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Fuchs M, Gonzalez C, Frisch Y, Hahn P, Matthies P, Gruening M, Pinto Dos Santos D, Dratsch T, Kim M, Nensa F, Trenz M, Mukhopadhyay A. Closing the loop for AI-ready radiology. ROFO-FORTSCHR RONTG 2024; 196:154-162. [PMID: 37582385 DOI: 10.1055/a-2124-1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND In recent years, AI has made significant advancements in medical diagnosis and prognosis. However, the incorporation of AI into clinical practice is still challenging and under-appreciated. We aim to demonstrate a possible vertical integration approach to close the loop for AI-ready radiology. METHOD This study highlights the importance of two-way communication for AI-assisted radiology. As a key part of the methodology, it demonstrates the integration of AI systems into clinical practice with structured reports and AI visualization, giving more insight into the AI system. By integrating cooperative lifelong learning into the AI system, we ensure the long-term effectiveness of the AI system, while keeping the radiologist in the loop. RESULTS: We demonstrate the use of lifelong learning for AI systems by incorporating AI visualization and structured reports. We evaluate Memory Aware-Synapses and Rehearsal approach and find that both approaches work in practice. Furthermore, we see the advantage of lifelong learning algorithms that do not require the storing or maintaining of samples from previous datasets. CONCLUSION In conclusion, incorporating AI into the clinical routine of radiology requires a two-way communication approach and seamless integration of the AI system, which we achieve with structured reports and visualization of the insight gained by the model. Closing the loop for radiology leads to successful integration, enabling lifelong learning for the AI system, which is crucial for sustainable long-term performance. KEY POINTS · The integration of AI systems into the clinical routine with structured reports and AI visualization.. · Two-way communication between AI and radiologists is necessary to enable AI that keeps the radiologist in the loop.. · Closing the loop enables lifelong learning, which is crucial for long-term, high-performing AI in radiology..
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Affiliation(s)
| | | | | | | | | | - Maximilian Gruening
- Interorganisational Informationssystems, Georg-August-Universität Göttingen, Goettingen, Germany
| | - Daniel Pinto Dos Santos
- Institute for Diagnostic and Interventional Radiology, Uniklinik Koln, Germany
- Institute for Diagnostic and Interventional Radiology, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Thomas Dratsch
- Institute for Diagnostic and Interventional Radiology, Uniklinik Koln, Germany
| | - Moon Kim
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum Essen, Germany
- Institute for Artificial Intelligence in Medicine, Universitätsklinikum Essen, Germany
| | - Felix Nensa
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum Essen, Germany
- Institute for Artificial Intelligence in Medicine, Universitätsklinikum Essen, Germany
| | - Manuel Trenz
- Interorganisational Informationssystems, Georg-August-Universität Göttingen, Goettingen, Germany
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Abstract
Purpose: To compare physician reimbursements for vitreoretinal surgeries with office-based patient care. Methods: A theoretical model was performed comparing physician work reimbursements for the 10 most common vitreoretinal surgeries with office-based work relative value units (wRVUs) that could have been generated during the same global time period. The reference physician was modeled at 40 patients per 8-hour workday. A lower volume physician and higher volume physician were modeled at 30 patients/day and 50 patients/day, respectively. The reimbursement rates and allocated times for surgery were based on the 2021 values set by Medicare, and the average wRVU per office visit was based on 2021 real-world data from the Vestrum Retinal Healthcare Database. Results: In the reference case, performing any of the 10 most common vitreoretinal surgeries was associated with an opportunity cost with a weighted mean of 49% (range, 40%-68%) relative to lost office productivity. The Centers for Medicare & Medicaid Services (CMS) allocated a weighted mean intraservice time of 73 minutes; however, the reference physician would have to complete the surgery with a weighted average of 5 minutes (range, -31-12 minutes) for surgical wRVUs to equal office-based reimbursements. Performing these 10 surgeries was associated with a 25% opportunity cost even for the lower volume physician and 61% for the higher volume physician. Probability sensitivity analysis with a range of conditions identified opportunity costs from surgery in over 99% of simulated scenarios. Conclusions: Medicare reimbursements for the physician work component of vitreoretinal surgeries represented a significant opportunity cost for the physician relative to office-based patient care of equivalent time, especially for busier physicians. The model did not explore practice overhead and professional liability insurance, which are factored separately by CMS and may influence the opportunity cost depending on utilization. The average threshold surgery times for surgical reimbursements to equal office-based reimbursements may be difficult to achieve.
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Affiliation(s)
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rahul Reddy
- Department of Ophthalmology, University of Arizona, Phoenix, AZ, USA
| | | | | | - Jill Blim
- American Society of Retina Specialists, Chicago, IL, USA
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3
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Sodhi GS, Haq Z, Aggarwal N, Boucher N, Emerson GG, Hahn P. Evolving Treatment Patterns in Diabetic Macular Edema Between 2015 and 2020. J Vitreoretin Dis 2023; 7:199-202. [PMID: 37188218 PMCID: PMC10170625 DOI: 10.1177/24741264231156096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To explore the recent evolution of diabetic macular edema (DME) treatment practice patterns over 5 years among retina specialists in the United States. Methods: This retrospective analysis assessed 306 700 eyes with newly diagnosed DME from the Vestrum Health database between January 2015 and October 2020. The year-over-year and cumulative 5-year distributions of eyes treated with antivascular endothelial growth factor (anti-VEGF) agents, steroids, focal laser, or any combination and those of untreated eyes were calculated. Changes from baseline visual acuity were assessed. Results: Yearly treatment patterns changed significantly from 2015 (n = 18056) to 2020 (n = 11042). The proportion of untreated patients declined over time (32.7% vs 27.7%; P < .001), the use of anti-VEGF monotherapy increased (43.5% vs 61.8%; P < .001), the use of focal laser monotherapy declined (9.7% vs 3.0%; P < .001), and the use of steroid monotherapy remained stable (0.9% vs 0.7%; P = 1.000). Of eyes that maintained follow-up for 5 years (from 2015 to 2020), 16.3% were untreated while 77.5% were treated with anti-VEGF agents (as monotherapy or combination therapy). Vision gains in treated patients remained approximately stable from 2015 (3.6 letters) to 2020 (3.5 letters). Conclusions: From 2015 to 2020, treatment patterns for DME evolved toward greater anti-VEGF monotherapy, stable steroid monotherapy, less laser monotherapy, and fewer untreated eyes.
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Affiliation(s)
| | - Zeeshan Haq
- Retina Consultants of Minnesota, Edina, MN, USA
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4
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Mulligan K, Kim J, Tysinger B, Blim J, Emerson G, Ferrone PJ, Kim JE, Seabury S, Hahn P. The Broader Economic Value of Treatment for Diabetic Macular Edema. Diabetes Care 2023:148674. [PMID: 37186032 DOI: 10.2337/dc22-2527] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To simulate economic outcomes for individuals with diabetic macular edema (DME) and estimate the economic value of direct and indirect benefits associated with DME treatment. RESEARCH DESIGN AND METHODS Our study pairs individual and cohort analyses to demonstrate the value of treatment for DME. We used a microsimulation model to simulate self-reported vision (SRV) and economic outcomes for individuals with DME. Four scenarios derived from clinical trial data were simulated and compared for a lifetime horizon: untreated, anti-VEGF therapy, laser, and steroid. To quantify the relative magnitude of costs and benefits of DME treatment in the U.S., we used a cohort-level analysis based on real-world treatment parameters derived from published data. RESULTS In the model, excellent/good SRV roughly corresponded to 20/40 or better visual acuity. A representative 51-year-old treated for DME would spend 30-35% additional years with excellent/good SRV and 29-32% fewer years with fair/poor SRV relative to being untreated. A treated individual would experience 4-5% greater life expectancy and 9-13% more quality-adjusted life-years. Indirect benefits from treatment included 6-9% more years working, 12-19% greater lifetime earnings, and 8-16% fewer years with disability. For the U.S. DME cohort (1.1. million people), total direct benefit was $63.0 billion over 20 years, and total indirect benefit was $4.8 billion. Net value (benefit - cost) of treatment ranged from $28.1 billion to $52.8 billion. CONCLUSIONS Treatment for DME provides economic value to patients and society through improved vision, life expectancy, and quality of life and indirectly through improved employment and disability outcomes.
