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Reif S, Schubert S, Stiefel J, Husri F, Fischlein T, Pauschinger M, Klucken J. Supporting patients with heart failure with digital therapeutics-A pilot study in Germany. Digit Health 2022; 8:20552076221143899. [PMID: 36583086 PMCID: PMC9793018 DOI: 10.1177/20552076221143899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Continuous monitoring and targeted behavioral interventions have been shown to improve health status and quality of life for heart failure patients. Digital therapeutics offer the possibility to make more frequent monitoring and targeted behavioral interventions available for more people. Methods We conduct a pilot study with 71 patients who were given a smartphone app and wearables for a 3-month period. Clinical indicators as well as patient-reported outcomes were collected at entry and exit examinations. Results The New York Heart Association class remained stable or improved. Most quantitative outcome measures improved (6-minute walk test distance + 21 m, Kansas City Cardiomyopathy Questionnaire summary score + 6.0 points, European Heard Failure Self-care Behavior Scale summary score + 6.6 points, correct answers in the Atlanta Heart Failure Knowledge Test + 2.1), although the changes were mainly not significantly different from zero. There was no change in EQ-5D weight and 9-item Shared Decision-Making Questionnaire summary score. Conclusions This before-after comparison shows that an app-based intervention can work as a digital therapeutic for heart failure patients.
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Affiliation(s)
- S. Reif
- ZEW – Leibniz Centre for European Economic Research, Mannheim,
Germany,S. Reif, ZEW - Leibniz Centre for European
Economic Research, L7 1, 68161 Mannheim, Germany.
| | - S. Schubert
- ZEW – Leibniz Centre for European Economic Research, Mannheim,
Germany,FAU University Erlangen-Nurnberg, Nürnberg, Germany
| | - J. Stiefel
- dmac – Medical Valley Digital Health Application Center, Bamberg,
Germany
| | - F. Husri
- Department of Cardiac Surgery, Klinikum Nürnberg (Cardiovascular
Center), Paracelsus Medical University, Nürnberg, Germany
| | - T. Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg (Cardiovascular
Center), Paracelsus Medical University, Nürnberg, Germany
| | - M. Pauschinger
- Department of Cardiology, Klinikum Nürnberg (Cardiovascular Center),
Paracelsus Medical University, Nürnberg, Germany
| | - J. Klucken
- Digital Medicine Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg,Medicine Group, Department of Precision Health, Luxembourg Institute
of Health (LIH), Strassen, Luxembourg,Digital Medicine Group, Centre Hospitalier de Luxembourg (CHL),
Luxembourg
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Sameluck N, Skrodzki M, Glatzel PS, Reif S. Persistierender Ductus arteriosus (PDA) und Vorhofseptumdefekt (ASD) bei einem Schaflamm. Tierarztl Prax Ausg G Grosstiere Nutztiere 2018. [DOI: 10.1055/s-0038-1622972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungBerichtet wird über ein Rhönschaf, das nach dem plötzlichen Auftreten von respiratorischen Symptomen in der 12. Lebenswoche aufgrund eines auskultatorisch festgestellten Maschinengeräusches vollständig kardiologisch untersucht wurde. Bei der Röntgenuntersuchung imponierte neben einem Lungenödem eine ausgeprägte Kardiomegalie. Im Elektrokardiogramm fielen eine Sinustachykardie, eine verlängerte P-Wellen-Dauer, eine erhöhte P‖-Amplitude sowie erhöhte Amplituden der R‖- und Q‖-Zacken auf. Echokardiographisch wurde eine massive Dilatation der beiden Kammern, der Vorhöfe sowie der A. pulmonalis beobachtet. Das Vorhofseptum wies eine ausgeprägte Vorwölbung in das rechte Atrium mit einem zentral gelegenen Defekt auf. Ein persistierender Ductus arteriosus konnte echokardiographisch nicht sicher nachgewiesen werden. Bei der pathologischen Untersuchung wurden ein Vorhofseptumdefekt mit großer aneurysmatischer Membran sowie ein persistierender Ductus arteriosus gefunden.
