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Marshall A, Kommoss KF, Ortmann H, Kirchner M, Jauckus J, Sinn P, Strowitzki T, Germeyer A. Comparing gene expression in deep infiltrating endometriosis with adenomyosis uteri: evidence for dysregulation of oncogene pathways. Reprod Biol Endocrinol 2023; 21:33. [PMID: 37005590 PMCID: PMC10067221 DOI: 10.1186/s12958-023-01083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The pathogenesis of deep infiltrating endometriosis (DIE) is poorly understood. It is considered a benign disease but has histologic features of malignancy, such as local invasion or gene mutations. Moreover, it is not clear whether its invasive potential is comparable to that of adenomyosis uteri (FA), or whether it has a different biological background. Therefore, the aim of this study was to molecularly characterize the gene expression signatures of both diseases in order to gain insight into the common or different underlying pathomechanisms and to provide clues to pathomechanisms of tumor development based on these diseases. METHODS In this study, we analyzed formalin-fixed and paraffin-embedded tissue samples from two independent cohorts. One cohort involved 7 female patients with histologically confirmed FA, the other cohort 19 female patients with histologically confirmed DIE. The epithelium of both entities was microdissected in a laser-guided fashion and RNA was extracted. We analyzed the expression of 770 genes using the nCounter expression assay human PanCancer (Nanostring Technology). RESULTS In total, 162 genes were identified to be significantly down-regulated (n = 46) or up-regulated (n = 116) in DIE (for log2-fold changes of < 0.66 or > 1.5 and an adjusted p-value of < 0.05) compared to FA. Gene ontology and KEGG pathway analysis of increased gene expression in DIE compared to FA revealed significant overlap with genes upregulated in the PI3K pathway and focal adhesion signaling pathway as well as other solid cancer pathways. In FA, on the other hand, genes of the RAS pathway showed significant expression compared to DIE. CONCLUSION DIE and FA differ significantly at the RNA expression level: in DIE the most expressed genes were those belonging to the PI3K pathway, and in FA those belonging to the RAS pathway.
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Affiliation(s)
- A Marshall
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - K F Kommoss
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - H Ortmann
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Kirchner
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - J Jauckus
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - P Sinn
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - T Strowitzki
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Germeyer
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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Kowalewski KF, Neuberger M, Sidoti Abate M, Kirchner M, Haney C, Westhoff N, Michel M, Honeck P, Nuhn P, Kriegmair M. Randomized controlled phase II trial of ROBOtic-assisted versus conventional open partial nephrectomy: The ROBOCOP II study. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lusky F, Schindler H, Elshiaty M, Gaissmaier L, Daniello L, Bozorgmehr F, Kuon J, Shah R, Schneider M, Eichhorn F, Trudzinski F, Angeles A, Janke F, Kirchner M, Kazdal D, Stenzinger A, Sültmann H, Thomas M, Christopoulos P. EP08.01-031 Blood Gene Expression Changes in Metastatic Lung Cancer under second-line Immunotherapy according to Clinical Response. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rempel E, Kluck K, Beck S, Ourailidis I, Kazdal D, Neumann O, Volckmar AL, Kirchner M, Goldschmid H, Pfarr N, Weichert W, Hübschmann D, Fröhling S, Sutter C, Schaaf CP, Schirmacher P, Endris V, Stenzinger A, Budczies J. Pan-cancer analysis of genomic scar patterns caused by homologous repair deficiency (HRD). NPJ Precis Oncol 2022; 6:36. [PMID: 35681079 PMCID: PMC9184602 DOI: 10.1038/s41698-022-00276-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Homologous repair deficiency (HRD) is present in many cancer types at variable prevalence and can indicate response to platinum-based chemotherapy and PARP inhibition. We developed a tumor classification system based on the loss of function of genes in the homologous recombination repair (HRR) pathway. To this end, somatic and germline alterations in BRCA1/2 and 140 other HRR genes were included and assessed for the impact on gene function. Additionally, information on the allelic hit type and on BRCA1 promoter hypermethylation was included. The HRDsum score including LOH, LST, and TAI was calculated for 8847 tumors of the TCGA cohort starting from genotyping data and for the subcohort of ovarian cancer also starting from WES data. Pan-cancer, deleterious BRCA1/2 alterations were detected in 4% of the tumors, while 18% of the tumors were HRD-positive (HRDsum ≥ 42). Across 33 cancer types, both BRCA1/2 alterations and HRD-positivity were most prevalent in ovarian cancer (20% and 69%). Pan-cancer, tumors with biallelic deleterious alterations in BRCA1/2 were separated strongly from tumors without relevant alterations (AUC = 0.89), while separation for tumors with monoallelic deleterious BRCA1/2 alterations was weak (AUC = 0.53). Tumors with biallelic deleterious alterations in other HHR genes were separated moderately from tumors without relevant alterations (AUC = 0.63), while separation for tumors with such monoallelic alterations was weaker (AUC = 0.57). In ovarian cancer, HRDsum scores calculated from WES data correlated strongly with HRDsum scores calculated from genotyping data (R = 0.87) and were slightly (4%) higher. We comprehensively analyzed HRD scores and their association with mutations in HRR genes in common cancer types. Our study identifies important parameters influencing HRD measurement and argues for an integration of HRDsum score with specific mutational profiles.
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Affiliation(s)
- E Rempel
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - K Kluck
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - S Beck
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany.,Center for Personalized Medicine (ZPM) Heidelberg, 69120, Heidelberg, Germany
| | - I Ourailidis
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - D Kazdal
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg site, 69120, Heidelberg, Germany
| | - O Neumann
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A L Volckmar
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - M Kirchner
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - H Goldschmid
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - N Pfarr
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - W Weichert
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, 81675, Munich, Germany.,German Cancer Consortium (DKTK), 69120, Heidelberg, Germany
| | - D Hübschmann
- German Cancer Consortium (DKTK), 69120, Heidelberg, Germany.,Division of Translational Medical Oncology, NCT Heidelberg and DKFZ, 69120, Heidelberg, Germany.,NCT Molecular Diagnostics Program, NCT Heidelberg and DKFZ, 69120, Heidelberg, Germany
| | - S Fröhling
- Center for Personalized Medicine (ZPM) Heidelberg, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), 69120, Heidelberg, Germany.,Division of Translational Medical Oncology, NCT Heidelberg and DKFZ, 69120, Heidelberg, Germany.,NCT Molecular Diagnostics Program, NCT Heidelberg and DKFZ, 69120, Heidelberg, Germany
| | - C Sutter
- Institute of Human Genetics, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - C P Schaaf
- Center for Personalized Medicine (ZPM) Heidelberg, 69120, Heidelberg, Germany.,Institute of Human Genetics, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - P Schirmacher
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), 69120, Heidelberg, Germany
| | - V Endris
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A Stenzinger
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany. .,Center for Personalized Medicine (ZPM) Heidelberg, 69120, Heidelberg, Germany. .,German Center for Lung Research (DZL), Heidelberg site, 69120, Heidelberg, Germany. .,German Cancer Consortium (DKTK), 69120, Heidelberg, Germany.
| | - J Budczies
- Institute of Pathology, Heidelberg University Hospital, 69120, Heidelberg, Germany. .,Center for Personalized Medicine (ZPM) Heidelberg, 69120, Heidelberg, Germany. .,German Center for Lung Research (DZL), Heidelberg site, 69120, Heidelberg, Germany. .,German Cancer Consortium (DKTK), 69120, Heidelberg, Germany.