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Affiliation(s)
- Karen Mulligan
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
| | - Jaehong Kim
- School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Bryan Tysinger
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
| | - Jill Blim
- American Society of Retina Specialists, Chicago, IL
| | | | | | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Seth Seabury
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
- School of Pharmacy, University of Southern California, Los Angeles, CA
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5
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O'Hagan D, Shandilya S, Hahn P, Gardner M, Farzan M, Ardeshir A. OP 6.8 – 00102 In vivo evolution of env in SHIV-AD8-infected rhesus macaques after AAV-eCD4-Ig therapy. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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6
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Fraser DD, Miller MR, Martin CM, Slessarev M, Hahn P, Higgins I, Melo C, Pest MA, Rothery N, Wang X, Zeidler J, Cruz-Aguado JA. Cohort-Specific Serological Recognition of SARS-CoV-2 Variant RBD Antigens. Ann Clin Lab Sci 2022; 52:651-662. [PMID: 36197765] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Estimating the response of different population cohorts to new SARS-CoV-2 variants is important to customize measures of control. Our goal was to evaluate how antibodies from sera of infected and vaccinated people recognize antigens expressed by different SARS-CoV-2 variants. METHODS We compared sera from vaccinated donors and four patient/donor cohorts: Sera from critically ill patients collected 2-7 days and more than 10 days after admission to an intensive care unit, a NIBSC/WHO reference panel of SARS-CoV-2 positive individuals, and ambulatory or hospitalized (but not critically ill) positive donors. Samples were tested with an anti-SARS-CoV-2 ELISA kit coated with SARS-CoV-2 RBD recombinant antigens including mutations present in eleven of the most widespread variants. RESULTS Sera from vaccinated individuals exhibited higher antibody binding (P<0.001) than sera from infected (but not critically ill) individuals when tested against the wild type (WT) and each of 11 variants' receptor binding domain (RBD). Antibodies' binding to the SARS-CoV-2 antigens of at least 6 variants, including Variants of Concern (VOCs), was reduced in comparison to the WT in vaccinated and non-critically ill convalescence individuals. CONCLUSION Understanding differences between population cohorts in the antibody titers against WT vs variant RBD antigens can help design variant-specific immunoassays for surveillance and evaluation of the epidemiology of new variants.
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Affiliation(s)
- Douglas D Fraser
- Lawson Health Research Institute, Department of Pediatrics, Western University, Department of Clinical Neurological Sciences, Western University, Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Michael R Miller
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Claudio M Martin
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Paul Hahn
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | - Ian Higgins
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | | | | | - Nate Rothery
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
| | - Xiaoqin Wang
- Diagnostics Biochem Canada Inc, London, Ontario, Canada
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7
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Leung EH, Leder HA, Patel S, Reddy R, Boucher N, Sharma C, Blim J, Awh C, Hahn P. Opportunity Cost of Retinal Detachment Surgery vs Office-Based Patient Care. Journal of VitreoRetinal Diseases 2022; 6:278-283. [PMID: 37007922 PMCID: PMC9976036 DOI: 10.1177/24741264221098669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work compares physician reimbursements for retinal detachment (RD) surgery with office-based patient care. Methods: A theoretical model was constructed from the physician’s perspective for performing a 90-minute uncomplicated RD surgery with its associated perioperative work in the global period (Current Procedural Terminology code 67108) compared with managing 40 patients per 8-hour clinic day in the equivalent time period. The reimbursement rates were based on the 2019 values set by the US Centers for Medicare and Medicaid Services (CMS). Sensitivity analyses were performed varying the perioperative times, clinical productivity, and postoperative visits. Results: The CMS physician reimbursement rate for 67108 surgery was 17.13 work relative value units (wRVUs); meanwhile, the physician in the reference case could have generated 40.89 wRVUs in the office. CMS reimbursement therefore represented a 58% opportunity cost relative to lost office productivity for the physician. A significant disparity was still present even when modeling 30 patients per day. In sensitivity analyses, clinical productivity exceeded surgical compensation in 99% of modeled scenarios. In threshold analyses, the surgeon in the reference case would have to complete the surgery and all immediate perioperative care within 18 minutes to equal the total CMS valuation. Conclusions: CMS reimbursement for RD surgery resulted in a significant opportunity cost for the physician relative to office-based patient care, which was more pronounced for more efficient clinicians in the office. The sensitivity analyses supported the robustness of the model. Reductions in surgery reimbursements relative to office-based patient care might disincentivize busy clinicians.
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Affiliation(s)
| | | | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rahul Reddy
- Department of Ophthalmology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | - Jill Blim
- American Society of Retina Specialists, Chicago, IL, USA
| | - Carl Awh
- Tennessee Retina, Nashville, TN, USA
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Batzner A, Seggewiss H, Hahn P, Sahiti F, Maack C, Gerull B, Stoerk S, Morbach C. Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): DFG
Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance.
Purpose
In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM.
Methods
We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient <30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments.
Results
In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p < 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups.
Conclusions
Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.
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Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - P Hahn
- University Hospital of Wurzburg, Wurzburg, Germany
| | - F Sahiti
- University Hospital of Wurzburg, Wurzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - B Gerull
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - S Stoerk
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - C Morbach
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
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Hahn P, Blim JF, Packo K, Jumper JM, Murray T, Awh CC. The Impact of COVID-19 on US and International Retina Specialists, Their Practices, and Their Patients. J Vitreoretin Dis 2022; 6:40-46. [PMID: 37007725 PMCID: PMC9976225 DOI: 10.1177/24741264211034112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This work analyzes data from a series of surveys developed by the American Society of Retina Specialists (ASRS) that assesses the impact of COVID-19 on physicians, their practices, and their patients. Methods Five surveys were sent by the ASRS between March and July 2020 to more than 2600 US and international retina specialists. Data and trends from these surveys were analyzed. Results Most responding retina specialists (87%-95% in the United States and internationally) reported having no known COVID-related symptoms despite reported limitations in personal protective equipment. Clinic volumes globally were drastically reduced in March 2020 with only partial recovery through July 2020, which was slower internationally than in the United States. Practices were compelled to reduce staff and physician employment levels. Most respondents estimated some degree of delay in patient treatment with corresponding declines in vision and/or anatomy that were attributed most frequently to patients' fears of the pandemic and least frequently to office unavailability. Conclusions The reported impact of COVID-19 on retina specialists, their practices, and their patients has been substantial. Although retina specialists were quickly resilient in optimizing delivery of patient care in a manner safe for patients and providers, the reduction in clinic volume has been devastating in the United States and internationally, with negative impacts on patient outcomes, reductions in practices' volume and employment, and risk to practices' financial health. Future studies will be required to quantify losses associated with these unprecedented and ongoing circumstances caused by the pandemic.
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Affiliation(s)
| | - Jill F. Blim
- American Society of Retina Specialists, Chicago, IL, USA
| | - Kirk Packo
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
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10
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DeRuyter NP, Patel S, Chen Q, Leder H, Leung E, Reddy R, Blim J, Awh CC, Hahn P. Trends in Medicare Reimbursement for Common Vitreoretinal Procedures: 2011-2020. Ophthalmology 2022; 129:829-831. [DOI: 10.1016/j.ophtha.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022] Open
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Witkin AJ, Hahn P, Murray TG, Arevalo JF, Blinder KJ, Choudhry N, Emerson GG, Goldberg RA, Kim SJ, Pearlman J, Schneider EW, Tabandeh H, Wong RW. Brolucizumab-associated intraocular inflammation in eyes without retinal vasculitis. J Vitreoretin Dis 2021; 5:326-332. [PMID: 34604691 PMCID: PMC8486264 DOI: 10.1177/2474126420975303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To analyze a series of eyes with brolucizumab-associated intraocular inflammation (IOI) without retinal vasculitis reported to the American Society of Retina Specialists (ASRS). Methods The ASRS Research and Safety in Therapeutics (ReST) Committee analyzed clinical characteristics from submitted reports of IOI after brolucizumab. Eyes with retinal vasculitis or that received intraocular antibiotics were excluded. Results Forty-nine eyes of 45 patients were collected. Mean visual acuity (VA) at baseline was 20/49 (range 20/20 - 5/200). Patients presented with IOI a mean of 24 (range 3-63) days after most recent brolucizumab injection; 61% presented for an unscheduled visit while 39% presented at routine follow-up. Mean VA at IOI presentation was 20/67 (range 20/20 - 3/200). Most common symptoms were floaters (78%) and blurry vision (76%). Pain (20%) and redness (16%) were less common; 3 (6%) eyes were asymptomatic. IOI was anterior only in 18%, posterior only in 31%, and both anterior and posterior in 51% of eyes. Treatment included topical steroids alone in 67% eyes, while 10% eyes received no treatment. Mean VA at last follow-up was 20/56 (range 20/20 - 1/200). Three (6%) eyes lost 3 or more lines and 1 (2%) eye lost 6 or more lines. Conclusions Brolucizumab-associated IOI without retinal vasculitis typically presented with a delayed onset of a few weeks. Often, visual acuity decline was relatively mild. Most symptoms resolved and nearly all had a return to baseline VA, but a small percentage of patients had a significant decrease in VA at last follow-up.
