, Deutschland
| | - J Bardutzky
- Klinik für Neurologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Bösel
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - H J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G J Hubert
- Klinik für Neurologie, München-Klinik Harlaching, München, Deutschland
| | - C Gumbinger
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Frey BM, Petersen M, Schlemm E, Mayer C, Hanning U, Engelke K, Fiehler J, Borof K, Jagodzinski A, Gerloff C, Thomalla G, Cheng B. White matter integrity and structural brain network topology in cerebral small vessel disease: The Hamburg city health study. Hum Brain Mapp 2021; 42:1406-1415. [PMID: 33289924 PMCID: PMC7927298 DOI: 10.1002/hbm.25301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Cerebral small vessel disease is a common finding in the elderly and associated with various clinical sequelae. Previous studies suggest disturbances in the integration capabilities of structural brain networks as a mediating link between imaging and clinical presentations. To what extent cerebral small vessel disease might interfere with other measures of global network topology is not well understood. Connectomes were reconstructed via diffusion weighted imaging in a sample of 930 participants from a population based epidemiologic study. Linear models were fitted testing for an association of graph-theoretical measures reflecting integration and segregation with both the Peak width of Skeletonized Mean Diffusivity (PSMD) and the load of white matter hyperintensities of presumed vascular origin (WMH). The latter were subdivided in periventricular and deep for an analysis of localisation-dependent correlations of cerebral small vessel disease. The median WMH volume was 0.6 mL (1.4) and the median PSMD 2.18 mm2 /s x 10-4 (0.5). The connectomes showed a median density of 0.880 (0.030), the median values for normalised global efficiency, normalised clustering coefficient, modularity Q and small-world propensity were 0.780 (0.045), 1.182 (0.034), 0.593 (0.026) and 0.876 (0.040) respectively. An increasing burden of cerebral small vessel disease was significantly associated with a decreased integration and increased segregation and thus decreased small-worldness of structural brain networks. Even in rather healthy subjects increased cerebral small vessel disease burden is accompanied by topological brain network disturbances. Segregation parameters and small-worldness might as well contribute to the understanding of the known clinical sequelae of cerebral small vessel disease.
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Affiliation(s)
- Benedikt M. Frey
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marvin Petersen
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Eckhard Schlemm
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Carola Mayer
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Uta Hanning
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Kristin Engelke
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jens Fiehler
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Katrin Borof
- Epidemiological study centerUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Annika Jagodzinski
- Epidemiological study centerUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of General and Interventional CardiologyUniversity Heart and Vascular CenterHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Bastian Cheng
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Vargas C, Bhangoo R, Petersen M, Thorpe C, Wong W, Rwigema J, Daniels T, Keole S, Schild S, DeWees T. Relationship and Applicability of Biologic Rectal Dose and Rectal Bleeding for Standard, Moderate, and Extreme Fractionation Proton Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cheng T, Bhangoo R, Petersen M, Thorpe C, Anderson J, Vargas C, Halyard M, Schild S, DeWees T, Wong W. Radiation Recall Dermatitis: A Systematic Literature Search and Review of the Literature. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1478] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Laughlin B, Jethwa K, Sannapaneni S, Petersen M, Ko S, Mullikin T, Haddock M, Ashman J, Rule W, Halfdanarson T, Merrell K, Wittich MN, Bekaii-Saab T, Mahipal A, Ahn D, Harmsen W, DeWees T, Hallemeier C, Sio T. Impact of Definitive Chemoradiation on Clinical Outcomes in Unresectable Hilar or Extrahepatic Cholangiocarcinoma: A Multi-campus, Single-institutional Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Foster C, Shohfi E, Petersen M. P158 ONE IN A MILLION: ANAPHYLAXIS TO VARIVAX® IN A NON-IMMUNE HEALTHCARE WORKER. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Garda A, Petersen M, Haddock M, Petersen I. Definitive Radiotherapy Including Simultaneous Integrated Boost for Locally Advanced Squamous Cell Carcinoma of the Vulva: Oncologic Outcomes and Toxicity. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1547] [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: 11/16/2022]