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Tapking C, Hundeshagen G, Kirchner M, Fischer S, Kneser U, Bliesener B. Tranexamic acid reduced blood transfusions in acute burn surgery: A retrospective case-controlled trial. Burns 2022; 48:522-528. [PMID: 35339324 DOI: 10.1016/j.burns.2022.03.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Early excision and grafting of burn wounds are key for reducing prevalence of infection and sepsis. However, it is associated with massive blood loss and patients frequently require large numbers of blood transfusions. This study aimed to evaluate the effect of tranexamic acid (TXA) on blood transfusion requirements in acute burn surgery. METHODS Patients admitted to the burn intensive care unit between January 2018 and May 2021 and received TXA before first surgery for wound excision and grafting were matched in a 1:2 ratio to patients that did not receive TXA (confounders age,sex,total body surface area (TBSA) burned). Primary endpoint of the analysis was the total number of transfused units of red blood cells (RBC) intra- and postoperatively up to 48 h. Fresh frozen plasma (FFP) and platelets were evaluated. Endpoints were compared between groups using van Elteren tests adjusting for strata variable age, gender, TBSA. RESULTS Twenty-six TXA patients were matched with 52 control patients resulting in similar distributions of gender (77.9%(TXA)vs. 82.7%(control) males, p=0.542), age (51.7±21.3vs.48.3 ±17.4years,p = 0.459) and %TBSA burned (33.5%(IQR34)vs. 38.5% (IQR 30.5),p = 1.000). TXA group received significantly less RBC units intraoperatively (2.5(IQR 2.0)vs.4.0 units (IQR4.0), p = 0.038) and in total (4.0(IQR3.0)vs.6.0(IQR4.0),p = 0.017). TXA patients also received less blood products in general (RBC, FFP, platelets) in each period and in total. We found no significant difference in length of stay (24.0(IQR26.0)vs.33.0 days (IQR 0.5),p = 0.367) or mortality (15.4%vs.21.2%, p = 0.542). DISCUSSION This study shows that necessity for blood transfusions in acute burn surgery may be reduced significantly by administration of TXA perioperatively. Randomized-controlled trials are needed to prove these findings.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - M Kirchner
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - S Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - B Bliesener
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Anesthesia, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, Denvir L, Thankamony A, Campbell FM, Wadwa RP, Buckingham BA, Davis N, DiMeglio LA, Mauras N, Besser REJ, Ghatak A, Weinzimer SA, Hood KK, Fox DS, Kanapka L, Kollman C, Sibayan J, Beck RW, Hovorka R, Hovorka R, Acerini CL, Thankamony A, Allen JM, Boughton CK, Dovc K, Dunger DB, Ware J, Musolino G, Tauschmann M, Wilinska ME, Hayes JF, Hartnell S, Slegtenhorst S, Ruan Y, Haydock M, Mangat J, Denvir L, Kanthagnany SK, Law J, Randell T, Sachdev P, Saxton M, Coupe A, Stafford S, Ball A, Keeton R, Cresswell R, Crate L, Cripps H, Fazackerley H, Looby L, Navarra H, Saddington C, Smith V, Verhoeven V, Bratt S, Khan N, Moyes L, Sandhu K, West C, Wadwa RP, Alonso G, Forlenza G, Slover R, Towers L, Berget C, Coakley A, Escobar E, Jost E, Lange S, Messer L, Thivener K, Campbell FM, Yong J, Metcalfe E, Allen M, Ambler S, Waheed S, Exall J, Tulip J, Buckingham BA, Ekhlaspour L, Maahs D, Norlander L, Jacobson T, Twon M, Weir C, Leverenz B, Keller J, Davis N, Kumaran A, Trevelyan N, Dewar H, Price G, Crouch G, Ensom R, Haskell L, Lueddeke LM, Mauras N, Benson M, Bird K, Englert K, Permuy J, Ponthieux K, Marrero-Hernandez J, DiMeglio LA, Ismail H, Jolivette H, Sanchez J, Woerner S, Kirchner M, Mullen M, Tebbe M, Besser REJ, Basu S, London R, Makaya T, Ryan F, Megson C, Bowen-Morris J, Haest J, Law R, Stamford I, Ghatak A, Deakin M, Phelan K, Thornborough K, Shakeshaft J, Weinzimer SA, Cengiz E, Sherr JL, Van Name M, Weyman K, Carria L, Steffen A, Zgorski M, Sibayan J, Beck RW, Borgman S, Davis J, Rusnak J, Hellman A, Cheng P, Kanapka L, Kollman C, McCarthy C, Chalasani S, Hood KK, Hanes S, Viana J, Lanning M, Fox DS, Arreaza-Rubin G, Eggerman T, Green N, Janicek R, Gabrielson D, Belle SH, Castle J, Green J, Legault L, Willi SM, Wysham C. Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial. Lancet Digit Health 2022; 4:e245-e255. [PMID: 35272971 DOI: 10.1016/s2589-7500(22)00020-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. METHODS In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. FINDINGS Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. INTERPRETATION The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Azukaitis K, Kirchner M, Doyon A, Litwin M, Bayazit A, Duzova A, Canpolat N, Jankauskiene A, Shroff R, Melk A, Querfeld U, Schaefer F. POS-228 LONGITUDINAL CHANGES AND DETERMINANTS OF PULSE WAVE VELOCITY IN CHILDREN WITH CHRONIC KIDNEY DISEASE. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Damerau A, Kirchner M, Pfeiffenberger M, Lang A, Buttgereit F, Gaber T. AB0040 PYRUVATE DEHYDROGENASE KINASES AS A POTENTIAL TARGET IN THE TREATMENT OF OSTEOARTHRITIS TO UNLEASH THE METABOLIC FLOW? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2829] [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: 11/04/2022]
Abstract
Background:While osteoarthritis (OA) is the most common joint disease worldwide, rheumatoid arthritis (RA) represents the most common type of autoimmune arthritis. In both diseases, fibroblast-like synoviocytes (FLS), which maintain the structural and dynamic integrity of the joint, have been identified as key drivers of cartilage degradation. FLS can be divided into two major populations. The destructive phenotype which is restricted to the THY1- FLS of the synovial lining promotes bone erosion, while THY1+ FLS of the sublining layer drives synovitis. The FLS phenotype is shaped by glucose metabolism, which promotes disease progression in patients with synovitis. However, profound knowledge about the contribution of FLS to pathogenic mechanisms in cartilage degradation is limited.Objectives:Here, we present the phenotypic features of FLS obtained from patients with OA (OA-FLS) compared to bone marrow-derived mesenchymal stromal cells (MSC) on transcriptomic, proteomic and metabolic levels with the aims (i) to identify novel targets for the development of disease-modifying osteoarthritis drugs and (ii) to distinguish both cell types.Methods:To this end, we comprehensively compared human bone marrow-derived MSC with OA-FLS isolated from human knee joint sections. MSC and OA-FLS were characterized in detail according to their multipotency, surface marker pattern, cell viability, proliferation rate, morphology and expression of fibroblast- and metabolic-related markers using flow cytometry, immunofluorescence and SeahorseTM. More in-depth, selected gene and protein expression patterns were analyzed using qPCR and mass spectrometry.Results:We observed a similar phenotype of OA-FLS and MSC with regard to the minimal criteria that define a MSC phenotype. In-depth comparison of OA-FLS and MSC on proteome level revealed 598 differentially expressed proteins. We observed no differences in the expression of classical fibroblast markers such as vimentin, tenascin C and decorin as confirmed on RNA level. Remarkably, fibronectin, which is mainly produced by fibroblasts, is significantly lower expressed at both protein and RNA levels in OA-FLS together with collagen type 1 and CD106. Conversely, CD9, CD54 and fibroblast-specific protein-1 were expressed significantly higher in FLS at both levels, while hyaluronan synthase 1-3 remained unchanged. Of note, in terms of mitochondrial function, human OA-FLS show a significantly lower basal respiration and ATP production than MSC, but a comparable spare respiratory capacity and cellular mitochondrial dehydrogenase activity (NADH amount) per cell. Additionally, we identified the pyruvate dehydrogenase kinase (PDK) 3 to be highly expressed in OA-FLS, while the expression of mitochondrial ATP synthase subunits, electron transport chain complexes and glycolytic enzymes was comparable with MSC. Finally, inhibition of PDK by using DCA resulted in a significant increase in oxygen consumption rate and ATP production in OA-FLS. Thus, our data newly suggest, that PDKs may play a crucial role in the pathogenesis of OA and possibly RA.Conclusion:Our data provide evidence that, although the classical fibroblast markers do not discriminate between MSC and FLS, the latter demonstrate a significantly higher expression of PDKs, known to inhibit the pyruvate entry into the TCA cycle which finally limits the mitochondrial ATP production. Therefore, shifting the metabolism of FLS from glycolysis to mitochondrial respiration via inhibition of PDKs might be a novel approach in OA for the development of disease-modifying osteoarthritis drugs in order to unleash the metabolic flow.Disclosure of Interests:None declared
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Manzini G, Klotz U, Hines I, Henne-Bruns D, Kremer M, Kirchner M. BILCAP-study: Should patients with resected biliary tract cancer really receive adjuvant chemotherapy with capecitabine? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
According to the 2019 published ASCO guidelines patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy based solely on the results of the BILCAP trial. Aim of this work is to analyze the quality of the BILCAP trial.