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Patnaik A, Appleman LJ, Tolcher AW, Papadopoulos KP, Beeram M, Rasco DW, Weiss GJ, Sachdev JC, Chadha M, Fulk M, Ejadi S, Mountz JM, Lotze MT, Toledo FGS, Chu E, Jeffers M, Peña C, Xia C, Reif S, Genvresse I, Ramanathan RK. First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas. Ann Oncol 2017; 27:1928-40. [PMID: 27672108 PMCID: PMC5035790 DOI: 10.1093/annonc/mdw282] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of copanlisib, a phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors or non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Phase I dose-escalation study including patients with advanced solid tumors or NHL, and a cohort of patients with type 2 diabetes mellitus. Patients received three weekly intravenous infusions of copanlisib per 28-day cycle over the dose range 0.1-1.2 mg/kg. Plasma copanlisib levels were analyzed for pharmacokinetics. Biomarker analysis included PIK3CA, KRAS, BRAF, and PTEN mutational status and PTEN immunohistochemistry. Whole-body [(18)F]-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) was carried out at baseline and following the first dose to assess early pharmacodynamic effects. Plasma glucose and insulin levels were evaluated serially. RESULTS Fifty-seven patients received treatment. The MTD was 0.8 mg/kg copanlisib. The most frequent treatment-related adverse events were nausea and transient hyperglycemia. Copanlisib exposure was dose-proportional with no accumulation; peak exposure positively correlated with transient hyperglycemia post-infusion. Sixteen of 20 patients treated at the MTD had reduced (18)FDG-PET uptake; 7 (33%) had a reduction >25%. One patient achieved a complete response (CR; endometrial carcinoma exhibiting both PIK3CA and PTEN mutations and complete PTEN loss) and two had a partial response (PR; both metastatic breast cancer). Among the nine NHL patients, all six with follicular lymphoma (FL) responded (one CR and five PRs) and one patient with diffuse large B-cell lymphoma had a PR by investigator assessment; two patients with FL who achieved CR (per post hoc independent radiologic review) were on treatment >3 years. CONCLUSION Copanlisib, dosed intermittently on days 1, 8, and 15 of a 28-day cycle, was well tolerated and the MTD was determined to be 0.8 mg/kg. Copanlisib exhibited dose-proportional pharmacokinetics and promising anti-tumor activity, particularly in patients with NHL. CLINICALTRIALSGOV NCT00962611; https://clinicaltrials.gov/ct2/show/NCT00962611.
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Affiliation(s)
- A Patnaik
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | | | - A W Tolcher
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - K P Papadopoulos
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - M Beeram
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - D W Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - G J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale Cancer Treatment Centers of America, Goodyear
| | - J C Sachdev
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Chadha
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Fulk
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - S Ejadi
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | | | - M T Lotze
- University of Pittsburgh, Pittsburgh
| | | | - E Chu
- University of Pittsburgh, Pittsburgh
| | - M Jeffers
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Peña
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Xia
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - S Reif
- Bayer Pharma AG, Berlin, Germany
| | | | - R K Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
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Gar C, Rottenkolber M, Grallert H, Banning F, Freibothe I, Sacco V, Wichmann C, Reif S, Potzel A, Dauber V, Schendell C, Sommer NN, Wolfarth B, Seissler J, Lechner A, Ferrari U. Physical fitness and plasma leptin in women with recent gestational diabetes. PLoS One 2017; 12:e0179128. [PMID: 28609470 PMCID: PMC5469459 DOI: 10.1371/journal.pone.0179128] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/19/2016] [Accepted: 05/24/2017] [Indexed: 12/15/2022] Open
Abstract
Aims/Hypothesis Low physical fitness (PF) is a risk factor for type 2 diabetes mellitus (T2D). Women with a history of gestational diabetes (GDM) are at risk for T2D at a young age, but the role of PF in this population is not clear. PF has also been found to correlate inversely with plasma leptin in previous studies. Here, we examine whether women who had GDM have lower PF than women after a normoglycemic pregnancy and, second, whether PF is associated with plasma leptin, independently of body fat mass. Methods Cross-sectional analysis of 236 participants in the PPSDiab Study (cohort study of women 3–16 months after delivery, 152 after gestational diabetes (pGDM), 84 after normoglycemic pregnancy (control subjects); consecutively recruited 2011–16); medical history, physical examination with bioelectrical impedance analysis (BIA), whole body magnetic resonance imaging (MRI) (n = 154), 5-point oral glucose tolerance test, cardiopulmonary exercise testing, clinical chemistry including fasting plasma leptin; statistical analysis with Mann–Whitney U and t -test, Spearman correlation coefficient, multiple linear regression. Results Women pGDM had lower maximally achieved oxygen uptake (VO2peak/kg: 25.7(21.3–29.9) vs. 30.0(26.6–34.1)ml/min/kg; total VO2peak: 1733(1552–2005) vs. 1970(1767–2238)ml/min; p<0.0001 for both), and maximum workload (122.5(105.5–136.5) vs. 141.0(128.5–159.5)W; p<0.0001). Fasting plasma leptin correlated inversely with PF (VO2peak/kg ρ = -0.72 p<0.0001; VO2peak ρ = -0.16 p = 0.015; max. load ρ = -0.35 p<0.0001). These associations remained significant with adjustment for body mass index, or for body fat mass (BIA and MRI). Conclusions/Interpretation Women with a recent history of GDM were less fit than control subjects. Low PF may therefore contribute to the risk for T2D after GDM. This should be tested in intervention studies. Low PF also associated with increased leptin levels–independently of body fat. PF may therefore influence leptin levels and signaling. This hypothesis requires further investigation.