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Buras M, Breen W, Laack N, Daniels T, Golafshar M, Petersen M, Mahajan A, Keole S, Vern-Gross T, Ahmed S, DeWees T. Patient vs. Parent: Tracking Correlation and Differences in Pediatric Quality of Life (PedsQL) Based on Evaluator Using a Prospective Registry in a Large-Volume, Multi-Site Practice. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1511] [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: 11/28/2022]
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Bhangoo R, DeWees T, Petersen M, Thorpe C, Wong W, Rwigema J, Daniels T, Keole S, Schild S, Vargas C. Rectum Dose-Volume Histogram (DVH) Parameters And Patient-Reported EPIC-Bowel Domain For Patients Undergoing Radiotherapy (RT) For Prostate Cancer (PC): A Single-Center Prospective Registry Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.411] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yu N, Lee S, Petersen M, Ashman J, Vora S, DeWees T, Laack N, Mahajan A, Merrell K, Lyons M, Mrugala M, Bendok B, Porter A, Peterson J, Brown P, Sio T. Trimodality Therapy is Associated with Improved Overall Survival in Gliosarcoma: A Multi-Site Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2029] [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: 11/16/2022]
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Laughlin B, Petersen M, Yu N, Ashman J, Rule W, Borad M, Aqel B, Sonbol M, Byrne T, Mathur A, Moss A, Bekaii-Saab T, Reddy K, Hewitt W, Singer A, Ahn D, DeWees T, Sio T. Clinical Outcome Associated with Neoadjuvant ChemoRT and Orthotopic Liver Transplantation Vs. Surgical Resection with Adjuvant RT Vs. Definitive ChemoRT in Patients with Hilar or Extrahepatic Cholangiocarcinoma: A Single-Hospital Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Golafshar M, Bhangoo R, Petersen M, Thorpe C, Wong W, Rwigema J, Daniels T, Keole S, Schild S, Vargas C, DeWees T. Clinically Interpretable Predictions of Patient-Reported Adverse Events (PRO-CTCAE) for Prostate Cancer Utilizing Artificial Neural Networks. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Petersen M, Frey BM, Schlemm E, Mayer C, Hanning U, Engelke K, Fiehler J, Borof K, Jagodzinski A, Gerloff C, Thomalla G, Cheng B. Network Localisation of White Matter Damage in Cerebral Small Vessel Disease. Sci Rep 2020; 10:9210. [PMID: 32514044 PMCID: PMC7280237 DOI: 10.1038/s41598-020-66013-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a widespread condition associated to stroke, dementia and depression. To shed light on its opaque pathophysiology, we conducted a neuroimaging study aiming to assess the location of CSVD-induced damage in the human brain network. Structural connectomes of 930 subjects of the Hamburg City Health Study were reconstructed from diffusion weighted imaging. The connectome edges were partitioned into groups according to specific schemes: (1) connection to grey matter regions, (2) course and length of underlying streamlines. Peak-width of skeletonised mean diffusivity (PSMD) - a surrogate marker for CSVD - was related to each edge group's connectivity in a linear regression analysis allowing localisation of CSVD-induced effects. PSMD was associated with statistically significant decreases in connectivity of most investigated edge groups except those involved in connecting limbic, insular, temporal or cerebellar regions. Connectivity of interhemispheric and long intrahemispheric edges as well as edges connecting subcortical and frontal brain regions decreased most severely with increasing PSMD. In conclusion, MRI findings of CSVD are associated with widespread impairment of structural brain network connectivity, which supports the understanding of CSVD as a global brain disease. The pattern of regional preference might provide a link to clinical phenotypes of CSVD.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristin Engelke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Borof