Methods
Design, conduct, statistics and reporting of the study were analyzed according to the Delphi list and the CONSORT checklist. The risk of bias was assessed using the Cochrane Risk of Bias Tool.
Results
Several shortcomings could be identified in the study regarding design, conduct, statistics and reporting. The BILCAP study is a randomized, controlled, multicenter, phase 3 study which was done across 44 specialist hepatopancreatobiliary centres in the UK. Despite the inclusion of high specialized centres, the number of included patients each year for each center is extremely low. In particular, a total of 447 patients were included by 44 centers over a period of 11 years, meaning that less than 1 patient was included in this study every year by each center. However, the analysis was not adjusted for center which was one of the stratification factors. Follow up treatment for patients who had disease recurrence was not recorded. Randomization procedure is not well described. Minimization technique was adopted for stratification but mode of application is poorly reported and the choice of variables not justified. No blinding was present. Extensive power evaluations after adjusting the number of needed events, due to lower event rates than expected, were not done. For the observed HR = 0.81 with 234 events statistical power is only around 37%. 4 out of 9 items of the Delphi list and 6 out of 35 items of the CONSORT checklist were not properly addressed. According to the Cochrane Risk of Bias Tool (RoB 2) the overall risk-of-bias judgment for the outcome overall survival of the BILCAP study was “some concerns”. Almost all authors declared to have received funds from pharmaceutical companies, so a conflict of interest cannot be excluded. Additionally, the funding agency for this study (Cancer Research UK and Roche) had an advisory role in design and the first author of the BILCAP study was also involved in the generation of the ASCO guideline.
Conclusion
Based on the results of this study there is not enough evidence for the administration of adjuvant chemotherapy with capecitabine in patients with resected biliary tract cancer.
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Affiliation(s)
- G Manzini
- Department of Visceral Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - U Klotz
- Department of Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - I Hines
- Nutritional Science, East Carolina University, Greenville, USA
| | - D Henne-Bruns
- Department of Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - M Kremer
- Department of Visceral Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - M Kirchner
- Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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10
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Gulden C, Blasini R, Nassirian A, Stein A, Altun FB, Kirchner M, Prokosch HU, Boeker M. Prototypical Clinical Trial Registry Based on Fast Healthcare Interoperability Resources (FHIR): Design and Implementation Study. JMIR Med Inform 2021; 9:e20470. [PMID: 33433393 PMCID: PMC7837997 DOI: 10.2196/20470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trial registries increase transparency in medical research by making information and results of planned, ongoing, and completed studies publicly available. However, the registration of clinical trials remains a time-consuming manual task complicated by the fact that the same studies often need to be registered in different registries with different data entry requirements and interfaces. Objective This study investigates how Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) may be used as a standardized format for exchanging and storing clinical trial records. Methods We designed and prototypically implemented an open-source central trial registry containing records from university hospitals, which are automatically exported and updated by local study management systems. Results We provided an architecture and implementation of a multisite clinical trials registry based on HL7 FHIR as a data storage and exchange format. Conclusions The results show that FHIR resources establish a harmonized view of study information from heterogeneous sources by enabling automated data exchange between trial centers and central study registries.
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Affiliation(s)
- Christian Gulden
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Romina Blasini
- Institute of Medical Informatics, Justus-Liebig-University Gießen, Gießen, Germany
| | - Azadeh Nassirian
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Dresden University of Technology, Dresden, Germany
| | - Alexandra Stein
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Fatma Betül Altun
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Melanie Kirchner
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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11
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Christopoulos P, Kirchner M, Roeper J, Saalfeld F, Janning M, Bozorgmehr F, Magios N, Kazdal D, Volckmar AL, Brückner LM, Bochtler T, Kriegsmann M, Endris V, Penzel R, Kriegsmann K, Eichhorn M, Herth FJF, Heussel CP, El Shafie RA, Schneider MA, Muley T, Meister M, Faehling M, Fischer JR, Heukamp L, Schirmacher P, Bischoff H, Wermke M, Loges S, Griesinger F, Stenzinger A, Thomas M. Risk stratification of EGFR + lung cancer diagnosed with panel-based next-generation sequencing. Lung Cancer 2020; 148:105-112. [PMID: 32871455 DOI: 10.1016/j.lungcan.2020.08.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Panel-based next-generation sequencing (NGS) is increasingly used for the diagnosis of EGFR-mutated non-small-cell lung cancer (NSCLC) and could improve risk assessment in combination with clinical parameters. MATERIALS AND METHODS To this end, we retrospectively analyzed the outcome of 400 tyrosine kinase inhibitor (TKI)-treated EGFR+ NSCLC patients with validation of results in an independent cohort (n = 130). RESULTS EGFR alterations other than exon 19 deletions (non-del19), TP53 co-mutations, and brain metastases at baseline showed independent associations of similar strengths with progression-free (PFS hazard ratios [HR] 2.1-2.3) and overall survival (OS HR 1.7-2.2), in combination defining patient subgroups with distinct outcome (EGFR+NSCLC risk Score, "ENS", p < 0.001). Co-mutations beyond TP53 were rarely detected by our multigene panel (<5%) and not associated with clinical endpoints. Smoking did not affect outcome independently, but was associated with non-del19 EGFR mutations (p < 0.05) and comorbidities (p < 0.001). Laboratory parameters, like the blood lymphocyte-to-neutrophil ratio and serum LDH, correlated with the metastatic pattern (p < 0.01), but had no independent prognostic value. Reduced ECOG performance status (PS) was associated with comorbidities (p < 0.05) and shorter OS (p < 0.05), but preserved TKI efficacy. Non-adenocarcinoma histology was also associated with shorter OS (p < 0.05), but rare (2-3 %). The ECOG PS and non-adenocarcinoma histology could not be validated in our independent cohort, and did not increase the range of prognostication alongside the ENS. CONCLUSIONS EGFR variant, TP53 status and brain metastases predict TKI efficacy and survival in EGFR+ NSCLC irrespective of other currently available parameters ("ENS"). Together, they constitute a practical and reproducible approach for risk stratification of newly diagnosed metastatic EGFR+ NSCLC.