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Affiliation(s)
- C. Gar
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - M. Rottenkolber
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - H. Grallert
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
| | - F. Banning
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - I. Freibothe
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - V. Sacco
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - C. Wichmann
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - S. Reif
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - A. Potzel
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - V. Dauber
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - C. Schendell
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - N. N. Sommer
- Institut für klinische Radiologie, Klinikum der Universitaet Muenchen, Munich, Germany
| | - B. Wolfarth
- Humboldt Universitaet/Charité, Universitaetsmedizin Berlin, Abteilung Sportmedizin, Berlin, Germany
| | - J. Seissler
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
| | - A. Lechner
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
- * E-mail:
| | - U. Ferrari
- Diabetes Research Group, Medizinische Klinik IV, Klinikum der Universitaet Muenchen, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Hawlitschek C, Rottenkolber M, Grallert H, Banning F, Freibothe I, Sacco V, Wichmann C, Reif S, Potzel A, Dauber V, Schendell C, Wolfarth B, Seißler J, Lechner A, Ferrari U. Plasmaleptin und körperliche Fitness bei jungen Frauen mit und ohne erhöhtem Risiko für T2D. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580931] [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: 10/21/2022]
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Reif S, Rottenkolber M, Ferrari U, Banning F, Freibothe I, Sacco V, Wichmann C, Hawlitschek C, Potzel A, Hetterich H, Sommer N, Grallert H, Lehmann R, Seißler J, Lechner A. Hohe Fetuin-A-Werte korrelieren mit geringer körperlicher Fitness und niedrigerer Insulinempfindlichkeit bei Frauen nach Gestationsdiabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580924] [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: 10/21/2022]
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro Urda V, Fernandez Villanueva JM, Corona Figueroa A, Hernandez Reina L, Fernandez Lozano I, Bartoletti A, Bocconcelli P, Giuli S, Kappenberger L, Massa R, Svetlich C, Tarsi G, Tronconi F, Vitale E, Pietrucha AZ, Bzukala I, Wnuk M, Stryjewski P, Konduracka E, Haissaguerre M, Wegrzynowska M, Kruszelnicka O, Nessler J, Lousinha A, Labandeiro J, Antunes E, Silva S, Alves S, Timoteo A, Oliveira M, Sehra R, Cruz Ferreira R, Pietrucha AZ, Wnuk M, Jedrzejczyk-Spaho J, Bzukala I, Kruszelnicka O, Wegrzynowska M, Piwowarska W, Nessler J, Krummen D, Briggs C, Rappel WJ, Narayan S, Sediva L, Neuzil P, Petru J, Skoda J, Janotka M, Chovanec M, Yamashiro K, Takami K, Sakamoto Y, Satoh K, Suzuki T, Nakagawa H, Romanov A, Pokushalov E, Artemenko S, Shabanov V, Stenin I, Elesin D, Turov A, Yakubov A, Hioki M, Matsuo S, Ito K, Narui R, Yamashita S, Sugimoto K, Yoshimura M, Yamane T, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Yakubov A, Miyazaki S, Shah AJ, Hocini M, Jais P, Haissaguerre M, Di Biase L, Gallinghouse JD, Rajappan K, Kautzner J, Dello Russo A, Tondo C, Lorgat F, Natale A, Balta O, Buenz K, Paessler M, Anders H, Horlitz M, Deneke T, Lickfett L, Liberman I, Linhart M, Andrie R, Mittmann-Braun E, Stockigt F, Nickenig G, Schrickel J, Tilz R, Rillig A, Feige B, Metzner A, Fuernkranz A, Burchard A, Wissner E, Ouyang F, Betts TR, Jones MA, Wong KCK, Qureshi N, Bashir Y, Rajappan K, Romanov A, Pokushalov E, Corbucci G, Artemenko S, Shabanov V, Turov A, Losik D, Selina V, Crandall MA, Daniels C, Daoud E, Kalbfleisch S, Yamaji H, Murakami T, Kawamura H, Murakami M, Hina K, Kusachi S, Dakos G, Vassilikos V, Paraskevaidis S, Mantziari A, Theophylogiannakos S, Chouvarda I, Chatzizisis I, Styliadis I, Kimura T, Fukumoto K, Nishiyama N, Aizawa Y, Fukuda Y, Sato T, Miyoshi S, Takatsuki S, Navarrete Casas AJ, Ali I, Conte FC, Moran M, Graham BG, Kalejs O, Lacis R, Stradins P, Koris A, Putnins I, Vikmane M, Lejnieks A, Erglis A, Estrada A, Perez Silva A, Castrejon S, Doiny D, Merino JL, Baranchuk A, Greiss I, Simpson CS, Abdollah H, Redfearn DP, Buys-Topart M, Nitzsche R, Thibault B, Deisenhofer I, Reents T, Ammar S, Fichtner S, Kathan