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Affiliation(s)
| | | | | | | | | | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Canada
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12
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Affiliation(s)
- Jessica May Franklin
- Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, Virginia
| | - Paul Hahn
- Andrew Rader United States Army Health Clinic, Fort Myer, Virginia
| | - Eric Fillman
- Clinical Pathology Associates, San Antonio, Texas
| | - Wendi Wohltmann
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
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13
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Witkin AJ, Hahn P, Murray TG, Arevalo JF, Blinder KJ, Choudhry N, Emerson GG, Goldberg RA, Kim SJ, Pearlman J, Schneider EW, Tabandeh H, Wong RW. Occlusive Retinal Vasculitis Following Intravitreal Brolucizumab. ACTA ACUST UNITED AC 2020; 4:269-279. [PMID: 32789284 DOI: 10.1177/2474126420930863] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To analyze a case series of retinal vasculitis reported to the American Society of Retina Specialists (ASRS) following Food and Drug Administration approval of brolucizumab for treatment of neovascular age-related macular degeneration. Methods The ASRS Research and Safety in Therapeutics Committee analyzed clinical and imaging characteristics from submitted reports of retinal vasculitis after brolucizumab. Results Retinal vasculitis was reported in 26 eyes of 25 patients (22 [88%] female) after treatment with brolucizumab. Imaging studies were available for 24 of 26 eyes. Most cases (92%) were associated with intraocular inflammation, which presented at a mean of 25 days (range, 3-63 days) after the most recent brolucizumab injection. Mean visual acuity (VA) was 20/52 (range, 20/25-4/200) before the adverse event, 20/151 (range, 20/25-hand motion) at presentation of the adverse event, and 20/243 (range, 20/30-light perception) at last follow-up. Twelve eyes (46%) had a greater than 3-line decrease in VA at final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse. Analysis of retinal imaging identified vasculopathy that involved retinal arteries (91%), retinal veins (79%), and choroidal vessels (48%). Occlusive disease was apparent on imaging in 83% of eyes. Treatment approaches were varied. Conclusions Retinal vasculitis has been identified in a series of eyes following brolucizumab. Although a few eyes in this series were asymptomatic or minimally symptomatic, some eyes had significant vision loss. A careful examination for signs of active inflammation prior to brolucizumab injection is recommended. Once vasculopathy is suspected, angiographic imaging may help define the spectrum of involvement. Optimal treatment strategies remain unknown.
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Affiliation(s)
| | | | | | | | | | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, ON, Canada
| | | | | | - Stephen J Kim
- Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Mikhail M, Jiang S, Hahn P, Orlin A, Rao RC, Choudhry N. OCTA: A Practical Method of Image Averaging Using Adobe Photoshop Software. Ophthalmic Surg Lasers Imaging Retina 2020; 50:802-807. [PMID: 31877227 DOI: 10.3928/23258160-20191119-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE To describe a method for averaging ocular coherence tomography angiography (OCTA) images using a commercially available photo editing software: Adobe Photoshop CC 2017. PATIENTS AND METHODS This single-center study assessed the feasibility of using Adobe Photoshop as an OCTA image averaging tool. Three 3.0 mm × 3.0 mm OCTA images from each eye were obtained using commercially available OCTA devices. Captured OCTA images were exported in high-resolution TIFF format, imported as an image stack, aligned using an automated function, and averaged by creating a Smart Object using Photoshop CC 2017 software. In conjunction with qualitative assessment, the main outcome of the study was image grader preferences with respect to clarity of the foveal avascular zone (FAZ), blood vessel delineation, and the ability to identify abnormal vasculature. RESULTS After removing OCTA scans with significant image distortion, 25 sets of images were included in the analysis. Adobe Photoshop CC 2017 successfully aligned and averaged all images of the superficial and deep retinal plexuses that contained a minimum 40% overlap. Three independent retinal specialists found the averaged images to be slightly or definitely preferable to the original 87%, 89%, and 69% of the time with respect to clarity of the FAZ, clarity of blood vessel delineation, and the ability to identify abnormal vasculature, respectively. CONCLUSIONS Adobe Photoshop CC 2017 is an excellent tool for image averaging, producing high-quality resulting OCTA images. As an easily accessible software, Photoshop has the potential for use in a diversity of pathological conditions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:802-807.].
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Talbot J, Hahn P, Kroehling L, Nguyen H, Li D, Littman DR. Feeding-dependent VIP neuron-ILC3 circuit regulates the intestinal barrier. Nature 2020; 579:575-580. [PMID: 32050257 PMCID: PMC7135938 DOI: 10.1038/s41586-020-2039-9] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
The intestinal mucosa serves both as a conduit for the uptake of food-derived nutrients and microbiome-derived metabolites, and as a barrier that prevents tissue invasion by microorganisms and tempers inflammatory responses to the myriad contents of the lumen. How the intestine coordinates physiological and immune responses to food consumption to optimize nutrient uptake while maintaining barrier functions remains unclear. Here we show in mice how a gut neuronal signal triggered by food intake is integrated with intestinal antimicrobial and metabolic responses that are controlled by type-3 innate lymphoid cells (ILC3)1-3. Food consumption rapidly activates a population of enteric neurons that express vasoactive intestinal peptide (VIP)4. Projections of VIP-producing neurons (VIPergic neurons) in the lamina propria are in close proximity to clusters of ILC3 that selectively express VIP receptor type 2 (VIPR2; also known as VPAC2). Production of interleukin (IL)-22 by ILC3, which is upregulated by the presence of commensal microorganisms such as segmented filamentous bacteria5-7, is inhibited upon engagement of VIPR2. As a consequence, levels of antimicrobial peptide derived from epithelial cells are reduced but the expression of lipid-binding proteins and transporters is increased8. During food consumption, the activation of VIPergic neurons thus enhances the growth of segmented filamentous bacteria associated with the epithelium, and increases lipid absorption. Our results reveal a feeding- and circadian-regulated dynamic neuroimmune circuit in the intestine that promotes a trade-off between innate immune protection mediated by IL-22 and the efficiency of nutrient absorption. Modulation of this pathway may therefore be effective for enhancing resistance to enteropathogens2,3,9 and for the treatment of metabolic diseases.
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Affiliation(s)
- Jhimmy Talbot
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Paul Hahn
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Lina Kroehling
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Henry Nguyen
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Dayi Li
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Dan R Littman
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA.
- Howard Hughes Medical Institute, New York, NY, USA.
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Rizzo S, Barale PO, Ayello-Scheer S, Devenyi RG, Delyfer MN, Korobelnik JF, Rachitskaya A, Yuan A, Jayasundera KT, Zacks DN, Handa JT, Montezuma SR, Koozekanani D, Stanga PE, da Cruz L, Walter P, Augustin AJ, Chizzolini M, Olmos de Koo LC, Ho AC, Kirchhof B, Hahn P, Vajzovic L, Iezzi R, Gaucher D, Arevalo JF, Gregori NZ, Grisanti S, Özmert E, Yoon YH, Kokame GT, Lim JI, Szurman P, de Juan E, Rezende FA, Salzmann J, Richard G, Huang SS, Merlini F, Patel U, Cruz C, Greenberg RJ, Justus S, Cinelli L, Humayun MS. ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS: Incidence, Causes, and Best Practices for Managing and Preventing Conjunctival Erosion. Retina 2020; 40:303-311. [PMID: 31972801 DOI: 10.1097/iae.0000000000002394] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.