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Affiliation(s)
- P Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Roeper
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine - Oncology, Oldenburg, Germany
| | - F Saalfeld
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - M Janning
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Personalized Oncology, University Hospital Mannheim, Mannheim, Germany
| | - F Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - N Magios
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - D Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - A L Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - L M Brückner
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - T Bochtler
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Kriegsmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - V Endris
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - R Penzel
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Kriegsmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - F J F Herth
- Department of Pulmonology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - C P Heussel
- Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - R A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - M A Schneider
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - T Muley
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Meister
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Faehling
- Department of Pneumology, Esslingen Hospital, Esslingen, Germany
| | - J R Fischer
- Department of Thoracic Oncology, Lungenklinik Loewenstein, Loewenstein, Germany
| | - L Heukamp
- Institut Für Hämatopathologie Hamburg, Hamburg, Germany
| | - P Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - H Bischoff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - M Wermke
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - S Loges
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Personalized Oncology, University Hospital Mannheim, Mannheim, Germany
| | - F Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine - Oncology, Oldenburg, Germany
| | - A Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
| | - M Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
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Ehlers L, Kuppe A, Damerau A, Kirchner M, Strehl C, Buttgereit F, Gaber T. FRI0004 SURFACE AMP DEAMINASE 2 AS A NOVEL REGULATOR MODIFYING THE EXTRACELLULAR ATP-ADENOSINE BALANCE THAT IS DIFFERENTIALLY EXPRESSED IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2813] [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: 11/04/2022]
Abstract
Background:Adenosine and its nucleotides represent crucial immunomodulators in the extracellular environment. ATP and ADP are released from stressed cells in states of inflammation, whereas adenosine serves as a key anti-inflammatory mediator1. The ectonucleotidases CD39 and CD73 are responsible for the sequential catabolism of ATP to adenosine via AMP, thereby promoting an anti-inflammatory milieu induced by the “adenosine halo”. Great importance has been attributed to these enzymes in the pathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and as targets in cancer therapy2 3. AMPD2 mediates AMP deamination to IMP, thus constituting an ambiguous mediator both enhancing the degradation of inflammatory ATP and reducing the formation of protective adenosine. Here, we postulate that this pathway is also present on the cell surface of immune cells and modified under inflammatory conditions.Objectives:Therefore, we analysed surface AMPD2 expression and its modulation on distinct cell lines and primary immune cells.Figure 1.Surface AMPD2 as a novel regulator of the extracellular ATP-adenosine balance.Methods:Firstly, AMPD2 surface expression was verified by immunoprecipitation from membrane fractions isolated from cell lines (HEK293 and HMEC1) and CD14+ monocytes analysed by western blot and mass spectrometry. In addition, surface biotinylation of the aforementioned cells was performed. Also, AMPD2 surface expression was evaluated by flow cytometry, analysing both cell lines (HEK293, HMEC1, THP1, and Jurkat) and primary human immune cells from healthy donors and patients with RA.Secondly, co-expression of surface AMPD2, CD39 and CD73 on PBMCs was analysed by flow cytometry directly after isolation as well as after a 24h culture period. Moreover, surface expression was assessed after immunostimulation and Golgi transport inhibition.Results:AMPD2 surface expression was confirmed by western blot and mass spectrometry of (i) precipitated AMPD2 from membrane fractions and (ii) biotinylated surface molecules in HEK293 and HMEC1 as well as CD14+ monocytes. Surface expression was reduced after AMPD2 knockdown in HEK293. Flow cytometric analysis further verified AMPD2 surface expression and revealed a significant decrease after Golgi transport inhibition (p<0.01). TLR stimulation strongly enhanced the surface expression of AMPD2 and CD39 on monocytes (p<0.05), whereas dexamethasone at high therapeutic doses inversely affected AMPD2 surface expression on lymphocytes and monocytes (p<0.01). Analysis of AMPD2 surface expression on PBMCs from RA patients revealed higher expression levels compared to sex- and age-matched healthy controls (p<0.05).Conclusion:We demonstrate AMPD2 surface expression on immune cells for the first time. Hence, we reveal a novel regulator of the extracellular ATP-adenosine balance that is differentially expressed in RA patients compared to healthy controls. The extracellular conversion of AMP into IMP may constitute a shunt-like mechanism adding to the CD39-CD73 system controlling immunomodulation.References:[1]Regateiro FS, Cobbold SP, Waldmann H. CD73 and adenosine generation in the creation of regulatory microenvironments.Clinical and experimental immunology2013;171(1):1-7. doi: 10.1111/j.1365-2249.2012.04623.x[2]Morandi F, Horenstein AL, Rizzo R, et al. The Role of Extracellular Adenosine Generation in the Development of Autoimmune Diseases.Mediators of inflammation2018;2018:7019398. doi: 10.1155/2018/7019398[3]Allard B, Longhi MS, Robson SC, et al. The ectonucleotidases CD39 and CD73: Novel checkpoint inhibitor targets.Immunol Rev2017;276(1):121-44. doi: 10.1111/imr.12528Acknowledgments:This project is funded by an unrestricted grant by Horizon Pharma plc.Disclosure of Interests:Lisa Ehlers: None declared, Aditi Kuppe: None declared, Alexandra Damerau: None declared, Marieluise Kirchner: None declared, Cindy Strehl: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi., Timo Gaber: None declared
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Christopoulos P, Volckmar AL, Bozorgmehr F, Magios N, Kuon J, Kirchner M, Kazdal D, Endris V, Bochtler T, Herth F, Heussel CP, Winter H, Muley T, Meister M, Fischer J, Rieken S, Faehling M, Bischoff H, Stenzinger A, Thomas M. Real-world implementation of sequential targeted therapies for EGFR-mutated NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Kazdal D, Allgäuer M, Budczies J, Kriegsmann M, Leichsenring J, Volckmar A, Kirchner M, Neumann O, Brandt R, Rempel E, Tala S, Harms A, Plögler C, Von Winterfeld M, Penzel R, Schirmacher P, Endris V, Stenzinger A. P1.04-13 Delineating Spatial Heterogeneity of Tumor Mutational Burden (TMB) Counts in Pulmonary Adenocarcinoma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Kirchner M, Sayers E, Cawthraw S, Duggett N, Gosling R, Jenkins C, Dallman TJ, Mueller-Doblies D, Anjum MF. A sensitive method for the recovery of Escherichia coli serogroup O55 including Shiga toxin-producing variants for potential use in outbreaks. J Appl Microbiol 2019; 127:889-896. [PMID: 31183950 PMCID: PMC6852171 DOI: 10.1111/jam.14345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022]
Abstract
AIM Shiga toxin-producing Escherichia coli (STEC) cause bloody diarrhoea, kidney failure and occasionally death. However, identifying the source of infection caused by STEC other than serogroup O157 is hampered by the availability of sensitive methods for detecting these pathogens. In this study, we developed novel tools for detecting E. coli O55 that is potentially associated with human outbreaks. METHODS AND RESULTS Overall specificity of immuno-magnetic separation (IMS) beads coated with anti-O55 serum was good with exception of cross-reactivity with E. coli O22 and O23, which was eliminated using an O55-specific PCR. Limit of detection for E. coli O55 using O55-IMS beads in spiked cattle faeces was on average 50 CFU per ml (range 1-90), and improved to <10 CFU per ml using the O55-specific PCR, following IMS on samples enriched for 2 h with E. coli O55. Application of these tools to test cattle faeces collected on-farm allowed the isolation of O55:H19, which through whole genome sequencing was compared to STEC O55:H7 human outbreak strains. CONCLUSION These tools provide a sensitive method which could be used to screen samples for STEC O55, whether environmental or human clinical. SIGNIFICANCE AND IMPACT OF THE STUDY Several human outbreaks reported in England were caused by STEC O55:H7. Tools developed here could assist in identification of the environmental source for these isolates, which has not yet been established.
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Affiliation(s)
- M Kirchner
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
| | - E Sayers
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK.,University of East Anglia/Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - S Cawthraw
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
| | - N Duggett
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
| | - R Gosling
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
| | | | | | - D Mueller-Doblies
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
| | - M F Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey, UK
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16
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Gulden C, Kirchner M, Schüttler C, Hinderer M, Kampf M, Prokosch HU, Toddenroth D. Extractive summarization of clinical trial descriptions. Int J Med Inform 2019; 129:114-121. [PMID: 31445245 DOI: 10.1016/j.ijmedinf.2019.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 04/06/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Text summarization of clinical trial descriptions has the potential to reduce the time required to familiarize oneself with the subject of studies by condensing long-form detailed descriptions to concise, meaning-preserving synopses. This work describes the process and quality of automatically generated summaries of clinical trial descriptions using extractive text summarization methods. METHODS We generated a novel dataset from the detailed descriptions and brief summaries of trials registered on clinicaltrials.gov. We executed several text summarization algorithms on the detailed descriptions in this corpus and calculated the standard ROUGE metrics using the brief summaries included in the record as a reference. To investigate the correlation of these metrics with human sentiments, four reviewers assessed the content-completeness of the generated summaries and the helpfulness of both the generated and reference summaries via a Likert scale questionnaire. RESULTS The filtering stages of the dataset generation process reduce the 277,228 trials registered on clinicaltrials.gov to 101,016 records usable for the summarization task. On average, the summaries in this corpus are 25% the length of the detailed descriptions. Of the evaluated text summarization methods, the TextRank algorithm exhibits the overall best performance with a ROUGE-1 F1 score of 0.3531, ROUGE-2 F1 score of 0.1723, and ROUGE-L F1 score of 0.3003. These scores correlate with the assessment of the helpfulness and content similarity by the human reviewers. Inter-rater agreement for the helpfulness and content similarity was slight and fair respectively (Fleiss' kappa of 0.12 and 0.22). CONCLUSIONS Extractive summarization is a viable tool for generating meaning-preserving synopses of detailed clinical trial descriptions. Further, the human evaluation has shown that the ROUGE-L F1 score is useful for rating the general quality of generated summaries of clinical trial descriptions in an automated way.