S, Kolb C, Hessling G, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Cano Perez O, Buendia F, Igual B, Osca JM, Sanchez JM, Sancho-Tello MJ, Olague JM, Salvador A, Calvo N, Tolosana JM, Fernandez-Armenta J, Matas M, Barbarin MC, Berruezo A, Brugada J, Mont L, Habibovic M, Van Den Broek KC, Theuns DAMJ, Jordaens L, Alings M, Van Der Voort PH, Pedersen SS, Pupita G, Molini S, Brambatti M, Capucci A, Molodykh S, Idov EM, Belyaev OV, Segreti L, Soldati E, Zucchelli G, Di Cori A, Viani S, Paperini L, De Lucia R, Bongiorni MG, Binner L, Taborsky M, Bello D, Heuer H, Ramza B, Jenniskens I, Johnson WB, Silvetti MS, Rava' L, Russo MS, Di Mambro C, Ammirati A, Gimigliano G, Prosperi M, Drago F, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Jacinto A, Trinca M, Mazzone P, Ciconte G, Marzi A, Paglino G, Vergara P, Sora N, Gulletta S, Della Bella P, Koppitz P, Fach A, Hobbiesiefken S, Fiehn E, Hambrecht R, Sperzel J, Jung M, Schmitt J, Pajitnev D, Burger H, Burger H, Goebel G, Ehrlich W, Walther T, Ziegelhoeffer T, Vancura V, Wichterle D, Melenovsky V, Kautzner J, Glikson M, Goldenberg G, Segev A, Dvir D, Kuzniec J, Finkelstein A, Hay I, Guetta V, Choo WK, Gupta S, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Banha M, Trinca M, Stojanov P, Raspopovic S, Vasic D, Savic D, Nikcevic G, Jovanovic V, Defaye P, Mondesert B, Mbaye A, Cassagneau R, Gagniere V, Jacon J, Sanfins V, Reis HR, Nobre JN, Martins VM, Duarte LD, Morais CM, Conceicao JC, Hero M, Rey JL, Thibault B, Ducharme A, Simpson C, Stuglin C, Blier L, Senaratne M, Khaykin Y, Pinter A, Mlynarska A, Mlynarski R, Sosnowski M, Wilczek J, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Dorobantu M, Radu A, Vatasescu RG, Yusu S, Ikeda T, Mera H, Miwa Y, Abe A, Miyakoshi M, Tsukada T, Yoshino H, Nayar V, Cantelon P, Rawling A, Belham MRD, Pugh PJ, Osca Asensi J, Sanchez JM, Cano O, Tejada D, Munoz B, Rodriguez M, Sancho-Tello MJ, Olague J, Wecke L, Van Hunnik A, Thompson T, Di Carlo L, Zdeblick M, Auricchio A, Prinzen F, Doltra Magarolas A, Bijnens B, Silva E, Penela D, Mont L, Tolosana JM, Brugada J, Sitges M, Ofman P, Navaravong L, Leng J, Peralta A, Hoffmeister P, Levine R, Cook J, Stoenescu M, Tettamanti ME, Revilla Orodea A, Lopez Diaz J, De La Fuente Galan L, Arnold R, Garcia Moran E, San Roman Calvar JA, Gomez Salvador I, Nakamura K, Takami M, Keida T, Mesato A, Higa S, Shimabukuro M, Masuzaki H, Proietti R, Sagone A, Domenichini G, Burri H, Valzania C, Biffi M, Sunthorn H, Gavaruzzi G, Foulkes H, Boriani G, Koh S, Hou W, Rosenberg S, Snell J, Poore J, Dalal N, Bornzin G, Kloppe A, Mijic D, Bogossian H, Ninios I, Zarse M, Lemke B, Guedon-Moreau L, Kouakam C, Klug D, Marquie C, 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Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [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: 11/15/2022] Open
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Deshmukh A, Sharma SS, Gobal FG, Singla SS, Hebbar PH, Paydak HP, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Shavadia J, Otieno H, Yonga G, Jinah A, Qvist JF, Soerensen PH, Dixen U, Ramirez-Marrero MA, Perez-Villardon B, Gaitan-Roman D, Jimenez-Navarro M, Delgado-Prieto JL, De Teresa-Galvan E, De Mora-Martin M, Deshmukh A, Hebbar PB, Wei WX, Gobal FG, Singla SS, Sharma SS, Paydak HP, Bardari S, Zecchin M, Salame' R, Vitali Serdoz L, Di Lenarda A, Guerrini N, Barbati G, Sinagra G, Hanazawa K, Kaitani K, Nakagawa Y, Lenaerts I, Driesen R, Hermida N, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R, Sehra R, Krummen D, Briggs C, Narayan S, Tanaka Y, Hirao K, Nakamura T, Inaba O, Yagishita A, Higuchi K, Hachiya H, Isobe M, Kallergis E, Kanoupakis EM, Mavrakis HE, Goudis CA, Maliaraki NE, Vardas PE, Sehra R, Krummen D, Briggs C, Narayan S, Kiuchi K, Piorkowski C, Kircher S, Gaspar T, Watanabe N, Bollmann A, Hindricks G, Wauters K, 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Kowalik I, Kraska A, Szwed H, Maury P, Hocini M, Sacher F, Duparc A, Mondoly P, Rollin A, Jais P, Haissaguerre M, Pap R, Kohari M, Bencsik G, Makai A, Saghy L, Forster T, Ebrille E, Scaglione M, Raimondo C, Caponi D, Di Donna P, Blandino A, Delcre SDL, Gaita F, Roca Luque I, Dos LDS, Rivas NRG, Pijuan APD, Perez J, Casaldaliga J, Garcia-Dorado DGD, Moya AMM, Sato H, Yagi T, Yambe T, Streitner F, Dietrich C, Mahl E, Schoene N, Veltmann C, Borggrefe M, Kuschyk J, Sadarmin PP, Wong KCK, Rajappan K, Bashir