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Affiliation(s)
- Stanislao Rizzo
- Azienda Ospedaliera Universitaria Careggi, Department of Medicine and Translational Surgery, University of Florence, Florence, Italy
| | - Pierre-Olivier Barale
- Sorbonne University, UPMC Univ Paris 06, INSERM U968, CNRS UMR 7210, Institute of Vision, Paris, France
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Sarah Ayello-Scheer
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Robert G Devenyi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marie-Noëlle Delyfer
- Inserm, Bordeaux Population Health Research Center, Team LEHA, University of Bordeaux, Bordeaux, France
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-François Korobelnik
- Inserm, Bordeaux Population Health Research Center, Team LEHA, University of Bordeaux, Bordeaux, France
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | | | - Alex Yuan
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - David N Zacks
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - James T Handa
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Dara Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Paulo E Stanga
- Manchester Vision Regeneration (MVR) Lab, Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lyndon da Cruz
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Albert J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Marzio Chizzolini
- Unità Operativa Complessa di Oculistica, Camposampiero-Cittadella (Padova), Padua, Italy
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, UW Medicine Eye Institute, University of Washington, Seattle, Washington
| | - Allen C Ho
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, Pennsylvania
| | - Bernd Kirchhof
- Department of Retina and Vitreous Surgery, Center of Ophthalmology, University of Cologne, Cologne, Germany
| | - Paul Hahn
- New Jersey Retina, Teaneck, New Jersey
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, Minnesota
| | - David Gaucher
- Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
- Laboratory of Bacteriology (EA- 7290), The Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
| | - J Fernando Arevalo
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ninel Z Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Luebeck, UKSH Luebeck, Germany
| | - Emin Özmert
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Peter Szurman
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | | | - Flavio A Rezende
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada
| | - Joël Salzmann
- Department of Ophthalmology, Clinique Générale-Beaulieu, Geneva, Switzerland
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Uday Patel
- Second Sight Medical Products, Inc, Sylmar, California
| | - Cynthia Cruz
- Second Sight Medical Products, Inc, Sylmar, California
| | | | | | - Laura Cinelli
- Azienda Ospedaliera Universitaria Careggi, Department of Medicine and Translational Surgery, University of Florence, Florence, Italy
| | - Mark S Humayun
- USC Institute for Biomedical Therapeutics, USC Roski Eye Institute, University of Southern California, Los Angeles, California; and
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Hinkle JW, Wykoff CC, Lim JI, Hahn P, Kim SJ, Tabandeh H, Flynn HW. “Iodine Allergy” and the Use of Povidone Iodine for Endophthalmitis Prophylaxis. Journal of VitreoRetinal Diseases 2019; 4:65-68. [PMID: 37009565 PMCID: PMC9976080 DOI: 10.1177/2474126419865991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- John W. Hinkle
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles C. Wykoff
- Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Jennifer I. Lim
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Stephen J. Kim
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Rizzo S, Barale PO, Ayello-Scheer S, Devenyi RG, Delyfer MN, Korobelnik JF, Rachitskaya A, Yuan A, Jayasundera KT, Zacks DN, Handa JT, Montezuma SR, Koozekanani D, Stanga P, da Cruz L, Walter P, Augustin AJ, Olmos de Koo LC, Ho AC, Kirchhof B, Hahn P, Vajzovic L, Iezzi R, Gaucher D, Arevalo JF, Gregori NZ, Wiedemann P, Özmert E, Lim JI, Rezende FA, Huang SS, Merlini F, Patel U, Greenberg RJ, Justus S, Bacherini D, Cinelli L, Humayun MS. Hypotony and the Argus II retinal prosthesis: causes, prevention and management. Br J Ophthalmol 2019; 104:518-523. [DOI: 10.1136/bjophthalmol-2019-314135] [Citation(s) in RCA: 5] [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: 03/07/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/15/2023]
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Kasimir-Bauer S, Bittner AK, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, Keup C. Abstract P4-01-10: The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The detection and characterization of circulating tumor cells (CTCs) as one of the analytes in liquid biopsy has been considered as surrogate marker to improve treatment decisions in metastatic breast cancer (MBC). In addition, cell-free tumor DNA (ctDNA) released by tumor cells and harboring tumor-associated variants is further discussed to give additional information for therapeutic options. Thus, CTC and ctDNA analysis from the same blood tube is desired. To test usability of plasma, generated after CTC isolation from whole blood for ctDNA analysis, we analyzed ctDNA from 42 hormone receptor-positive/HER2-negative MBC patients (pts) for the detection of tumor-associated variants (plasma isolated straight from whole blood) and compared the results for similarities and differences of the detected variants in a subgroup of these pts to those, obtained from plasma generated after CTC selection (taken from a separate tube).
Methods: 4 ml plasma of all MBC pts and 4 ml plasma obtained after immunomagnetic isolation of CTCs from 2x5ml blood [AdnaTest EMT-2/Stem Cell Select (n=17pts) followed by multimarker qPCR] were used for the analysis of cell-free DNA (cfDNA) applying the QIAamp MinElute ccfDNA Kit. A total of 30ng - 60ng cfDNA was applied for library construction using the QIAseq Targeted DNA Panel for Illumina with integrated unique molecular identifiers. Sequencing was executed on the NextSeq® 500 platform (Illumina, US). Data were analyzed using the QIAseq Targeted Sequencing Data Analysis Portal, the Biomedical Genomics Workbench and the Ingenuity Variant Analysis. All materials used were manufactured by QIAGEN, Germany.
Results: In the total cohort of 42 pts, most variants of all analyzed genes were detected in the MUC16 gene (31.2%). ERBB2, EGFR and AR (androgen receptor) also showed high numbers of variants (11.6%, 11.0% and 8.9%, respectively) with a majority detected pathogenic variants (47.7%) in AR. 92% of all detected variants showed an allele frequency of <5% and some of the detected MUC16, ERBB2 and AR mutations significantly correlated with overall survival. Comparing the plasma results from a separate blood draw with the results from plasma samples after CTC selection in a subgroup of 17/42 pts, no significant difference was found for cfDNA concentration but variability within the cohort. Whereas the variant comparison of ctDNA isolated from both plasma sources showed great concordance, additional variants (around 15%) were exclusively found in one of the two matched samples. Interestingly, in the variant population exclusively found in ctDNA isolated after CTC isolation, the relative amount of pathogenic variants was increased compared to the variant fraction only found in ctDNA from plasma of a separate blood tube. Results obtained for frequently overexpressed CTC transcripts in this subgroup included genes involved in the PI3K signaling pathway as well as ERBB2 and ERBB3 in about 30% of the pts.
Conclusion: We here present a feasible workflow for CTC and ctDNA evaluation for expression and mutation analysis from the same blood sample. These data emphasize that the use of different liquid biopsy analytes can empower treatment decisions of MBC pts in the future.
Citation Format: Kasimir-Bauer S, Bittner A-K, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, and Keup C. The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-10.
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Affiliation(s)
- S Kasimir-Bauer
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - A-K Bittner
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - O Hoffmann
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - S Hauch
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Sprenger-Haussels
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Storbeck
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - K Benyaa
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Hahn
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Mach
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Tewes
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - R Kimmig
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - C Keup
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
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Gregori NZ, Callaway NF, Hoeppner C, Yuan A, Rachitskaya A, Feuer W, Ameri H, Arevalo JF, Augustin AJ, Birch DG, Dagnelie G, Grisanti S, Davis JL, Hahn P, Handa JT, Ho AC, Huang SS, Humayun MS, Iezzi R, Jayasundera KT, Kokame GT, Lam BL, Lim JI, Mandava N, Montezuma SR, Olmos de Koo L, Szurman P, Vajzovic L, Wiedemann P, Weiland J, Yan J, Zacks DN. Retinal Anatomy and Electrode Array Position in Retinitis Pigmentosa Patients After Argus II Implantation: An International Study. Am J Ophthalmol 2018; 193:87-99. [PMID: 29940167 DOI: 10.1016/j.ajo.2018.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the retinal anatomy and array position in Argus II retinal prosthesis recipients. DESIGN Prospective, noncomparative cohort study. METHODS Setting: International multicenter study. PATIENTS Argus II recipients enrolled in the Post-Market Surveillance Studies. PROCEDURES Spectral-domain optical coherence tomography images collected for the Surveillance Studies (NCT01860092 and NCT01490827) were reviewed. Baseline and postoperative macular thickness, electrode-retina distance (gap), optic disc-array overlap, and preretinal membrane presence were recorded at 1, 3, 6, and 12 months. MAIN OUTCOME MEASURES Axial retinal thickness and axial gap along the array's long axis (a line between the tack and handle); maximal retinal thickness and maximal gap along a B-scan near the tack, midline, and handle. RESULTS Thirty-three patients from 16 surgical sites in the United States and Germany were included. Mean axial retinal thickness increased from month 1 through month 12 at each location, but reached statistical significance only at the array midline (P = .007). The rate of maximal thickness increase was highest near the array midline (slope = 6.02, P = .004), compared to the tack (slope = 3.60, P < .001) or the handle (slope = 1.93, P = .368). The mean axial and maximal gaps decreased over the study period, and the mean maximal gap size decrease was significant at midline (P = .032). Optic disc-array overlap was seen in the minority of patients. Preretinal membranes were common before and after implantation. CONCLUSIONS Progressive macular thickening under the array was common and corresponded to decreased electrode-retina gap over time. By month 12, the array was completely apposed to the macula in approximately half of the eyes.
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Oezdemir S, Komp M, Hahn P, Ruetten S. Decompression for cervical disc herniation using the full-endoscopic anterior technique. Oper Orthop Traumatol 2018; 31:1-10. [PMID: 29392340 DOI: 10.1007/s00064-018-0531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/30/2017] [Accepted: 02/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.
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Affiliation(s)
- S Oezdemir
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany.
| | - M Komp
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
| | - P Hahn
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
| | - S Ruetten
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
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Komp M, Oezdemir S, Hahn P, Ruetten S. Full-endoscopic posterior foraminotomy surgery for cervical disc herniations. Oper Orthop Traumatol 2018; 30:13-24. [DOI: 10.1007/s00064-017-0529-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
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Bittner R, Hahn P, Novak C, Lancaster T, Linden D, Reif A. PB 22 Association between genetic risk for schizophrenia and deactivation of the right temporo-parietal junction during working memory encoding – An imaging genetics study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bittner R, Seitz A, Hahn P, Raspor E, Novak C, Linden D, Goebel R, Reif A. FV 2 Reduced spatial variability in cortical working memory networks after macro-anatomical alignment – Converging evidence from multiple fMRI studies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Importance Use of laser vitreolysis for symptomatic floaters has increased in recent years, but prospective studies are not available and the complication profile is poorly understood. Objective To analyze cases of complications following laser vitreolysis as voluntarily reported to the American Society of Retina Specialists Research and Safety in Therapeutics (ASRS ReST) Committee, an independent task force formed to monitor device-related and drug-related safety events. Design, Setting, and Participants A retrospective assessment was performed of all cases of complications following laser vitreolysis that were voluntarily reported by practitioners throughout the United States to the ASRS ReST Committee from the first report on September 19, 2016, through March 16, 2017, the date of data analysis and manuscript writing. Main Outcomes and Measures Complications reported to the ASRS ReST Committee following laser vitreolysis were analyzed by type to gain an understanding of the spectrum of potential complications. Results A total of 16 complications following laser vitreolysis were reported in 15 patients by 7 US vitreoretinal specialists during the study period. Complications included elevated intraocular pressure leading to glaucoma; cataracts, including posterior capsule defects requiring cataract surgery; retinal tear; retinal detachment; retinal hemorrhages; scotomas; and an increased number of floaters. Conclusions and Relevance This report presents a spectrum of complications reported to the ASRS ReST Committee across 6 months. The rate of complications cannot be determined because the denominator of total cases is unknown. Also, these findings cannot determine whether there is a causal association between these complications and laser vitreolysis. Prospective studies are warranted to better understand the efficacy of this procedure and the frequency of attendant complications. Until then, practitioners should be aware of the profile of potential complications to properly inform patients during the consent process. The ASRS ReST Committee will continue to monitor device-related and drug-related adverse events and encourages active surveillance and reporting by all physicians.