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Affiliation(s)
- Christian Gulden
- Medical Informatics, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Melanie Kirchner
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Christina Schüttler
- Medical Informatics, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marc Hinderer
- Medical Informatics, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marvin Kampf
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Medical Informatics, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Dennis Toddenroth
- Medical Informatics, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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17
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Leichsenring J, Kazdal D, Ploeger C, Allgäuer M, Endris V, Volckmar AL, Neumann O, Kirchner M, Penzel R, Rempel E, Budczies J, Schirmacher P, Fröhling S, Stenzinger A. [From panel diagnostics to comprehensive genomic analysis : Infobesity or empowerment?]. Pathologe 2019; 40:235-242. [PMID: 31089797 DOI: 10.1007/s00292-019-0608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Precision oncology is obtaining a central role in the therapy of malignant diseases. The indication for targeted therapy is based on the identification of molecular targets for which next-generation sequencing (NGS) is commonly used nowadays. All approved predictive biomarkers and molecular targets, including gene fusions and copy number alterations, can be identified depending on panel design and method applied. Some clinical scenarios, however, may require more holistic genomic approaches, such as whole-genome/whole-exome and transcriptome analysis, which must be embedded in a clinical trial. Here, key aspects and applications of each method are summarized and discussed.
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Affiliation(s)
- J Leichsenring
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - D Kazdal
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Ploeger
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Allgäuer
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - V Endris
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A-L Volckmar
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - O Neumann
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kirchner
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - R Penzel
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E Rempel
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - J Budczies
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - P Schirmacher
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Fröhling
- Abteilung Translationale Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - A Stenzinger
- Pathologisches Institut, Molekularpathologisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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18
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Sommer M, Kirchner M, Gulden C, Egloffstein S, Lux MP, Beckmann MW, Mackensen A, Prokosch HU. Design and Implementation of a Single Source Multipurpose Hospital-Wide Clinical Trial Registry. Stud Health Technol Inform 2019; 258:164-168. [PMID: 30942738] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
IT-supported patient recruitment, serious adverse event reporting as well as making information about clinical trials accessible to the public on websites, are still major challenges in clinical trials. Too often the distribution of information about trials being performed within a hospital across numerous institutions and IT systems is a barrier to provide efficient IT support for such scenarios. Thus, the essential prerequisite to mastering those challenges is to achieve one single point of truth with adequate, complete, accurate and up-to-date information about all clinical trials running at a hospital. We describe the design and implementation of such a single source clinical trial registry serving multiple purposes at a university hospital.
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Affiliation(s)
- Marcus Sommer
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
| | - Melanie Kirchner
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
| | - Christian Gulden
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sainab Egloffstein
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Erlangen, Germany
| | - Michael Patrick Lux
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Erlangen, Germany
| | | | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Center for Medical Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
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Christopoulos P, Kirchner M, Bozorgmehr F, Endris V, Elsayed M, Budczies J, Ristau J, Penzel R, Herth F, Heussel C, Eichhorn M, Muley T, Meister M, Fischer J, Rieken S, Lasitschka F, Bischoff H, Sotillo R, Schirmacher P, Thomas M, Stenzinger A. Identification of a highly lethal V3+TP53+subset in ALK+lung adenocarcinoma. Int J Cancer 2018; 144:190-199. [DOI: 10.1002/ijc.31893] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Affiliation(s)
- P. Christopoulos
- Department of Thoracic Oncology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
| | - M. Kirchner
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - F. Bozorgmehr
- Department of Thoracic Oncology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
- Department of Radiation Oncology; Heidelberg University Hospital; Heidelberg Germany
| | - V. Endris
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - M. Elsayed
- Department of Thoracic Oncology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - J. Budczies
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - J. Ristau
- Department of Radiation Oncology; Heidelberg University Hospital; Heidelberg Germany
| | - R. Penzel
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - F.J. Herth
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Department of Pneumology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - C.P. Heussel
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - M. Eichhorn
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Department of Surgery; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - T. Muley
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Translational Research Unit; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - M. Meister
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Translational Research Unit; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - J.R. Fischer
- Department of Thoracic Oncology; Lungenklinik Löwenstein; Löwenstein Germany
| | - S. Rieken
- Department of Radiation Oncology; Heidelberg University Hospital; Heidelberg Germany
| | - F. Lasitschka
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - H. Bischoff
- Department of Thoracic Oncology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
| | - R. Sotillo
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Division of Molecular Thoracic Oncology; German Cancer Research Center; Heidelberg Germany
| | - P. Schirmacher
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
| | - M. Thomas
- Department of Thoracic Oncology; Thoraxklinik at Heidelberg University Hospital; Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
| | - A. Stenzinger
- Translational Lung Research Center Heidelberg (TLRC-H); Heidelberg Germany, member of the German Center for Lung Research (DZL)
- Institute of Pathology, Heidelberg University Hospital; Heidelberg Germany
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Christopoulos P, Kirchner M, Bozorgmehr F, Endris V, Elsayed M, Magios N, Volckmar AL, Penzel R, Herth F, Heussel C, Winter H, Muley T, Meister M, Fischer J, Rieken S, Lasitschka F, Bischoff H, Schirmacher P, Thomas M, Stenzinger A. TP53 mutations impair overall survival of TKI-treated patients with oncogene-driven NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Heublein S, Braun E, Schulz A, Fremd C, Kirchner M, Jäger D, Sohn C, Sinn P, Schneeweiss A. Molekulare Prädiktoren zur Abschätzung des Therapieansprechens von Patientinnen mit frühem triple-negativen Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671613] [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)
- S Heublein
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - E Braun
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Schulz
- Pathologisches Institut der Universität Heidelberg, Heidelberg, Deutschland
| | - C Fremd
- Nationales Centrum für Tumorerkrankungen Heidelberg, Heidelberg, Deutschland
| | - M Kirchner
- Pathologisches Institut der Universität Heidelberg, Heidelberg, Deutschland
| | - D Jäger
- Nationales Centrum für Tumorerkrankungen Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
| | - P Sinn
- Pathologisches Institut der Universität Heidelberg, Heidelberg, Deutschland
| | - A Schneeweiss
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Deutschland
- Nationales Centrum für Tumorerkrankungen Heidelberg, Heidelberg, Deutschland
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Selvakumar G, Blümke W, Kirchner M, Schlüter B. PODeST - Process Optimization and Development through Sustainability. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855068] [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: 11/07/2022]
Affiliation(s)
- G. Selvakumar
- Evonik Technology & Infrastructure GmbH; Life Cycle Management, Environmental & Bioprocess Technology (VT-B); Paul-Baumann-Straße 1 45772 Marl Germany
| | - W. Blümke
- Evonik Technology & Infrastructure GmbH; Life Cycle Management, Environmental & Bioprocess Technology (VT-B); Rodenbacher Chaussee 4 63457 Hanau-Wolfgang Germany
| | - M. Kirchner
- Evonik Technology & Infrastructure GmbH; Life Cycle Management, Environmental & Bioprocess Technology (VT-B); Paul-Baumann-Straße 1 45772 Marl Germany
| | - B. Schlüter
- Evonik Technology & Infrastructure GmbH; Life Cycle Management, Environmental & Bioprocess Technology (VT-B); Paul-Baumann-Straße 1 45772 Marl Germany
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Blesgen A, Kirchner M, Kunze E. Abwasser- und Abgasbehandlung in der chemischen Industrie: Ganzheitliche Betrachtung und aktuelle Herausforderungen. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855131] [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: 11/08/2022]
Affiliation(s)
- A. Blesgen
- Evonik Technology & Infrastructure GmbH; Verfahrenstechnik & Engineering; Rodenbacher Chaussee 4 63457 Hanau Deutschland
| | - M. Kirchner
- Evonik Technology & Infrastructure GmbH; Verfahrenstechnik & Engineering; Paul-Baumann-Straße 1 45772 Marl Deutschland
| | - E. Kunze
- Evonik Nutrition & Care GmbH; Technology Platform Production Organics; Max-Wolf-Straße 7 36396 Steinau a. d. Str. Deutschland
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Christopoulos P, Elsayed M, Endris V, Bozorgmehr F, Kirchner M, Buchhalter I, Penzel R, Herth FJF, Heußel CP, Eichhorn M, Muley T, Meister M, Fischer JR, Warth A, Bischoff HG, Schirmacher P, Stenzinger A, Thomas M. EML4-ALK fusion variant V3 confers early treatment failure with first and second generation ALK TKI. Pneumologie 2018. [DOI: 10.1055/s-0037-1619261] [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)
- P Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg
| | - M Elsayed
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg
| | - V Endris
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg
| | - M Kirchner
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - I Buchhalter
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - R Penzel