Y, Betts TR, Svetlosak M, Leclercq C, Martins R, Hatala R, Daubert JC, Mabo P, Koide M, Hamano G, Taniguchi T, Yamato M, Sasaki N, Hirooka K, Ikeda Y, Yasumura Y, Dichtl W, Wolber T, Paoli U, Bruellmann S, Berger T, Stuehlinger M, Duru F, Hintringer F, Kanoupakis E, Mavrakis H, Kallergis E, Koutalas E, Saloustros I, Goudis C, Chlouverakis G, Vardas P, Herre JM, Saeed M, Saberi L, Neuman S, An Y, Ando K, Goya M, Nagashima M, Yamaji K, Soga Y, Iwabuchi M, Nobuyoshi M, Baranchuk A, Femenia F, Miranda Hermosilla R, Lopez Diez JC, Serra JL, Valentino M, Retyk E, Galizio N, Kwasniewski W, Filipecki A, Orszulak W, Urbanczyk-Swic D, Trusz - Gluza M, Piot O, Degand B, Da Costa A, Donofrio A, Scanu P, Quesada A, Rousseauplasse A, Padeletti L, Kloppe A, Mijic D, Bogossian H, Zarse M, Lemke B, Tyler J, Comfort G, Kalbfleisch S, Deering TF, Epstein AE, Greenberg SMG, Goldman DS, Rhude J, Majewski JP, Lelakowski J, Tomala I, Santos CM, Miranda RS, Sousa PJ, Cavaco DM, Adragao PP, Knops RE, Wilde AA, Da Costa A, Belhameche M, Hermida JS, Dovellini E, Frohlig G, Siot P, Degand B, Duray GZ, Israel CW, Brachmann J, Seidl KH, Foresti M, Birkenhauer F, Hohnloser SH, Ferreira C, Mateus P, Ribeiro H, Carvalho S, Ferreira A, Moreira J, Kadro W, Rahim H, Turkmani M, Abu Lebdeh M, Altabban A, Raimondo C, Scaglione M, Ebrille E, Caponi D, Di Donna P, Cerrato N, Delcre SDL, Gaita F, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Kvantaliani T, Akhvlediani M, Namdar M, Steffel J, Jetzer S, Bayrak F, Chierchia GB, Jenni R, Duru F, Brugada P, Bakos Z, Medvedev M MM, Jonas Carlsson JC, Fredrik Holmqvist FH, Pyotr Platonov PP, Nurbaev T, Pirnazarov M, Nikishin A, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Simeonidou E, Kastellanos S, Varounis C, Michalakeas C, Koniari C, Nikolopoulou A, Anastasiou-Nana M, Furukawa Y, Yamada T, Morita T, Tanaka K, Iwasaki Y, Kawasaki M, Kuramoto Y, Fukunami M, Blanche C, Tran N, Rigamonti F, Zimmermann M, Okisheva E, Tsaregorodtsev D, Sulimov V, Novikova D, Popkova T, Udachkina E, Korsakova Y, Volkov A, Novikov A, Alexandrova E, Nasonov E, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Kartsagoulis E, Asimakopoulos S, Stefanadis C, Marocolo M, Barbosa Neto O, Carvalho AC, Marques Neto SR, Mota GR, Barbosa PRB, Fernandez-Fernandez A, Manzano Fernandez S, Pastor-Perez FJ, Barquero-Perez O, Goya-Esteban R, Salar M, Rojo-Alvarez JL, Garcia-Alberola A, Takigawa M, Kawamura M, Aiba T, Kamakura S, Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [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: 11/14/2022] Open
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9
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Weiss B, Lebowitz O, Fidder HH, Maza I, Levine A, Shaoul R, Reif S, Bujanover Y, Karban A. Response to medical treatment in patients with Crohn's disease: the role of NOD2/CRAD15, disease phenotype, and age of diagnosis. Dig Dis Sci 2010; 55:1674-80. [PMID: 19693669 DOI: 10.1007/s10620-009-0936-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 11/17/2008] [Accepted: 07/16/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE Factors influencing response to medications in Crohn's disease (CD) patients are not fully understood. We aimed to evaluate the relationships between NOD2/CARD15 mutations, disease phenotype and age of CD diagnosis and response to medical treatment with systemic steroids, azathioprine (AZA) or 6-mercaptopurine (6-MP), and infliximab. METHODS A retrospective medical records analysis was made of patients previously tested for the CD-associated NOD2/CARD15 mutations. Harvey- Bradshaw score was used to assess remission or response to therapy. RESULTS CD-associated NOD2/CARD15 mutations were not related to the rate of steroids dependency or clinical response to AZA/6-MP and infliximab. Steroid dependency was associated with colonic involvement. Thirty-three of 127 (26%) patients with colonic disease were steroid dependent, compared with 7/72 (9.7%) patients with isolated small bowel disease (ISBD), (p = 0.009). ISBD was mildly associated with a better remission/response to AZA/6-MP treatment. Disease behavior and age of diagnosis were not related to response to therapy. CONCLUSIONS Response to treatment with systemic steroids, AZA/6-MP and infliximab are not related to NOD2/CARD15 mutations, age of diagnosis and disease behavior. Patients with colonic disease have higher rates of steroid dependency.