- Epidemiological study center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Jagodzinski
- Epidemiological study center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vøls KK, Kjelgaard-Hansen M, Ley CD, Hansen AK, Petersen M. In vivo fluorescence molecular tomography of induced haemarthrosis in haemophilic mice: link between bleeding characteristics and development of bone pathology. BMC Musculoskelet Disord 2020; 21:241. [PMID: 32290832 PMCID: PMC7158129 DOI: 10.1186/s12891-020-03267-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background Haemophilic arthropathy is a chronic and debilitating joint disease caused by recurrent spontaneous joint bleeds in patients with haemophilia. Understanding how characteristics of individual joint bleeds relate to the subsequent development of arthropathy could improve management and prevention of this joint disease. Here, we aimed to explore relations between joint bleed characteristics and development of bone pathology in a mouse model of haemophilic arthropathy by using novel in vivo imaging methodology. Methods We characterised induced knee bleeds in a murine model of haemophilic arthropathy by quantitative in vivo fluorescence molecular tomography (FMT) and by measurements of changes in the diameter of the injured knee. Wild-type mice and non-injured haemophilic mice acted as controls. Development of arthropathy was characterised by post mortem evaluation of bone pathology by micro-CT 14 days after bleed-induction. In an in vitro study, we assessed the effect of blood on the quantification of fluorescent signal with FMT. Results In most injured haemophilic mice, we observed significant loss of trabecular bone, and half of the mice developed pathological bone remodelling. Development of pathological bone remodelling was associated with significantly increased fluorescent signal and diameter of the injured knee just 1 day after induction of the bleed. Further, a correlation between the fluorescent signal 1 day after induction of the bleed and loss of trabecular bone reached borderline significance. In the in vitro study, we found that high concentrations of blood significantly decreased the fluorescent signal. Conclusion Our results add novel insights on the pathogenesis of haemophilic arthropathy and underline the importance of the acute phase of joint bleeds for the subsequent development of arthropathy.
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Affiliation(s)
- K K Vøls
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark. .,Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - M Kjelgaard-Hansen
- Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - C D Ley
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
| | - A K Hansen
- Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - M Petersen
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, 2760, Maaloev, Denmark
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Tiedt S, Herzberg M, Küpper C, Feil K, Kellert L, Dorn F, Liebig T, Alegiani A, Dichgans M, Wollenweber FA, Alber B, Bangard C, Berrouschot J, Bode F, Boeckh-Behrens T, Bohner G, Bormann A, Braun M, Eckert B, Fiehler J, Flottmann F, Gerloff C, Hamann G, Henn K, Kastrup A, Kraemer C, Krause L, Lehm M, Liman J, Lowens S, Mpotsaris A, Nolte C, Papanagiotou P, Petersen M, Petzold G, Pfeilschifter W, Psychogios M, Reich A, von Rennenberg R, Röther J, Schäfer J, Siebert E, Siedow A, Solymosi L, Thomalla G, Thonke S, Wagner M, Wunderlich S, Zweynert S. Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke. Stroke 2020; 51:1014-1016. [DOI: 10.1161/strokeaha.119.028383] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs).
Methods—
Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry–Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables.
Results—
Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%;
P
=0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%;
P
<0.001) compared with noncardioembolic LVO. Cardioembolic LVO was associated with better functional outcome at discharge (adjusted odds ratio, 1.61 [95% CI, 1.37–1.88]) and 90 days (adjusted odds ratio, 1.29 [95% CI, 1.09–1.53]). In mediation analysis, reperfusion explained 47% of the effect of etiology on functional outcome at discharge.
Conclusions—
These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.