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Institute of Internal Medicine III – Pneumology, Thoraxklinik, University Hospital Heidelberg
| | - CP Heußel
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
| | - M Eichhorn
- Chirurgie, Thoraxklinik Heidelberg gGmbH
| | - T Muley
- Translational Research Unit, Thoraxklinik, University Hospital Heidelberg
| | - M Meister
- Translational Research Unit, Thoraxklinik, University Hospital Heidelberg
| | - JR Fischer
- Department of Oncology, Lungenklinik Löwenstein
| | - A Warth
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - HG Bischoff
- Thoraxklinik Heidelberg, University Hospital Heidelberg
| | - P Schirmacher
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Stenzinger
- Institute of Pathology, Heidelberg University Hospital; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - M Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg
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Affiliation(s)
- M. Kirchner
- RiskLab Switzerland, Department of Mathematics, ETH Zurich, Zurich, Switzerland
| | - A. Bercher
- RiskLab Switzerland, Department of Mathematics, ETH Zurich, Zurich, Switzerland
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Brecht L, Wallwiener M, Schott S, Domschke C, Dinkic C, Golatta M, Schuetz F, Fluhr H, Stenzinger A, Kirchner M, Sohn C, Rom J. Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606228] [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: 10/18/2022] Open
Affiliation(s)
- L Brecht
- St. Josef's Hospital, Department for internal medicine, Heidelberg
| | - M Wallwiener
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - S Schott
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - C Domschke
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - C Dinkic
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - M Golatta
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - F Schuetz
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - H Fluhr
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - A Stenzinger
- University of Heidelberg, Department of Pathology, Heidelberg
| | - M Kirchner
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg
| | - C Sohn
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
| | - J Rom
- University of Heidelberg, Department for Gynaecology and Obstetrics, Heidelberg
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Kirchner M, Lemma F, Randall L, Anjum MF. Loop-mediated isothermal amplification for extended spectrum β-lactamase gene detection in poultry carcase. Vet Rec 2017; 181:119. [PMID: 28512232 DOI: 10.1136/vr.104150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/04/2022]
Affiliation(s)
- M Kirchner
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
| | - F Lemma
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
| | - L Randall
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
| | - M F Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
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Lachmann R, Kirchner M, Aebischer A, Mertens E. Erhebung des Ausmaßes der dem ÖGD gemeldeten Fälle von Skabies in Deutschland im Jahr 2016. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - E Mertens
- Niedersächsisches Landesgesundheitsamt, Hannover
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Bauerschmitz GJ, Ziegler E, Kirchner M, Emons G, Gründker C. Vergleich EMT-spezifischer Genexpressionmuster einer neuen „aggressiven“ MCF-7 Zelllinie mit der Wildtyp MCF-7 Zelllinie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388376] [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: 10/24/2022] Open
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31
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Patapovas A, Dormann H, Sedlmayr B, Kirchner M, Sonst A, Müller F, Pfistermeister B, Plank-Kiegele B, Vogler R, Maas R, Criegee-Rieck M, Prokosch HU, Bürkle T. Medication safety and knowledge-based functions: a stepwise approach against information overload. Br J Clin Pharmacol 2014; 76 Suppl 1:14-24. [PMID: 24007449 DOI: 10.1111/bcp.12190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/31/2013] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim was to improve medication safety in an emergency department (ED) by enhancing the integration and presentation of safety information for drug therapy. METHODS Based on an evaluation of safety of drug therapy issues in the ED and a review of computer-assisted intervention technologies we redesigned an electronic case sheet and implemented computer-assisted interventions into the routine work flow. We devised a four step system of alerts, and facilitated access to different levels of drug information. System use was analyzed over a period of 6 months. In addition, physicians answered a survey based on the technology acceptance model TAM2. RESULTS The new application was implemented in an informal manner to avoid work flow disruption. Log files demonstrated that step I, 'valid indication' was utilized for 3% of the recorded drugs and step II 'tooltip for well-known drug risks' for 48% of the drugs. In the questionnaire, the computer-assisted interventions were rated better than previous paper based measures (checklists, posters) with regard to usefulness, support of work and information quality. CONCLUSION A stepwise assisting intervention received positive user acceptance. Some intervention steps have been seldom used, others quite often. We think that we were able to avoid over-alerting and work flow intrusion in a critical ED environment.
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Affiliation(s)
- Andrius Patapovas
- Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Müller F, Dormann H, Pfistermeister B, Sonst A, Patapovas A, Vogler R, Hartmann N, Plank-Kiegele B, Kirchner M, Bürkle T, Maas R. Application of the Pareto principle to identify and address drug-therapy safety issues. Eur J Clin Pharmacol 2014; 70:727-36. [PMID: 24652477 DOI: 10.1007/s00228-014-1665-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/18/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Adverse drug events (ADE) and medication errors (ME) are common causes of morbidity in patients presenting at emergency departments (ED). Recognition of ADE as being drug related and prevention of ME are key to enhancing pharmacotherapy safety in ED. We assessed the applicability of the Pareto principle (~80 % of effects result from 20 % of causes) to address locally relevant problems of drug therapy. METHODS In 752 cases consecutively admitted to the nontraumatic ED of a major regional hospital, ADE, ME, contributing drugs, preventability, and detection rates of ADE by ED staff were investigated. Symptoms, errors, and drugs were sorted by frequency in order to apply the Pareto principle. RESULTS In total, 242 ADE were observed, and 148 (61.2 %) were assessed as preventable. ADE contributed to 110 inpatient hospitalizations. The ten most frequent symptoms were causally involved in 88 (80.0 %) inpatient hospitalizations. Only 45 (18.6 %) ADE were recognized as drug-related problems until discharge from the ED. A limited set of 33 drugs accounted for 184 (76.0 %) ADE; ME contributed to 57 ADE. Frequency-based listing of ADE, ME, and drugs involved allowed identification of the most relevant problems and development of easily to implement safety measures, such as wall and pocket charts. CONCLUSIONS The Pareto principle provides a method for identifying the locally most relevant ADE, ME, and involved drugs. This permits subsequent development of interventions to increase patient safety in the ED admission process that best suit local needs.
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Affiliation(s)
- Fabian Müller
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstrasse 17, 91054, Erlangen, Germany,
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Schroeder P, Belis CA, Schnelle-Kreis J, Herzig R, Prevot ASH, Raveton M, Kirchner M, Catinon M. Why air quality in the Alps remains a matter of concern. The impact of organic pollutants in the alpine area. Environ Sci Pollut Res Int 2014; 21:252-267. [PMID: 24046224 DOI: 10.1007/s11356-013-2058-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
In the middle of Europe, the Alps form a geographical and meteorological trap for atmospheric pollutants including volatile and semi-volatile organic compounds emitted in the surrounding lowlands. This is due to their barrier effects, high precipitation rates, and low ambient temperatures. Also the pollutants emitted in the cities inside the Alps spread in the region depending on orographic and meteorological conditions. Although a number of studies on the distribution and effect of pollutants in the Alps has been published, comprehensive information on potential hazards, and ways to improve this sensible environment are lacking. This opinion paper is the result of a discussion during the Winterseminar of the AlpsBioCluster project in Munich. It summarizes the current literature and presents some case studies on local pollution sources in the Alps, and the possibility of using biomonitoring techniques to assess critical pollution loads and distributions.
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Affiliation(s)
- P Schroeder
- Helmholtz Zentrum München, GmbH, Research Unit Microbe Plant Interactions, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany,
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Kirchner M, Mafura M, Hunt T, Card R, Anjum M. Antibiotic resistance gene profiling of faecal and oral anaerobes collected during an antibiotic challenge trial. Anaerobe 2013; 23:20-2. [DOI: 10.1016/j.anaerobe.2013.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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Kirchner M, Schubert P, Getrost T, Haas CT. Effect of altered surfaces on postural sway characteristics in elderly subjects. Hum Mov Sci 2013; 32:1467-79. [PMID: 24055362 DOI: 10.1016/j.humov.2013.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/14/2012] [Accepted: 05/01/2013] [Indexed: 12/26/2022]
Abstract
Mobility is essentially based on successful balance control. The evaluation of functional strategies for postural stability is requisite for effective balance rehabilitation and fall prevention in elderly subjects. Our objective was to clarify control mechanisms of different standing positions reflecting challenges of typical everyday life situations. For this purpose, elderly subjects stood on different surfaces resulting in a change of the biomechanical constraints. Sway parameters out of time and frequency domain were calculated from center-of-pressure (COP) excursions. Besides the classic quantification of the amount of sway variability, we investigated the temporal organization of postural sway by means of nonlinear time series analysis. Limb load symmetry was quantified via foot pressure insoles. We found task dependent motor outputs: (1) asymmetrical loading in all conditions; (2) altered amount and structure of COP movements with dissimilar changes in medio-lateral and anterior-posterior direction; (3) changes of the motor output affect several time scales especially when standing on a balance board or with one foot on a step. Our results indicate that elderly subjects preferred forcefully one limb which supports a step-initiation strategy. Modifications of the postural sway structure refer to the interaction of multiple control mechanisms to cope with the altered demands. The identification of postural strategies employed in daily activities augments the ecological validity of postural control studies.