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Affiliation(s)
- B Weiss
- Division of Pediatric Gastroenterology and Nutrition, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
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10
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Schmid P, Kiewe P, Possinger K, Korfel A, Lindemann S, Giurescu M, Reif S, Wiesinger H, Thiel E, Kühnhardt D. Phase I study of the novel, fully synthetic epothilone sagopilone (ZK-EPO) in patients with solid tumors. Ann Oncol 2010; 21:633-639. [DOI: 10.1093/annonc/mdp491] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Oosthuizen JMC, Bornman MS, Barnard HC, Schulenburg GW, Boomker D, Reif S. Melatonin and Steroid-Dependent Carcinomas/Melatonin und Steroid-abhängige Carcinome. Andrologia 2009. [DOI: 10.1111/j.1439-0272.1989.tb02439.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Bornman MS, Oosthuizen JMC, Barnard HC, Schulenburg GW, Boomker D, Reif S. Melatonin and Sperm Motility/Melatonin und Spermatozoenmotilität. Andrologia 2009. [DOI: 10.1111/j.1439-0272.1989.tb02456.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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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13
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Dikobe AM, Van Staden CW, Reif S, Bornman M. Deficient testosterone levels in men above 45 years with major depressive disorder - an age-matched case control study. S Afr J Psychiatr 2007. [DOI: 10.4102/sajpsychiatry.v13i3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<p><strong>Background.</strong> Symptoms of partial androgen deficiency in ageing men (PADAM) overlap considerably with those of major depressive disorder. The relationship between these conditions is complicated by the usual age-related decline in serum testosterone concentrations.</p><p><strong>Objectives.</strong> To test the hypothesis that depressed men above 45 years of age have lower serum testosterone concentrations than age-matched controls.</p><p><strong>Method.</strong> Serum testosterone fractions of 20 men above the age of 45 years suffering from a major depressive disorder were compared with those of 20 healthy men. An age-matched controlled design was used to account for the usual age-related decline in serum testosterone concentrations.</p><p><strong>Results.</strong> Testosterone concentrations of men suffering from a major depressive disorder were statistically significantly lower than those of an age-matched control group without depression. Conclusion. The role of testosterone deficiency in depressed men needs to be examined further in order for appropriate treatment options to be developed.</p>
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14
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Abstract
OBJECTIVE To investigate the prevalence and characteristics of non-alcoholic fatty liver disease (NAFLD) and identify predictors for NAFLD in an overweight paediatric population. METHODS The study group included 58 overweight (BMI-SDS 3.37 +/- 1) patients aged 8-18 years attending the paediatric obesity clinic. They underwent a clinical and biochemical work-up and liver ultrasonography. Grading of liver steatosis severity was done according to discrepancy in ultrasonographic liver-kidney densities. RESULTS The prevalence of NAFLD was 60.3%. There was a highly significant (p = 0.004) association between severity of obesity and the presence or absence of liver steatosis. The study cohort was divided into three groups: group 1 (patients with normal ultrasonographic liver structure and normal liver enzymes), group 2 (patients with ultrasonographic fatty liver and normal liver enzymes) and group 3 (patients with ultrasonographic fatty liver and elevated liver enzymes). The BMI-SDS was significantly higher in group 3 compared to group 1 (4.2 +/- 1.1 vs. 2.8 +/- 0.9, p < 0.001). The rate of obesity complications was more prevalent in group 3 compared to groups 1 and 2 (p < 0.001). The insulin resistance index was higher in group 3 compared to group 1 (0.75 +/- 0.2 vs. 0.47 +/- 0.3, p < 0.05). CONCLUSIONS The prevalence of NAFLD in our study cohort was high (60.3%). Patients with steatosis and elevated liver enzymes had a higher risk for obesity complications. Measurements of liver enzymes alone are insufficient, and liver ultrasonography is required for early identification of NAFLD.
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Affiliation(s)
- R Sagi
- Department of Pediatrics, and Pediatric Gastroenterology Unit, Dana Children's Hopsital, Tel Aviv, Israel
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15
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Mould DR, Baumann A, Kuhlmann J, Keating MJ, Weitman S, Hillmen P, Brettman LR, Reif S, Bonate PL. Population pharmacokinetics-pharmacodynamics of alemtuzumab (Campath) in patients with chronic lymphocytic leukaemia and its link to treatment response. Br J Clin Pharmacol 2007; 64:278-91. [PMID: 17506867 PMCID: PMC2000651 DOI: 10.1111/j.1365-2125.2007.02914.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To characterize alemtuzumab pharmacokinetics and its exposure-response relationship with white blood cell (WBC) count in patients with B-cell chronic lymphocytic leukaemia (CLL). METHODS Nonlinear mixed effects models were used to characterize plasma concentration-time data and WBC count-time data from 67 patients. Logistic regression was used to relate summary measures of drug exposure to tumour response. RESULTS Alemtuzumab pharmacokinetics were best characterized by a two-compartment model with nonlinear elimination where V(max) (microg h(-1)) was [1020 x (WBC count/10 x 10(9) l(-1))(0.194)], K(m) was 338 microg l(-1), V(1) was 11.3 l, Q was 1.05 l h(-1) and V(2) was 41.5 l. Intersubject variability (ISV) in V(max), K(m), V(1) and V(2) was 32%, 145%, 84% and 179%, respectively. The reduction in WBC over time was modelled by a stimulatory loss indirect response model with values of 18.2 for E(max), 306 microg l(-1) for EC(50), 1.56 x 10(9) cells l(-1) h(-1) for K(in) and 0.029 per h for K(out). The probability of achieving a complete or partial response was >/=50% when the maximal trough concentration exceeded 13.2 microg ml(-1) or when AUC(0-tau) exceeded 484 microg h(-1) ml(-1). CONCLUSIONS Alemtuzumab displayed time- and concentration-dependent pharmacokinetics with large interpatient variability, both in pharmacokinetics and pharmacodynamics, which was probably reflective of differences in tumour burden among patients. A direct relationship between maximal trough concentrations and clinical outcomes was observed, with increasing alemtuzumab exposure resulting in a greater probability of positive tumour response.