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Affiliation(s)
- Steffen Tiedt
- From the Institute for Stroke and Dementia Research (S.T., M.D., F.A.W.), University Hospital, LMU Munich, Germany
| | - Moriz Herzberg
- From the Institute for Stroke and Dementia Research (S.T., M.D., F.A.W.), University Hospital, LMU Munich, Germany
- Institute of Neuroradiology (M.H., F.D., T.L.), University Hospital, LMU Munich, Germany
| | - Clemens Küpper
- Department of Neurology (C.K., K.F., L.K., F.A.W.), University Hospital, LMU Munich, Germany
| | - Katharina Feil
- Department of Neurology (C.K., K.F., L.K., F.A.W.), University Hospital, LMU Munich, Germany
| | - Lars Kellert
- Department of Neurology (C.K., K.F., L.K., F.A.W.), University Hospital, LMU Munich, Germany
| | - Franziska Dorn
- Institute of Neuroradiology (M.H., F.D., T.L.), University Hospital, LMU Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology (M.H., F.D., T.L.), University Hospital, LMU Munich, Germany
| | - Anna Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (A.A.)
| | | | - Frank A. Wollenweber
- From the Institute for Stroke and Dementia Research (S.T., M.D., F.A.W.), University Hospital, LMU Munich, Germany
- Department of Neurology (C.K., K.F., L.K., F.A.W.), University Hospital, LMU Munich, Germany
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Wiles PG, Gray IK, Kissling RC, Delahanty C, Evers J, Greenwood K, Grimshaw K, Hibbert M, Kelly K, Luckin H, McGregor K, Morris A, Petersen M, Ross F, Valli M. Routine Analysis of Proteins by Kjeldahl and Dumas Methods: Review and Interlaboratory Study Using Dairy Products. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.3.620] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
abstract
The Kjeldahl and Dumas (combustion) methods were compared in 11 laboratories analyzing samples of milk, skim milk powder, whole milk powder, whey protein concentrate, infant formula, casein, caseinate, 2 reference compounds (glycine and EDTA), and a secondary reference skim milk powder. The comparison was conducted by using international standards where applicable. Overall means were 8.818 g N/100 g by the Kjeldahl method and 8.810 g N/100 g by the Dumas method. No evidence was found for a consistent bias between methods that may be of concern in the trading of dairy produce. A review of more than 10 related trials revealed a lack of consensus in the bias between the 2 methods, suggesting that differences in methodology and sources of systematic error may be contributors. For samples containing >2 g N/100 g, the Dumas relative repeatability and reproducibility standard deviations were consistently about 0.35 and 0.75%, respectively, whereas the corresponding Kjeldahl values declined generally with N content and were significantly larger. The Dumas precision characteristics may be due to the dominance of Leco analyzers in this trials, and in most other recent trials, rather than an inherent method attribute. Protein determination methods for dairy products need to be reviewed and updated. The Dumas method needs Codex Alimentarius status as a recognized test method.
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Affiliation(s)
- Peter G Wiles
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
| | - Ian K Gray
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
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Wilhite T, Jethwa K, Hellekson C, Routman D, Stish B, Petersen M, Harmsen W, Quevedo F, Park S, Olivier K, Choo C, Pisansky T, Mynderse L, Karnes R, Kwon E, Davis B. Low Rates of in-Field Recurrence with Regional Nodal Salvage Radiation and Temporary Androgen Deprivation for Pelvic and/or Para-Aortic Prostate Cancer Nodal Recurrences Detected By C11 Choline PET/CT Following Primary Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frey BM, Petersen M, Mayer C, Schulz M, Cheng B, Thomalla G. Characterization of White Matter Hyperintensities in Large-Scale MRI-Studies. Front Neurol 2019; 10:238. [PMID: 30972001 PMCID: PMC6443932 DOI: 10.3389/fneur.2019.00238] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. As a manifestation of cerebral small vessel disease, WMH are considered to be a vascular contributor to various sequelae such as cognitive decline, dementia, depression, stroke as well as gait and balance problems. While pathophysiology and therapeutical options remain unclear, large-scale studies have improved the understanding of WMH, particularly by quantitative assessment of WMH. In this review, we aimed to provide an overview of the characteristics, research subjects and segmentation techniques of these studies. Methods: We performed a systematic review according to the PRISMA statement. One thousand one hundred and ninety-six potentially relevant articles were identified via PubMed search. Six further articles classified as relevant were added