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Affiliation(s)
- M Kirchner
- Goethe-University, Institute of Sport Sciences, Ginnheimer Landstr. 39, 60487 Frankfurt am Main, Germany.
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Sedlmayr B, Patapovas A, Kirchner M, Sonst A, Müller F, Pfistermeister B, Plank-Kiegele B, Vogler R, Criegee-Rieck M, Prokosch HU, Dormann H, Maas R, Bürkle T. Comparative evaluation of different medication safety measures for the emergency department: physicians' usage and acceptance of training, poster, checklist and computerized decision support. BMC Med Inform Decis Mak 2013; 13:79. [PMID: 23890121 PMCID: PMC3733614 DOI: 10.1186/1472-6947-13-79] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 07/19/2013] [Indexed: 01/31/2023] Open
Abstract
Background Although usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Our objective was to comparatively investigate a set of traditional medication safety measures such as medication safety training for physicians, paper-based posters and checklists concerning potential medication problems versus the additional benefit of a computer-assisted medication check. We concentrated on usage, acceptance and suitability of such interventions in a busy emergency department (ED) of a 749 bed acute tertiary care hospital. Methods A retrospective, qualitative evaluation study was conducted using a field observation and a questionnaire-based survey. Six physicians were observed while treating 20 patient cases; the questionnaire, based on the Technology Acceptance Model 2 (TAM2), has been answered by nine ED physicians. Results During field observations, we did not observe direct use of any of the implemented interventions for medication safety (paper-based and electronic). Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters. However, despite their positive attitude, physicians most often stated that they use the interventions in only up to ten percent for subjectively “critical” orders. Main reasons behind the low usage were deficits in ease-of-use and fit to the workflow. The intention to use the interventions was rather high after overcoming these barriers. Conclusions Methodologically, the study contributes to Technology Acceptance Model (TAM) research in an ED setting and confirms TAM2 as a helpful diagnostic tool in identifying barriers for a successful implementation of medication safety interventions. In our case, identified barriers explaining the low utilization of the implemented medication safety interventions - despite their positive reception - include deficits in accessibility, briefing for the physicians about the interventions, ease-of-use and compatibility to the working environment.
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Affiliation(s)
- Brita Sedlmayr
- Chair of Medical Informatics, University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Karabul N, Gökce S, Kirchner M, Mannhardt W, Mengel E. Cytokines in treated and untreated Pompe patients. BMC Musculoskelet Disord 2013. [PMCID: PMC3666922 DOI: 10.1186/1471-2474-14-s2-p6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Kersten S, Kirchner M. Zur Veränderung der posturalen Kontrolle bei Multiple Sklerose Patienten. Akt Neurol 2013. [DOI: 10.1055/s-0033-1337985] [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: 10/27/2022]
Affiliation(s)
- S. Kersten
- Sportwissenschaftliches Institut, Universität des Saarlandes, Saarbrücken
| | - M. Kirchner
- Institut für Sportwissenschaften, Goethe-Universität, Frankfurt am Main
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Dormann H, Sonst A, Müller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bürkle T, Maas R. Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110:213-9. [PMID: 23596501 DOI: 10.3238/arztebl.2013.0213] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/06/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lists of potentially inappropriate medications (PIMs) for the elderly, such as the German PRISCUS list, have been published as expert recommendations with the aim of improving drug safety for this patient group. In this study, we tried to determine how often adverse drug events occur in the emergency department and what role PRISCUS medications might play in these events. METHODS We prospectively reviewed the medical records of 752 patients who were treated in the emergency department (ED) of a level III hospital in Germany for adverse drug events due to medication errors (MEs) and for adverse drug reactions (ADRs). The evaluation was performed in two steps by pharmacologists, clinical pharmacologists, and board-certified internists. RESULTS Both clinically important MEs and ADRs became more common with advancing age. Among the 351 patients who were over age 65, 307 (87.5%) were taking at least one medication at home. Of these 307 patients, 16.6% (95% confidence interval [CI]: 12.9-21.2%) were taking at least one PIM, as defined by the German PRISCUS list. In relative terms, PIMs were more commonly associated with ADRs or MEs than other drugs (27.0% [95% CI: 17.5-39.1% versus 15.7% [95% CI: 14.1-17.4%], Odds ratio 1.99 [95% CI: 1.23-3.52: p = 0.018), but in absolute terms ADRs and MEs involved non-PIM more often than PIM. CONCLUSION Elderly patients more frequently suffer from ADR and from the clinical consequences of medication errors. Elderly patients taking PIMs are more likely to suffer from ADRs and MEs, even though most drug-related events are still attributable to non-PIM.
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Affiliation(s)
- Harald Dormann
- Department of Emergency Medicine, Hospital Fürth, Germany
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40
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Kirchner M, McLaren I, Clifton-Hadley FA, Liebana E, Wales AD, Davies RH. A comparison between longitudinal shedding patterns of Salmonella
Typhimurium and Salmonella
Dublin on dairy farms. Vet Rec 2012; 171:194. [DOI: 10.1136/vr.100865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M. Kirchner
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
| | - I. McLaren
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
| | - F. A. Clifton-Hadley
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
| | - E. Liebana
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
| | - A. D. Wales
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
| | - R. H. Davies
- Department of Bacteriology; Animal Health and Veterinary Laboratories Agency; Woodham Lane, New Haw Addlestone Surrey KT15 3NB UK
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41
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Diercke M, Kirchner M, Claussen K, Wienecke WR, Strotmann I, Frangenberg J, Schiffmann A, Bettge-Weller G, Arvand M, Uphoff H. Spätes Cluster von STEC O104:H4-Infektionen in Niedersachsen und Hessen verursacht durch kontaminierte Lebensmittel, Mai 2011. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1307352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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Kirchner M, Sahling G, Uhlig G, Gunkel W, Klings KW. Does the red tide-forming dinoflagellatenoctiluca scintillansfeed on bacteria? ACTA ACUST UNITED AC 2012. [DOI: 10.1080/00364827.1996.10413610] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Stöcker P, Rosner B, Werber D, Kirchner M, Reinecke A, Wichmann-Schauer H, Prager R, Rabsch W, Frank C. Outbreak of Salmonella Montevideo associated with a dietary food supplement flagged in the Rapid Alert System for Food and Feed (RASFF) in Germany, 2010. Euro Surveill 2011; 16:20040. [PMID: 22221497] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany. Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1-90 years) were mainly affected. An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case-control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1-infinity, p-value=0.002). Restricting the case-control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8-infinity, p-value=0.001). Trace-back of the supplement's main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak.
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Affiliation(s)
- P Stöcker
- Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany.
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44
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Stöcker P, Rosner B, Werber D, Kirchner M, Reinecke A, Wichmann-Schauer H, Prager R, Rabsch W, Frank C. Outbreak of Salmonella Montevideo associated with a dietary food supplement flagged in the Rapid Alert System for Food and Feed (RASFF) in Germany, 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.50.20040-en] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- P Stöcker
- Robert Koch Institute, Department Infectious Disease Epidemiology, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - B Rosner
- Robert Koch Institute, Department Infectious Disease Epidemiology, Berlin, Germany
| | - D Werber
- Robert Koch Institute, Department Infectious Disease Epidemiology, Berlin, Germany
| | - M Kirchner
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
| | - A Reinecke
- Federal Institute for Risk Assessment, Berlin, Germany
| | | | - R Prager
- National Reference Centre for Salmonella and other Enterics, Robert Koch Institute, Wernigerode Branch, Germany
| | - W Rabsch
- National Reference Centre for Salmonella and other Enterics, Robert Koch Institute, Wernigerode Branch, Germany
| | - C Frank
- Institute for Hygiene and Public Health, University of Bonn, Germany
- Robert Koch Institute, Department Infectious Disease Epidemiology, Berlin, Germany
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45
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Kirchner M, Marier E, Miller A, Snow L, McLaren I, Davies R, Clifton-Hadley F, Cook A. Application of variable number of tandem repeat analysis to track Salmonella enterica ssp. enterica serovar Typhimurium infection of pigs reared on three British farms through the production cycle to the abattoir. J Appl Microbiol 2011; 111:960-70. [DOI: 10.1111/j.1365-2672.2011.05096.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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46
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Kirchner M, Bürkle T, Patapovas A, Mathews A, Sojer R, Müller F, Dormann H, Maas R, Prokosch HU. Building the technical infrastructure to support a study on drug safety in a general hospital. Stud Health Technol Inform 2011; 169:325-329. [PMID: 21893766] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe reorganization steps and the required technical infrastructure to support a multidisciplinary research project aimed at improving the safety of drug therapy in an emergency department (ED) of a community hospital. Assessment of drug safety required consolidation of data from various sources in a single source approach. We solved this by transferring digital data from the hospital information system (HIS) and attached clinical systems into a pseudonymized study database (secuTrial), which is also used as a web based data capturing tool to rate drug associated risk situations, extended by a technical extension for dynamic upload of further data. Paper-based documentation in the ED was digitized using a digital pen technology.