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Unglaub F, Langer MF, Hohendorff B, Müller LP, Unglaub JM, Hahn P, Krimmer H, Spies CK. [Distal radius fracture of the adult : Diagnostics and therapy]. Orthopade 2017; 46:93-110. [PMID: 27815606 DOI: 10.1007/s00132-016-3347-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fractures of the distal radius are very common. The majority of patients are elderly females. High impact trauma are often responsible for fractures in young men. Clinical and radiological diagnostics, including computer-assisted tomography (CAT) scan, are generally sufficient. The indication for conservative treatment is still recommended for specific fracture patterns. Application of palmar locking plates after open reduction proved to be efficacious for the majority of fracture patterns. Furthermore, precise detection and treatment of concomitant lesions are mandatory in order to prevent complications.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - B Hohendorff
- Hand-, Ästhetische, Plastische Chirurgie, Elbe Kliniken, Stade, Deutschland
| | - L P Müller
- Klinik und Polyklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - J M Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - H Krimmer
- Zentrum für Hand- und Fußchirurgie, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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Grewal DS, Carrasco-Zevallos OM, Gunther R, Izatt JA, Toth CA, Hahn P. Intra-operative microscope-integrated swept-source optical coherence tomography guided placement of Argus II retinal prosthesis. Acta Ophthalmol 2017; 95:e431-e432. [PMID: 27321093 DOI: 10.1111/aos.13123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dilraj S. Grewal
- Department of Ophthalmology; Duke University Medical Center; Durham NC USA
| | | | - Randall Gunther
- Department of Biomedical Engineering; Duke University; Durham NC USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering; Duke University; Durham NC USA
| | - Cynthia A. Toth
- Department of Ophthalmology; Duke University Medical Center; Durham NC USA
- Department of Biomedical Engineering; Duke University; Durham NC USA
| | - Paul Hahn
- Department of Ophthalmology; Duke University Medical Center; Durham NC USA
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Rüttermann S, Sobotta A, Hahn P, Kiessling C, Härtl A. Teaching and assessment of communication skills in undergraduate dental education - a survey in German-speaking countries. Eur J Dent Educ 2017; 21:151-158. [PMID: 26960532 DOI: 10.1111/eje.12194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Teaching communication is perceived to be of importance in dental education. Several reports have been published worldwide in the educational literature describing modifications of the dental curriculum by implementing the teaching of communication skills. Surveys which evaluate the current state of training and assessment of communication skills in dental education in different countries exist already in some countries, but little information is available about German-speaking countries. MATERIAL AND METHODS In a cross-sectional study with the aim of a census, all 36 dental schools in Germany (30), Austria (3), and Switzerland (3) were surveyed. RESULTS The present survey revealed that at 26 of the 34 dental schools (76%), communication skills training has been implemented. Training of communication skills mainly takes place between the 6th and the 9th semester. Ten schools were able to implement a partly longitudinal curriculum, while the other sites only offer stand-alone courses. Of the 34 dental schools, six assess communication skills in a summative way. Three of those schools also use formative assessments for their students. Another seven sites only use formative assessment. From the various formats of assessment, OSCE is mentioned most frequently. CONCLUSION The necessity to train and assess communication skills has reached German-speaking dental schools. The present survey allows an overview of the training and assessment of communication skills in undergraduate dental education in German-speaking Europe.
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Affiliation(s)
- S Rüttermann
- Department of Operative Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - A Sobotta
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - P Hahn
- Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Medical School and Hospital, Freiburg, Germany
| | - C Kiessling
- Department of Assessment, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - A Härtl
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
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31
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Unglaub F, Langer MF, Unglaub JM, Sauerbier M, Müller LP, Krimmer H, Hahn P, Spies CK. (Teil‑)Arthrodesen am Handgelenk. Unfallchirurg 2017; 120:513-526. [DOI: 10.1007/s00113-017-0356-8] [Citation(s) in RCA: 7] [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] [Indexed: 12/21/2022]
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Abstract
Joint infections of the hand may lead to irreversible lesions and impairment of hand function due to early cartilage damage. Furthermore, persistent infections which are not treated immediately can cause osteitis and/or spread systemically. Finger joints are prone to infection due to bite wounds or crush and sharp injuries. Whereas the wrist is often affected in patients with immunosuppression or chronic diseases, such as diabetes mellitus. If diagnosis and therapy are delayed, joint damage may be inevitable. Therefore, urgent treatment of the infected joint is imperative to preserve the function of the hand. This article reviews the current diagnostics and treatment of joint infections of the hand.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - J M Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - B Hohendorff
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Kliniken Stade-Buxtehude GmbH, Stade, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Köln, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - S Löw
- Orthopädie und Unfallchirurgie, Caritas-Krankenhaus, Bad Mergentheim, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpiusklinik, Bad Rappenau Medizinische Fakultät Mannheim der Universität Heidelberg
| | - P Hahn
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau
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34
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Spies CK, Schäfer M, Ahrens C, Hahn P, Unglaub F. [Compression of the median nerve by chronic palmar dislocation of the lunate due to carpal collapse]. Unfallchirurg 2017; 120:712-714. [PMID: 28361358 DOI: 10.1007/s00113-017-0345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Carpal tunnel syndrome is among the most frequently diagnosed forms of peripheral nerve compression. Carpal tunnel syndrome due to carpal collapse that had progressed over decades, with a palmarly dislocated lunate, is rare. Hints of past trauma to the wrist going back decades should prompt further radiological examination in case of recurrent median nerve compression. With sufficient preoperative evaluation, the causes can be accurately detected and treated. Therefore, precise and complete history-taking is mandatory. Conclusions on further diagnostics that can be drawn from the latter must be consistently implemented to enable adequate therapy.
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Affiliation(s)
- C K Spies
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland.
| | - M Schäfer
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - C Ahrens
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
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Abstract
Dupuytren's disease is a chronic disease of the elderly. Assuming that life expectancy will increase considerably in the coming decades, Dupuytren's disease will gain more medical and socioeconomic relevance. In addition to well-known familial and genetic causes, other environmental factors (nicotine, diabetes, alcohol, trauma, work) are discussed. Knowledge of all factors and their influence on the onset and severity of the disease is important for diagnosis, therapy, and prevention of the disease.
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Affiliation(s)
- P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74206, Bad Rappenau, Deutschland.
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36
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Abstract
Dupuytren disease is a benign fibroproliferative disease of the palmar aponeurosis, which can cause considerable functional deficiencies for the person concerned. Partial aponeurectomy is the gold standard in primary surgery. Because it is minimally invasive and has short recovery and low complication rates, the importance of needle aponeurotomy under specific indications has been increasing in the last years. Needle aponeurotomy is a cost-effective treatment with low complication rates. The revision rate compared to partial aponeurectomy is higher. Under consideration of specified indications, needle aponeurotomy is an alternative treatment option.
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Affiliation(s)
- J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
- Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - S Löw
- Sektion Handchirurgie Klinik für Orthopädie und Unfallchirurgie, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
| | - C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland.
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Bitter K, Rüttermann S, Lippmann M, Hahn P, Giesler M. Self-assessment of competencies in dental education in Germany - a multicentred survey. Eur J Dent Educ 2016; 20:229-236. [PMID: 26272302 DOI: 10.1111/eje.12165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The aim was to assess the competencies of undergraduate dental students in Germany in the domains team competence, communicative competence, learning competence and scholarship. MATERIALS AND METHODS The survey was conducted at 11 dental schools that are equally distributed all over Germany. Competencies were assessed with the Freiburg Questionnaire to Assess Competencies in Medicine (FCM). A short version of the FCM was used in this study. This short form included the four domains: team competence (three items), communicative competence (eight items), learning competence (five items) and scholarship (four items). Students had to rate each item twice: first with regard to the respondent's current level of competence and second with regard to the level of competence that respondents think is required by their job. All items were rated on a five-point Likert scale (1 'very much' and 5 'not at all'). Responsible lecturers from all selected dental schools received another questionnaire to answer the questions whether the FCM domain corresponding learning objectives were taught at the respective dental school. RESULTS A total of 317 undergraduate students from 11 dental schools in their last clinical year participated. The response rate varied between 48% and 92%. Cronbach's α for the FCM scales addressing the current level of competencies ranged from 0.70 to 0.89 and for the scales measuring the presumed level of competencies demanded by their job ranged from 0.72 to 0.82. The mean values of the scales for the assessment of the presumed level of competencies demanded by the job were significantly lower compared to the mean values of the scales for the current level of competencies (P < 0.001 in all analyses). We found large differences between the two levels - in terms of 'standardised response means' (SRM) - in the domains team competence (SRM 1.34), learning competence (SRM 1.27) and communicative competence (SRM 1.18). Overall, the learning objectives that correspond to the assessed domains of competencies were taught to 19.6% completely, to 55.4% partially and to 25% not at all at the participating dental schools. CONCLUSION The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. These results indicate that the assessed domains are still barely integrated into dental medicine curricula in Germany and that further research in this field is needed.