manually. After applying a catalog of exclusion criteria, remaining articles were read full-text and the following information was extracted into a standardized form: year of publication, sample size, mean age of subjects in the study, the cohort included, and segmentation details like the definition of WMH, the segmentation method, reference to methods papers as well as validation measurements. Results: Our search resulted in the inclusion and full-text review of 137 articles. One hundred and thirty-four of them belonged to 37 prospective cohort studies. Median sample size was 1,030 with no increase over the covered years. Eighty studies investigated in the association of WMH and risk factors. Most of them focussed on arterial hypertension, diabetes mellitus type II and Apo E genotype and inflammatory markers. Sixty-three studies analyzed the association of WMH and secondary conditions like cognitive decline, mood disorder and brain atrophy. Studies applied various methods based on manual (3), semi-automated (57), and automated segmentation techniques (75). Only 18% of the articles referred to an explicit definition of WMH. Discussion: The review yielded a large number of studies engaged in WMH research. A remarkable variety of segmentation techniques was applied, and only a minority referred to a clear definition of WMH. Most addressed topics were risk factors and secondary clinical conditions. In conclusion, WMH research is a vivid field with a need for further standardization regarding definitions and used methods.
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Affiliation(s)
- Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Petersen M, Muscha J, Roberts A, Duke S. 261 Responses by heifers to development strategies using confinement or supplemented native range herbivory in Northern Great Plains. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J Muscha
- USDA-ARS,Miles City, MT, United States
| | - A Roberts
- USDA Agricultural Research Service, Fort Keogh Livestock and Range Research Laboratory,Miles City, MT, United States
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Evans M, Petersen M, McDermott D, Murphy P. ABNORMAL NEWBORN SCREEN IN A WHIM SYNDROME PATIENT. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.311] [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: 10/27/2022]
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43
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Rezniczek GA, Hilal Z, Dogan A, Petersen M, Tempfer CB. Concentrations of cisplatin and doxorubicin in ascites and peritoneal tumor nodules before and after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal metastasis. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671324] [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: 10/28/2022] Open
Affiliation(s)
- GA Rezniczek
- Ruhr-Universität Bochum/Marien Hospital Herne, Klinik für Frauenheilkunde und Geburtshilfe, Herne, Deutschland
| | - Z Hilal
- Ruhr-Universität Bochum/Marien Hospital Herne, Klinik für Frauenheilkunde und Geburtshilfe, Herne, Deutschland
| | - A Dogan
- Ruhr-Universität Bochum/Marien Hospital Herne, Klinik für Frauenheilkunde und Geburtshilfe, Herne, Deutschland
| | - M Petersen
- MVZ Eberhard & Partner, Dortmund, Deutschland
| | - CB Tempfer
- Ruhr-Universität Bochum/Marien Hospital Herne, Klinik für Frauenheilkunde und Geburtshilfe, Herne, Deutschland
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Rode F, Almholt K, Petersen M, Kreilgaard M, Kjalke M, Karpf DM, Groth AV, Johansen PB, Larsen LF, Loftager M, Haaning J. Preclinical pharmacokinetics and biodistribution of subcutaneously administered glycoPEGylated recombinant factor VIII (N8-GP) and development of a human pharmacokinetic prediction model. J Thromb Haemost 2018; 16:1141-1152. [PMID: 29582559 DOI: 10.1111/jth.14013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 11/29/2022]
Abstract
Essentials N8-GP is an extended half-life recombinant factor VIII (FVIII) for the treatment of hemophilia A. Subcutaneous (SC) FVIII dosing might reduce the treatment burden of prophylaxis. SC N8-GP has a favorable PK profile in animal models and disappears from skin injection sites. Combined animal (SC) and clinical (IV) data suggest that daily SC dosing may provide prophylaxis. SUMMARY Background N8-GP is an extended half-life recombinant factor VIII (FVIII) for the treatment of hemophilia A. Subcutaneous administration of FVIII may reduce the treatment burden of prophylaxis; however, standard FVIII products have low bioavailability after subcutaneous dosing in animals. Objective To evaluate the pharmacokinetics, effectiveness and local distribution of subcutaneously administered N8-GP in preclinical models and predict the human pharmacokinetic (PK) profile. Methods The pharmacokinetics of subcutaneously administered N8-GP were evaluated in FVIII