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47
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Hopkins KL, Kirchner M, Guerra B, Granier SA, Lucarelli C, Porrero MC, Jakubczak A, Threlfall EJ, Mevius DJ. Multiresistant Salmonella enterica serovar 4,[5],12:i:- in Europe: a new pandemic strain? Euro Surveill 2010. [DOI: 10.2807/ese.15.22.19580-en] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A marked increase in the prevalence of S. enterica serovar 4,[5],12:i:- with resistance to ampicillin, streptomycin, sulphonamides and tetracyclines (R-type ASSuT) has been noted in food-borne infections and in pigs/pig meat in several European countries in the last ten years. One hundred and sixteen strains of S. enterica serovar 4,[5],12:i:- from humans, pigs and pig meat isolated in England and Wales, France, Germany, Italy, Poland, Spain and the Netherlands were further subtyped by phage typing, pulsed-field gel electrophoresis and multilocus variable number tandem repeat analysis to investigate the genetic relationship among strains. PCR was performed to identify the fljB flagellar gene and the genes encoding resistance to ampicillin, streptomycin, sulphonamides and tetracyclines. Class 1 and 2 integrase genes were also sought. Results indicate that genetically related serovar 4,[5],12:i:- strains of definitive phage types DT193 and DT120 with ampicillin, streptomycin, sulphonamide and tetracycline resistance encoded by blaTEM, strA-strB, sul2 and tet(B) have emerged in several European countries, with pigs the likely reservoir of infection. Control measures are urgently needed to reduce spread of infection to humans via the food chain and thereby prevent the possible pandemic spread of serovar 4,[5],12:i:- of R-type ASSuT as occurred with S. Typhimurium DT104 during the 1990s.
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Affiliation(s)
- K L Hopkins
- Health Protection Agency Centre for Infections, London, United Kingdom
| | - M Kirchner
- Veterinary Laboratories Agency, Weybridge, United Kingdom
| | - B Guerra
- Federal Institute for Risk Assessment, Berlin, Germany
| | - S A Granier
- Agence Française de Sécurité Sanitaire des Aliments, Maisons-Alfort, France
| | | | - M C Porrero
- Health Surveillance Centre (VISAVET), University Complutense, Madrid, Spain
| | - A Jakubczak
- National Institute of Public Health, Warsaw, Poland
| | - E J Threlfall
- Health Protection Agency Centre for Infections, London, United Kingdom
| | - D. J Mevius
- Faculty of veterinary Medicine, Utrecht University, The Netherlands
- Central Veterinary Institute of Wageningen, Lelystad, The Netherlands
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48
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Hopkins KL, Kirchner M, Guerra B, Granier SA, Lucarelli C, Porrero MC, Jakubczak A, Threlfall EJ, Mevius DJ. Multiresistant Salmonella enterica serovar 4,[5],12:i:- in Europe: a new pandemic strain? Euro Surveill 2010; 15:19580. [PMID: 20546690] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
A marked increase in the prevalence of S. enterica serovar 4,[5],12:i:- with resistance to ampicillin, streptomycin, sulphonamides and tetracyclines (R-type ASSuT) has been noted in food-borne infections and in pigs/pig meat in several European countries in the last ten years. One hundred and sixteen strains of S. enterica serovar 4,[5],12:i:- from humans, pigs and pig meat isolated in England and Wales, France, Germany, Italy, Poland, Spain and the Netherlands were further subtyped by phage typing, pulsed-field gel electrophoresis and multilocus variable number tandem repeat analysis to investigate the genetic relationship among strains. PCR was performed to identify the fljB flagellar gene and the genes encoding resistance to ampicillin, streptomycin, sulphonamides and tetracyclines. Class 1 and 2 integrase genes were also sought. Results indicate that genetically related serovar 4,[5],12:i:- strains of definitive phage types DT193 and DT120 with ampicillin, streptomycin, sulphonamide and tetracycline resistance encoded by blaTEM, strA-strB, sul2 and tet(B) have emerged in several European countries, with pigs the likely reservoir of infection. Control measures are urgently needed to reduce spread of infection to humans via the food chain and thereby prevent the possible pandemic spread of serovar 4,[5],12:i:- of R-type ASSuT as occurred with S. Typhimurium DT104 during the 1990s.
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Affiliation(s)
- K L Hopkins
- Health Protection Agency Centre for Infections, London, United Kingdom.
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49
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Kirchner M, Faus-Kessler T, Jakobi G, Levy W, Henkelmann B, Bernhöft S, Kotalik J, Zsolnay A, Bassan R, Belis C, Kräuchi N, Moche W, Simoncic P, Uhl M, Weiss P, Schramm KW. Vertical distribution of organochlorine pesticides in humus along Alpine altitudinal profiles in relation to ambiental parameters. Environ Pollut 2009; 157:3238-3247. [PMID: 19596160 DOI: 10.1016/j.envpol.2009.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 06/03/2009] [Accepted: 06/03/2009] [Indexed: 05/28/2023]
Abstract
In forest soils along vertical profiles located in different parts of the Alps, concentrations of persistent organic pollutants (POPs), namely organochlorine pesticides (OCPs) like dichlorodiphenyltrichloroethanes (DDTs), hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH), heptachlor, aldrin, dieldrin and mirex, were measured. Though local characteristics of the sites are influenced by numerous factors like orographic and meteorological parameters, forest stand characteristics and humus parameters, we ascertained a marked vertical increase of concentrations of some organochlorine compounds in the soil. On the basis of climatological values of each site, we found that the contamination increase with altitude can be ascribed to a certain 'cold condensation effect'. In addition, the perennial atmospheric deposition of POPs is controlled by precipitation. Other key parameters explaining the accumulation of POPs are the soil organic carbon stocks, the turnover times, the re-volatilisation and degradation processes, which vary with altitude.
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Affiliation(s)
- M Kirchner
- Helmholtz Zentrum München, GmbH, Institutes of Ecological Chemistry, Developmental Genetics and Soil Ecology, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany.
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50
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Offenthaler I, Bassan R, Belis C, Jakobi G, Kirchner M, Kräuchi N, Moche W, Schramm KW, Sedivy I, Simoncic P, Uhl M, Weiss P. PCDD/F and PCB in spruce forests of the Alps. Environ Pollut 2009; 157:3280-3289. [PMID: 19570598 DOI: 10.1016/j.envpol.2009.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 05/17/2009] [Indexed: 05/28/2023]
Abstract
PCDD/F and PCB concentrations in remote mountainous spruce stands of the Central European Alps show strong geographic variation. Independent of the matrix (0.5 year old needles, humus or mineral soil), the highest pollutant levels were always found at the lateral zones of the mountain range. High levels coincided with strong precipitation, particularly along the northern margin of the study region. The most volatile PCB congener propagated farther into the colder, drier central Alps than the heavier species. Matrices with different accumulation history (needles and humus) repeatedly reflected different spatial emission patterns. Consistent with its much longer exposure, pollutant levels in humus exceeded those of needles by up to two orders of magnitude. Needle contamination varied with altitude but the vertical trends were highly variable between transsects and changed between years, too.
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Affiliation(s)
- I Offenthaler
- Austrian Environment Agency, Spittelauer Lände 5, 1090 Vienna, Austria.
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