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MESH Headings
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/pharmacology
- Antineoplastic Agents/pharmacokinetics
- Dose-Response Relationship, Drug
- Female
- Humans
- Immunoglobulin G/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukocyte Count
- Logistic Models
- Male
- Middle Aged
- Models, Biological
- Nonlinear Dynamics
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Affiliation(s)
- D R Mould
- Projections Research, Phoenixville, PA, USA
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16
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Bornman MS, Reif S. Serum testosterone levels in South African men and the onset of androgen decline in ageing males. S AFR J SURG 2007; 45:62, 64. [PMID: 17674565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- M S Bornman
- Department of Urology, University of Pretoria
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17
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Whetten R, Whetten K, Pence BW, Reif S, Conover C, Bouis S. Does distance affect utilization of substance abuse and mental health services in the presence of transportation services? AIDS Care 2007; 18 Suppl 1:S27-34. [PMID: 16938672 DOI: 10.1080/09540120600839397] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 10/24/2022]
Abstract
Long travel times have been identified as a significant barrier to accessing mental health and other critical services. This study examines whether distance to treatment was a barrier to receiving outpatient mental health and substance abuse care for HIV-positive persons when transportation was provided. Data from a cohort of HIV-positive persons who participated in a year-long substance abuse and mental health treatment programme were examined longitudinally. Transportation, which included buses, taxis, and mileage reimbursement for private transportation, was provided free of charge for participants who needed this assistance. Nearly three-quarters (74%) of participants utilized the transportation services. No statistically significant differences in retention in, or utilization of, the mental health and substance abuse treatment programme were identified by distance to the treatment site. This analysis demonstrated that increased distance to care did not decrease utilization of the treatment programme when transportation was provided to the client when necessary. These results provide preliminary evidence that distance to substance abuse and mental health services need not be a barrier to care for HIV-positive individuals when transportation is provided. Such options may need to be considered when trying to treat geographically dispersed individuals so that efficiencies in treatment can be attained.
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Affiliation(s)
- R Whetten
- Duke University, Durham, NC 27708, USA
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18
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Whetten K, Reif S, Ostermann J, Pence BW, Swartz M, Whetten R, Conover C, Bouis S, Thielman N, Eron J. Improving health outcomes among individuals with HIV, mental illness, and substance use disorders in the Southeast. AIDS Care 2007; 18 Suppl 1:S18-26. [PMID: 16938671 DOI: 10.1080/09540120600839330] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 10/24/2022]
Abstract
Providing behavioral treatment for mental health and substance use disorders among HIV-infected individuals is critical because these disorders have been associated with negative outcomes such as poorer medication adherence. This study examines the effectiveness of an integrated treatment model for HIV-infected individuals who have both substance use and mental disorders. Study participants (n = 141) were recruited through routine mental health and substance abuse screening at tertiary Infectious Disease clinics in North Carolina. The study participants received integrated mental health and substance abuse treatment for one year and were interviewed at three-month intervals. Using linear regression analyses, we detected statistically significant decreases in participants' psychiatric symptomatology, illicit substance use, alcohol use, and inpatient hospital days. Participants also reported fewer emergency room visits and were more likely to be receiving antiretroviral medications and adequate psychotropic medication regimens at follow-up. No changes in sexual risk, physical health, or medical adherence were detected after treatment participation. This integrated treatment model offers an option for treating HIV-infected individuals with mental health and substance use disorders that can be adapted for use in a variety of psychiatric and medical treatment settings.
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Affiliation(s)
- K Whetten
- Center for Health Policy, Law, and Management, Department of Public Policy, Duke University, Durham, NC 27708, USA.
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19
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Abstract
Many HIV-positive individuals face multiple barriers to care and therefore frequently experience unmet medical and support services needs. Rural areas often lack the infrastructure to support the delivery of comprehensive HIV services; however, few studies have examined service barriers faced by rural residents with HIV/AIDS, particularly in the South where two-thirds of people living with HIV/AIDS in rural areas reside. We surveyed North Carolina HIV/AIDS case managers (N = 111) employed at state-certified agencies regarding barriers to medical and support services that influence medication adherence for their rural and urban-living clients. For each of the seven barriers assessed (long travel for care, HIV-related stigma, and a lack of transportation; HIV-trained medical practitioners; housing; mental health services and substance abuse treatment), a substantial proportion of case managers (29-67%) reported it was a 'major problem'. For five of the seven barriers, rural case managers were significantly more likely to identify the barrier as a 'major problem'. Multivariate analysis revealed that rural case managers and case managers with more female clients reported a greater number of barriers. Because unmet medical and support service needs may result in poorer outcomes for HIV-positive individuals, barriers to these services must be identified and addressed, particularly in rural areas which may be highly underserved.