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Affiliation(s)
- K Bitter
- Department of Operative Dentistry and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - S Rüttermann
- Department of Operative Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt, Frankfurt, Germany
| | - M Lippmann
- Department of Medical Psychology and Medical Sociology, Medical Faculty, TU Dresden, Dresden, Germany
| | - P Hahn
- Department of Operative Dentistry and Periodontology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - M Giesler
- Students Deanery, Medical Faculty, University of Freiburg, Freiburg, Germany
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Abstract
Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.
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Affiliation(s)
| | | | - Paul Hahn
- Duke University Eye Center, Durham, NC, USA
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39
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Hahn P, Kirchberger MC, Unglaub F, Spies CK. [How Congruent is the Rating of the Results of Flexor Tendon Injury Repairs Using the Scores by Buck-Gramcko, Strickland, and the American Society for Surgery of the Hand?]. HANDCHIR MIKROCHIR P 2016; 48:290-5. [PMID: 27580442 DOI: 10.1055/s-0042-111892] [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: 10/21/2022] Open
Abstract
PURPOSE Scores are essential for comparing function after flexor tendon reconstructions. The Buck-Gramcko Score, the Strickland Score and the ASSH (American Society for Surgery of the Hand) Score are the most commonly applied rating systems. The purpose of this study is to evaluate these systems and their interchangeability. METHOD Based on an unrestricted metacarpophalangeal (MCP) joint of 0-0-90° or limited range of motion of the MCP joint of 0-30-90°, the scores of the 3 rating systems were assessed and graphically displayed for each possible finger position regarding proximal (PIP) and distal (DIP) interphalangeal joints. RESULTS Based on an unrestricted MCP joint, the scores of the 3 rating systems differed in 24-33% of the obtained values, depending on the sum of joint flexion and extension deficits of the aforementioned PIP and DIP joints. If the range of motion was restricted to 0-30-90° in the MCP joint, differing values were only observed in 16-19% of the obtained values. In extreme cases, scores for the same clinical presentation may thus be "excellent", "fair" or "poor", depending on which system has been used. CONCLUSION The different rating systems for the evaluation of flexor tendon reconstruction are neither identical nor adjustable. Therefore, consensus or at least a recommendation is needed regarding the system to be used. It may even be necessary to develop a generally accepted rating system to compare studies. In the meantime, the readings of the active and passive range of motion of all joints of the affected finger/thumb ought to be published in studies to compare and validate the results.
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Affiliation(s)
- P Hahn
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
| | | | - F Unglaub
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
| | - C K Spies
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
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40
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Yashkin AP, Hahn P, Sloan FA. Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death. Ophthalmology 2016; 123:2225-31. [PMID: 27523614 DOI: 10.1016/j.ophtha.2016.06.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the effect of availability of anti-vascular endothelial growth factor (VEGF) therapy on mortality and hospitalizations for acute myocardial infarction (AMI) and stroke over a 5-year follow-up period in United States Medicare beneficiaries newly diagnosed with exudative age-related macular degeneration (AMD) in 2006 compared with control groups consisting of beneficiaries (1) newly diagnosed with exudative AMD at a time when anti-VEGF therapy was not possible and (2) newly diagnosed with nonexudative AMD. DESIGN Retrospective cohort study. PARTICIPANTS Beneficiaries newly diagnosed with exudative and nonexudative AMD in 2000 and 2006 selected from a random longitudinal sample of Medicare 5% claims and enrollment files. METHODS Beneficiaries with a first diagnosis of exudative AMD in 2006 were the treatment group; beneficiaries newly diagnosed with exudative AMD in 2000 or nonexudative AMD in 2000 or 2006 were control groups. To deal with potential selection bias, we designed an intent-to-treat study, which controlled for nonadherence to prescribed regimens. The treatment group consisted of patients with clinically appropriate characteristics to receive anti-VEGF injections given that the therapy is available, bypassing the need to monitor whether treatment was actually received. Control groups consisted of patients with clinically appropriate characteristics but first diagnosed at a time when the therapy was unavailable (2000) and similar patients but for whom the therapy was not clinically indicated (2000, 2006). We used a Cox proportional hazard model. MAIN OUTCOME MEASURES All-cause mortality and hospitalization for AMI and stroke during follow-up. RESULTS No statistically significant changes in probabilities of death and hospitalizations for AMI and stroke within a 5-year follow-up period were identified in exudative AMD beneficiaries newly diagnosed in 2006, the beginning of widespread anti-VEGF use, compared with 2000. As an alternative to our main analysis, which excluded beneficiaries from nonexudative AMD group who received anti-VEGF therapies during follow-up, we performed a sensitivity analysis with this group of individuals reincluded (11% of beneficiaries newly diagnosed with nonexudative AMD in 2006). Results were similar. CONCLUSIONS Introduction of anti-VEGF agents in 2006 for treating exudative AMD has not posed a threat of increased risk of AMI, stroke, or all-cause mortality.
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Affiliation(s)
| | | | - Frank A Sloan
- Department of Economics, Duke University, Durham, North Carolina.
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41
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Ghodasra DH, Chen A, Arevalo JF, Birch DG, Branham K, Coley B, Dagnelie G, de Juan E, Devenyi RG, Dorn JD, Fisher A, Geruschat DR, Gregori NZ, Greenberg RJ, Hahn P, Ho AC, Howson A, Huang SS, Iezzi R, Khan N, Lam BL, Lim JI, Locke KG, Markowitz M, Ripley AM, Rankin M, Schimitzek H, Tripp F, Weiland JD, Yan J, Zacks DN, Jayasundera KT. Erratum to: Worldwide Argus II implantation: recommendations to optimize patient outcomes. BMC Ophthalmol 2016; 16:129. [PMID: 27473341 PMCID: PMC4965894 DOI: 10.1186/s12886-016-0259-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Adrienne Chen
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Kari Branham
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Brian Coley
- Second Sight Medical Products, Inc., Sylmar, CA, USA
| | - Gislin Dagnelie
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jessy D Dorn
- Second Sight Medical Products, Inc., Sylmar, CA, USA
| | | | - Duane R Geruschat
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ninel Z Gregori
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | - Paul Hahn
- Duke University Eye Center, Durham, NC, USA
| | - Allen C Ho
- Wills Eye Hospital, Philadelphia, PA, USA
| | - Ashley Howson
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Naheed Khan
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jennifer I Lim
- University of Illinois at Chicago Eye and Ear Infirmary, Chicago, IL, USA
| | - Kirsten G Locke
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Mark Rankin
- Canadian National Institute for the Blind, Toronto, Canada
| | - Hannah Schimitzek
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Fay Tripp
- Duke University Eye Center, Durham, NC, USA
| | - James D Weiland
- Department of Ophthalmology, University of Southern California, Los Anges, CA, USA
| | | | - David N Zacks
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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42
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Affiliation(s)
- F. Unglaub
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - P. Hahn
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - C. Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau
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43
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Abstract
Many congenital malformations of the hand and forearm, e. g. polydactyly, thumb duplication, syndactyly and radial aplasia, are already evident at birth and newborns are promptly referred to specialized departments. In contrast, orthopedic surgeons are often confronted with malformations of the hand and forearm, which gradually become clinically conspicuous during growth. This review article focuses on these specific malformations, which regularly upset the patients in practice and in most cases the parents even more so. In addition to the diagnostics and differential diagnostics, the conservative and surgical treatment options are presented.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - F Cakmak
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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44
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Li H, Wang S, Kong R, Ding W, Lee FH, Parker Z, Kim E, Learn GH, Hahn P, Policicchio B, Brocca-Cofano E, Deleage C, Hao X, Chuang GY, Gorman J, Gardner M, Lewis MG, Hatziioannou T, Santra S, Apetrei C, Pandrea I, Alam SM, Liao HX, Shen X, Tomaras GD, Farzan M, Chertova E, Keele BF, Estes JD, Lifson JD, Doms RW, Montefiori DC, Haynes BF, Sodroski JG, Kwong PD, Hahn BH, Shaw GM. Envelope residue 375 substitutions in simian-human immunodeficiency viruses enhance CD4 binding and replication in rhesus macaques. Proc Natl Acad Sci U S A 2016; 113:E3413-22. [PMID: 27247400 PMCID: PMC4914158 DOI: 10.1073/pnas.1606636113] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Most simian-human immunodeficiency viruses (SHIVs) bearing envelope (Env) glycoproteins from primary HIV-1 strains fail to infect rhesus macaques (RMs). We hypothesized that inefficient Env binding to rhesus CD4 (rhCD4) limits virus entry and replication and could be enhanced by substituting naturally occurring simian immunodeficiency virus Env residues at position 375, which resides at a critical location in the CD4-binding pocket and is under strong positive evolutionary pressure across the broad spectrum of primate lentiviruses. SHIVs containing primary or transmitted/founder HIV-1 subtype A, B, C, or D Envs with genotypic variants at residue 375 were constructed and analyzed in vitro and in vivo. Bulky hydrophobic or basic amino acids substituted for serine-375 enhanced Env affinity for rhCD4, virus entry into cells bearing rhCD4, and virus replication in primary rhCD4 T cells without appreciably affecting antigenicity or antibody-mediated neutralization sensitivity. Twenty-four RMs inoculated with subtype A, B, C, or D SHIVs all became productively infected with different Env375 variants-S, M, Y, H, W, or F-that were differentially selected in different Env backbones. Notably, SHIVs replicated persistently at titers comparable to HIV-1 in humans and elicited autologous neutralizing antibody responses typical of HIV-1. Seven animals succumbed to AIDS. These findings identify Env-rhCD4 binding as a critical determinant for productive SHIV infection in RMs and validate a novel and generalizable strategy for constructing SHIVs with Env glycoproteins of interest, including those that in humans elicit broadly neutralizing antibodies or bind particular Ig germ-line B-cell receptors.