knockout (F8-KO) mice and cynomolgus monkeys; a human PK prediction model in hemophilia A patients was developed. The hemostatic effect was evaluated in a tail vein bleeding model in F8-KO mice. The injection-site distribution and absorption of subcutaneously administered N8-GP were assessed in F8-KO mice by the use of temporal fluorescence imaging and immunohistochemistry. Results Subcutaneously administered N8-GP had a bioavailability, a first-order absorption rate and a half-life, respectively, of 24%, 0.094 h-1 and 14 h in F8-KO mice, and 26%, 0.33 h-1 and 15 h in cynomolgus monkeys. A dose-dependent effect of subcutaneously administered N8-GP on blood loss was observed in mice. A minimal amount of N8-GP was detected at the injection site 48-72 h after single or multiple dose(s) in F8-KO mice. Subcutaneously administered N8-GP was localized to the skin around the injection site, with time-dependent disappearance from the depot. PK modeling predicted that subcutaneously administered N8-GP at a daily dose of 12.5 IU kg-1 will provide FVIII trough levels of 2.5-10% in 95% of patients with severe hemophilia A. Conclusions Subcutaneously administered N8-GP may provide effective hemophilia A prophylaxis. A phase I clinical trial is underway to investigate this possibility.
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Affiliation(s)
- F Rode
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - K Almholt
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - M Petersen
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - M Kreilgaard
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - M Kjalke
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - D M Karpf
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - A V Groth
- Global Development, Novo Nordisk A/S, Søborg, Denmark
| | - P B Johansen
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - L F Larsen
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - M Loftager
- Global Research, Novo Nordisk A/S, Måløv, Denmark
| | - J Haaning
- Global Development, Novo Nordisk A/S, Søborg, Denmark
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45
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Jørgensen CC, Petersen M, Kehlet H, Aasvang EK. Analgesic consumption trajectories in 8975 patients 1 year after fast-track total hip or knee arthroplasty. Eur J Pain 2018; 22:1428-1438. [PMID: 29676839 DOI: 10.1002/ejp.1232] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Persistent or increased long-term opioid consumption has previously been described following total hip- (THA) and knee arthroplasty (TKA). However, detailed information on postoperative analgesic consumption trajectories and risk factors associated with continued need of analgesics in fast-track THA and TKA is sparse. METHODS This is a descriptive multicentre study in primary unilateral fast-track THA or TKA with prospective data on patient characteristics and information on reimbursement entitled dispensed prescriptions of paracetamol, non-steroidal anti-inflammatory drugs, opioids, anticonvulsants and antidepressants 1 month preoperatively and 1 year postoperatively. Patients were stratified according to preoperative opioid use. Postoperative analgesic consumption trajectories were stratified as increased, decreased or no use compared to the preoperative period. RESULTS Of 8975 patients (4849 THA/4126 TKA), 33.9% had relevant reimbursed prescriptions 9-12 months postoperatively. Of 2136 (23.8%) patients with preoperative opioid use, 3.4% had unchanged opioid consumption at 9-12 months postoperatively. However, increased opioid consumption after 9-12 months occurred in 17.6 (TKA) and 10.2% (THA) compared to 9.9 and 6.3% in opioid-naive TKA and THA patients, respectively. Increased NSAID and paracetamol use was seen in 11.5 and 12.4% of all patients. Preoperative analgesic use (any), TKA, psychiatric disorder, tobacco abuse, cardiac disease and use of walking aids were associated with increased opioid consumption. CONCLUSION Continued and increased opioid and other analgesic use occur in a clinically significant proportion of fast-track TKA and THA patients 9-12 months postoperatively, suggesting treatment failure and need for early intervention. Preoperative risk assessment may allow identification of patients in risk of increased postoperative opioid consumption. SIGNIFICANCE We found a considerable fraction of patients with continued or increased opioid consumption 9-12 months after fast-track THA and TKA. Increase in opioid consumption was more frequent in preoperative opioid users than opioid-naive patients, but a pattern of increased analgesic consumption was present across all analgesics. Our data demonstrate a need for increased focus on long-term analgesic strategies and postoperative follow-up after THA and TKA, especially in preoperative opioid users.
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Affiliation(s)
- C C Jørgensen
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Copenhagen, Denmark
- Section for Surgical Pathophysiology, 7621, Rigshospitalet, Copenhagen University, Denmark
| | - M Petersen
- Department 7612, Multidisciplinary Pain Center, Rigshospitalet, University Hospital, Denmark
| | - H Kehlet
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Copenhagen, Denmark
- Section for Surgical Pathophysiology, 7621, Rigshospitalet, Copenhagen University, Denmark
| | - E K Aasvang
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Copenhagen, Denmark
- Anaesthesiological Department, The Abdominal Centre, 2044, Rigshospitalet, Copenhagen University, Denmark
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46
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Stock S, Stierle U, Petersen M, Bucsky B, Richardt D, Sievers H. Comparison of the Ross Procedure in Patients with Endocarditis and Noninfective Valve Disease: Long-term Follow-up of 641 Patients. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627982] [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: 10/28/2022]
Affiliation(s)
- S. Stock
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - U. Stierle
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - M. Petersen
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - B. Bucsky
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - D. Richardt
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - H. Sievers
- Department of Cardiac and Thoacic Vascular Surgery, University of Luebeck, Luebeck, Germany
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Klotz S, Petersen M, Bucsky B, Stock S, Sievers H. Outcome of Valve-sparing vs Bentall Procedure in Acute Type A Aortic Dissection. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627851] [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: 10/28/2022]
Affiliation(s)
- S. Klotz
- Campus Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - M. Petersen
- Campus Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - B. Bucsky
- Campus Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - S. Stock
- Campus Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - H. Sievers
- Campus Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
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48
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Dominick C, Shepherd A, Kennedy V, Petersen M, Girda E, Huang E, Alvarez E. Genomic Profiling of Ovarian Squamous Cell Tumors to Drive Targeted Therapies. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.064] [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: 11/16/2022]
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49
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Teloh J, Waack I, Petersen M, Jakob H, Dohle D. Metabolism of Intraoperatively Administered Histidine in the Context of Bretschneider Cardioplegia. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598911] [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: 10/20/2022]
Affiliation(s)
- J.K. Teloh
- Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
| | - I.N. Waack
- Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
| | - M. Petersen
- Ambulatory Healthcare Center MVZ Dr. Eberhard und Partner, Dortmund, Germany
| | - H. Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Essen, Germany
| | - D.S. Dohle
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Essen, Germany
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50
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Christensen KR, Roepstorff K, Petersen M, Wiinberg B, Hansen AK, Kjelgaard-Hansen M, Nielsen LN. Visualization of haemophilic arthropathy in F8−/−rats by ultrasonography and micro-computed tomography. Haemophilia 2016; 23:152-162. [DOI: 10.1111/hae.13080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- K. R. Christensen
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
- Veterinary Disease Biology; University of Copenhagen; Frederiksberg Denmark
| | - K. Roepstorff
- Histology & Bioimaging; Novo Nordisk A/S; Maaloev Denmark
| | - M. Petersen
- Histology & Bioimaging; Novo Nordisk A/S; Maaloev Denmark
| | - B. Wiinberg
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
| | - A. K. Hansen
- Veterinary Disease Biology; University of Copenhagen; Frederiksberg Denmark
| | | | - L. N. Nielsen
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
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