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Affiliation(s)
- Hui Li
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Shuyi Wang
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Rui Kong
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Wenge Ding
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Fang-Hua Lee
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Zahra Parker
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Eunlim Kim
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Gerald H Learn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Paul Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Ben Policicchio
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA 15261
| | | | - Claire Deleage
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Xingpei Hao
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Gwo-Yu Chuang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Jason Gorman
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Matthew Gardner
- Department of Infectious Disease, Scripps Research Institute, Jupiter, FL 33458
| | | | | | - Sampa Santra
- Center of Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02215
| | - Cristian Apetrei
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA 15261
| | - Ivona Pandrea
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA 15261
| | - S Munir Alam
- Department of Medicine, Duke University, Durham, NC 27710
| | - Hua-Xin Liao
- Department of Medicine, Duke University, Durham, NC 27710
| | - Xiaoying Shen
- Department of Medicine, Duke University, Durham, NC 27710
| | | | - Michael Farzan
- Department of Infectious Disease, Scripps Research Institute, Jupiter, FL 33458
| | - Elena Chertova
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Brandon F Keele
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Jacob D Estes
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Jeffrey D Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Robert W Doms
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | | | | | - Joseph G Sodroski
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215
| | - Peter D Kwong
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory, Frederick, MD 21702
| | - Beatrice H Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104;
| | - George M Shaw
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104;
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Oellers P, Stinnett S, Hahn P. Valved versus nonvalved cannula small-gauge pars plana vitrectomy for repair of retinal detachments with Grade C proliferative vitreoretinopathy. Clin Ophthalmol 2016; 10:1001-6. [PMID: 27313445 PMCID: PMC4892836 DOI: 10.2147/opth.s104901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Valved cannulas are a recent addition to small-gauge pars plana vitrectomy (PPV) and provide stable intraocular fluidics. The goal of this study was to compare outcomes and postoperative complication rates of valved vs nonvalved cannula small-gauge PPV for repair of retinal detachments (RDs) complicated by Grade C proliferative vitreoretinopathy (PVR). Methods A retrospective chart review of 364 consecutive eyes with either valved or nonvalved cannula PPV for RD repair was performed. The primary outcomes were single surgery and final anatomic success and change in best-corrected visual acuity for repair of RDs complicated by Grade C PVR. Results We identified 36 eyes in the valved group and 31 eyes in the nonvalved group with Grade C PVR RD. The single surgery success was 83% vs 77% (P=0.555) and the final anatomic success was 94% vs 87% (P=0.404) in the valved vs nonvalved eyes, respectively. The mean final visual acuity gain was −0.36 logarithm of the minimum angle of resolution (logMAR; approximate Early Treatment Diabetes Retinopathy Study [ETDRS] score =17 letters) in valved eyes vs −0.33 logMAR (approximate ETDRS score =16 letters) in nonvalved eyes (P=0.81). Postoperative complication rates including postoperative day 1 hypotony, hypertony, and anterior chamber fibrin formation; postoperative retention of intraocular or subretinal perfluorocarbon liquid; and subsequent epiretinal membrane peel were not statistically different between groups. Conclusion Valved cannula PPV yields equivalent visual acuity and anatomic outcomes without increased postoperative complication rates compared to traditional nonvalved cannula PPV for Grade C PVR-associated RD repair.
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Affiliation(s)
- Patrick Oellers
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Stinnett
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Paul Hahn
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
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Abstract
PURPOSE To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes). METHODS Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent). RESULTS Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma. CONCLUSION Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.
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Affiliation(s)
- Yiqun Chen
- a Department of Economics , Duke University , Durham , NC , USA
| | - Paul Hahn
- b Department of Ophthalmology , Duke University School of Medicine , Durham , NC , USA
| | - Frank A Sloan
- a Department of Economics , Duke University , Durham , NC , USA
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Abstract
INTRODUCTION We aim to describe a mechanism of vision loss following vitrectomy surgery with retrobulbar block (RBB) associated with severe vascular stasis of the optic nerve and macula in order to improve safety of local anesthesia for ophthalmic surgery. CASE PRESENTATION We report three cases of patients who underwent pars plana vitrectomy (PPV) with retrobulbar anesthesia with no retrobulbar hemorrhage or elevated intraocular pressure (IOP). At the beginning, in each case, hypoperfusion of optic nerve and macula was noted. In the case of one patient with significant vasculopathic risk factors, the vascular stasis was severe, while in the other two cases, it was mild-to-moderate. In all cases, the perfusion of posterior pole began to improve almost immediately following the start of PPV. Because the IOP was not elevated and no retrobulbar hemorrhage was present, this suggested a compartment syndrome in the intraconal space. The patient with severe vascular stasis developed finger-counting vision but had normal postoperative angiogram findings and unrevealing cardiovascular workup. In the other two milder cases, the occurrence of ischemia was not visually significant. CONCLUSION Intraoperative ischemia should be considered in all cases of unexplained vision loss after ophthalmic surgery using RBB. Attention to vasculopathic risk factors and intra-operative hemodynamic parameters, in addition to the use of parabulbar block, may avoid this complication and permanent vision loss.
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Affiliation(s)
- Bozho Todorich
- Associated Retinal Consultants and Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA; Duke Eye Center, Duke University Medical Center, Durham, NC, USA
| | - Paul Hahn
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA
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Holbrook JT, Sugar EA, Burke AE, Vitale AT, Thorne JE, Davis JL, Jabs DA, Jaffe GJ, Branchaud B, Hahn P, Koreen L, Lad E(NM, Lin P, Martel JN, (Shah) Serrano N, Skalak C, Vajzovic L, Baer C, Bryant J, Chavala S, Cusick M, Day S, Dayani P, Ehlers J, Kesen M, Lee A, Melamud A, Qureshi JA, Scott AW, See RF, Shuler RK, Wood M, Yeh S, Fernandes A, Gibbs D, Leef D, Martin DF, Srivastava S, Dunn JP, Begum H, Boring J, Brotherson KL, Burkholder B, Butler NJ, Cain D, Cook MA, Emmert D, Graul JR, Herring M, Laing A, Leung TG, Mahon MC, Moradi A, Nwankwo A, Ostheimer TL, Reed T, Arnold E, Barnabie PM, Belair ML, Bolton SG, Brodine JB, Brown DM, Brune LM, Galor A, Gan T, Jacobowitz A, Kapoor M, Kedhar S, Kim S, Leder HA, Livingston AG, Morton Y, Nolan K, Peters GB, Soto P, Stevenson R, Tarver-Carr M, Wang Y, Foster CS, Anesi SD, Linda Bruner, Ceron O, Hinkle DM, Persons N, Wentworth B, Acevedo S, Anzaar F, Cesca T, Contero A, Fitzpatrick K, Goronga F, Johnson J, Lebron KQ, Marvell D, Morgan C, Patel N, Pinto J, Siddique SS, Sprague J, Yilmaz T, Sen HN, Bono M, Cunningham D, Hayes D, Koutsandreas D, Nussenblatt RB, Sherry PR, Short GL, Smith W, Temple A, Bamji A, Coleman H, Davuluri G, Faia L, Gottlieb C, Jirawuthiworavong GV, Lew JC, Mercer R, Obiyor D, Perry CH, Potapova N, Weichel E, Wroblewski KJ, Yeh S, Latkany PA, Coonan C, Honda A, Lorenzo-Latkany M, Masini R, Morell S, Nguyen A, Badamo J, Boyd KM, Enos M, Gallardo J, Jarczynski J, Lee JY, McGrosky M, Nour A, Sanchez M, Steinberg K, Stawell RJ, Breayley L, D'Sylva C, Glatz E, Hodgson L, Lim L, Ling C, McIntosh R, Morrison (Ewing) J, Newton A, Sanmugasundram S, Smallwood R, Zamir E, Hunt N, Jones L, Koukouras I, Williams S, Merrill PT, Carns D, Richine L, Voskuil-Marre DL, Woo K, Gaynes B, Giannoulis C, Hulvey P, Kernbauer E, Khan HS, Levine SJ, Toennessen S, Tonner E, Wang RC, Aguado H, Arceneaux S, Duignan K, Fish GE, Hesse N, Jaramillo D, Mackens M, Arnwine J, Callanan D, Cummings K, Gray K, Howden S, Mutz K, Sanchez B, Lightman S, Ismetova F, Prytherch A, Seguin-Greenstein S, Tomkins O, Bar A, Edwards K, Joshi L, Moraji J, Samy A, Stubbs T, Taylor S, Towler H, Tronnberg R, Holland GN, Almanzor RD, Castellanos J, Hubschman JP, Johiro AK, Kukuyev A, Levinson RD, McCannel CA, Ransome SS, Gonzales CR, Gupta A, Kalyani PS, Kapamajian MA, Kappel PJ, Arcinue C, Chuang J, Barteselli G, Currie G, Mendoza V, Powell D, Clark T, Cochran DE, Freeman WR, Hedaya J, Kemper T, Kozak I, LeMoine JM, Loughran ME, Magana L, Mojana F, Morrison V, Nguyen V, Oster SF, Acharya N, Clay D, Lee S, Lew M, Margolis TP, Stewart J, Wong IG, Brown D, Khouri CM, Goldstein DA, Birnbaum A, Degillio A, Rosa GDL, Ramirez C, Simjanowski E, Skelly M, Castro-Malek AL, Crooke CE, Huntley M, Nash K, Niec M, Pyatetsky D, Ramirez M, Rozenbajgier Z, Tessler HH, Davis JL, Albini TA, Chin M, Castaño D, Elizondo A, Ho M, Kovach JL, Lin RCS, Mandelcorn E, Nguyen JKD, Pacini A, Pineda S, Pinto DA, Rebimbas J, Stepien KE, Teran C, Elner SG, Bernard H, Fournier L, Godsey L, Goings L, Hackel R, Hesselgrave M, Jayasundera KT, Prusak R, Titus P, Bergeron M, Blosser R, Brown R, Chrisman-McClure C, Gothrup JR, Saxe SJ, Sizemore D, Kempen JH, Berger J, Drossner S, DuPont JC, Maguire AM, Petner J, Engelhard S, Hopkins T, McCall D, McRay M, Will D, Xu W, Lo J, Salvo R, Windsor E, Weeney L, Pavan PR, Albritton K, Leto J, Madow B, Mayor L, Pautler SE, Saxon W, Soto J, Goldstein B, Klukoff A, Lambright L, McDonald K, Ortiz M, Scymanky S, Szalay DD, Rao N, Davis T, Douglass J, Linton J, Padilla M, Ramos S, Aguirre A, Chong L, Cisneros L, Corona E, Eliott D, Fawzi A, Garcia J, Khurana R, Lim J, Mead R, Tsai JH, Vitale A, Bernstein PS, Carlstrom B, Gilman J, Hanseen S, Morris P, Ramirez D, Wegner K, Sheppard JD, Anthony B, Casper A, Felix-Kent L, Fernandez J, Johnson T, Scoper SV, Cole RD, Crawford N, Franklin L, Hamelin K, Martin J, Marx R, Schultz G, Webb J, Yeager P, Kim RY, Benz MS, Brown DM, Chen E, Fish RH, Kegley E, Shawver L, Wong TP, De La Garza R, Friday (Hay) S, Mutz K, Rao PK, Adcock E, Apte RS, Baladenski A, Curtis R, Gould S, Hebden A, Kambarian J, Meyer C, Pistorius S, Quinn M, Rathert G, Blinder KJ, Hartz A, Light P, Shah GK, VanGelder R, Jabs DA, Altaweel MM, Kempen JH, Kurinij N, Jabs DA, Almanzor RD, Altaweel MM, Brown D, Dunn JP, Holland GN, Kempen JH, Kim RY, Kurinij N, Prusakowski N, Thorne JE, Bolton SG, Brune LM, Clark T, Gilman J, Hubbard L, Martin DF, Nussenblatt RB, Wittes J, Barlow WE, Hochberg M, Lyon AT, Palestine AG, Simon LS, Altaweel MM, Kurinij N, Rosenbaum JT, Smith H, Kempen JH, Jaffe GJ, Davis J, Dunn JP, Martin DF, Thorne J, Vitale A, Thorne JE, Acharya NR, Kempen JH, Latkany PA, Vitale AT, Nussenblatt RB, VanGelder R, Almanzor RD, Boring JA, Gibbs D, Lee S, Prusakowski N, Thorne JE, Alexander J, Ng WP, Friedman DS, Adler A, Alexander J, Burke A, Katz J, Kempen JH, Prusakowski N, Reed S, Ansari H, Cohen N, Modak S, Ng WP, Sugar EA, Burke AE, Drye LT, Van Natta ML, Frick K, Katz J, Louis TA, Modak S, Shade D, Jabs DA, Pascual K, Slutsky-Sanon JS, Glomp C, Nieves MA, Stevens M, Allen A, Hilal Y, Holbrook JT, Abreu F, Burke A, Casper AS, Drye LT, Ewing C, Friedman DS, Hart A, Lears A, Li S, Meinert J, Morrison V, Nowakowski D, Prusakowski N, Reyes G, Shade DM, Smith J, Steuernagle K, Van Natta M, Venugopal V, Yu T, Adler A, Alexander J, Boring J, Chen P, Cohen N, Collins K, Dodge J, Frick KD, Jackson R, Jimenez C, Katz J, Landers A, Livingston H, Louis TA, Meinert CL, Modak S, Ng WP, Rayapudi S, Shen W, Shiflett C, Smith R, Tieman A, Tonascia JA, Zheng R, Altaweel MM, Allan J, Benz WK, Domalpally A, Johnson KA, Myers DJ, Pak JW, Reed S, Reimers JL, Christianson DJ, Chambers G, Fleischli MA, Freund J, Glander KE, Goulding A, Gama V, Gangaputra S, Hafford D, Harris SE, Hubbard LD, Joyce JM, Kruse CN, Nagle L, Remm A, Padden-Lechten GE, Pohlman A, Shaw RA, Sivesind P, Thayer D, Treichel E, Warren KJ, Watson SM, Webster MK, White JK, Wilhelmson T, Zhang G. Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. Am J Ophthalmol 2016; 164:29-36. [PMID: 26748056 DOI: 10.1016/j.ajo.2015.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. DESIGN Randomized clinical trial with extended follow-up. METHODS Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related. RESULTS A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P < .001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment. CONCLUSION There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.
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McDermott S, McCarthy C, Kilcoyne A, Hahn P, Gervais D, Blake M. Predictive value of image-guided percutaneous adrenal biopsy in patients with a new or suspected diagnosis of lung cancer. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.436] [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] Open
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Spies CK, Hohendorff B, Müller LP, Neiss WF, Hahn P, Unglaub F. [Proximal carpal row carpectomy]. Oper Orthop Traumatol 2016; 28:204-17. [PMID: 26914674 DOI: 10.1007/s00064-016-0440-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/15/2015] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Resection of the proximal carpal row, termed proximal row carpectomy (PRC), is performed in order to treat pathologies of the proximal carpal row or radiocarpal joint between the scaphoid and scaphoid facet. It entails the articulation of the capitate and the lunate facet. INDICATIONS Lunate necrosis, carpal collapse, joint infection with concomitant intercarpal ligament lesions. CONTRAINDICATIONS Severe cartilage lesions of the lunate facet and the capitate, wrist capsule laxity, rheumatoid arthritis, neuromuscular dysbalance of the wrist-covering soft tissue structures. SURGICAL TECHNIQUE Dorsal approach to the wrist, incision of the third and fourth extensor compartments, resection and coagulation of the dorsal interosseous nerve, usage of a ligament-sparing capsule incision, identification of the proximal carpal row and inspection of cartilage of the lunate facet and capitate, mobilization and excision of the lunate, scaphoid and triquetrum, articulation of lunate facet and capitate is controlled clinically and fluoroscopically, wound closure, application of plaster slabs. POSTOPERATIVE MANAGEMENT Immobilization of the wrist on plaster slabs for 2 weeks, removal of sutures after 14 days. RESULTS PRC is a surgical procedure with few complications. Satisfactory range of motion and grip strength could be preserved without limiting function of the upper extremity. Postoperative osteoarthritis of capitate and lunate facet did not correlate with the good clinical outcome.
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Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - B Hohendorff
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Stade, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - W F Neiss
- Institut I für Anatomie, Medizinische Fakultät, Köln, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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