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Affiliation(s)
- S Reif
- Duke University Center for Health Policy, Law and Management, Charlotte, NC 28207, USA.
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20
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Abstract
Comparison of the clinical and laboratory characteristics of infants and children with urinary tract infection caused by E. coli (n = 107) or other pathogens (n = 32) yielded a significantly higher association of non-E. coli disease with urinary tract anomalies, younger age, and previous antibiotic treatment. Underlying urinary tract anomalies were noted in 18 patients, of whom 14 (77%) were infected by non-E. coli pathogens. The most frequent anomaly was grade 3-4 vesicoureteral reflux (50%), followed by hydronephrosis (22.7%), ureteropelvic junction obstruction (9%), hypospadias (4.5%), pinpoint meatus (4.5%), and dysplastic kidney (4.5%).
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Affiliation(s)
- S Friedman
- Department of Pediatrics, Dana Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
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21
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Reif S, Whetten K, Lowe K, Ostermann J. Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States. AIDS Care 2006; 18:277-83. [PMID: 16809104 DOI: 10.1080/09540120500161868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 10/24/2022]
Abstract
Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet psychosocial needs and their relationship with health-care outcomes among individuals receiving HIV care in the southeastern US (n=526). We used multivariate logistic regression to examine the association of seven categories of unmet needs with HIV medication use and adherence. Most participants (84.5%) reported at least one service need in the past year. Nearly half (47%) of participants with service needs reported that at least one need was not met. Participants with one or more unmet needs were less likely to be taking any HIV medications (p = 0.007) and reported poorer medication adherence (p=0.013). The specific unmet needs for benefits (including Social Security, health insurance and prescription coverage) (p = 0.006) and a support group (p=0.040) were associated with being less likely to be taking any HIV medications. Unmet need for mental health-related counseling was associated with poorer medication adherence (p=0.003). Study findings regarding the high level of unmet need and the association of unmet need with poorer outcomes illustrate the importance of interventions to address these needs.
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Affiliation(s)
- S Reif
- Duke University Center for Health Policy, Law and Management, Health Inequalities Program, Durham, NC 28207, USA.
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22
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Steiner K, Graf M, Hecht K, Reif S, Rossbacher L, Pfister K, Kolb HJ, Schmetzer HM, Multhoff G. High HSP70-membrane expression on leukemic cells from patients with acute myeloid leukemia is associated with a worse prognosis. Leukemia 2006; 20:2076-9. [PMID: 16990768 DOI: 10.1038/sj.leu.2404391] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Graf M, Reif S, Hecht K, Kroell T, Nuessler V, Schmetzer H. Expression of poliovirus receptor-related proteins PRR1 and PRR2 in acute myeloid leukemia: first report of surface marker analysis, contribution to diagnosis, prognosis and implications for future therapeutical strategies. Eur J Haematol 2005; 75:477-84. [PMID: 16313259 DOI: 10.1111/j.1600-0609.2005.00539.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Poliovirus receptor-related (PRR) proteins belong to the Nectin-adhesion molecules' group, are expressed on endothelial cells and on CD34(+) stem cells and mediate the organization of endothelial and epithelial junctions. There is evidence to suggest, that those receptors could have a role in leukemia. We have studied the expression of PRR molecules PRR1 and PRR2 on mononuclear bone marrow (BM) cells of 55 patients with acute myeloid leukemia (AML) at first diagnosis by FACS-analysis using directly Phycoerythrin-labeled markers (PRR1 clone R1.302.12; PRR2 clone R2.477.1) in combination with other Fluorescein conjugated antibodies to evaluate the blast phenotype in AML. The leukemic gate included blasts and residual monocytes and lymphocytes. A case was defined as positive, if more than 20% of the gated cells expressed the regarding receptor. We could demonstrate, that on average 35% PRR1(+) or 45% PRR2(+) cells in AML were found. Within FAB-types we observed a high PRR1 expression in cases with M3 and M4 and lowest expressions in M0 and M5; a high PRR2 expression was found in cases with M3, M4, M5 and M1 and lowest expressions in M0 and M2. Separating our patients' cohorts in cytogenetic risk groups we could detect a significant higher proportion of PRR1(+) cases (73% vs. 25% of cases, P = 0.009) or PRR1(+) cells (57% vs. 18% of cases, P = 0.001) in the cytogenetic favorable risk vs. poor risk group (75% vs. 32% PRR2(+) cases). Moreover cut-off-values with a maximum probability for a significant differentiation between cases with higher or lower levels of these markers could be found: cases with >78% PRR1(+) and cases with >77% PRR2(+) cells were characterized by a tendency for longer relapse free survival times. Qui-square analyses showed, that 3 of 4 cases with FAB-type M3 (P = 0.03) or a favorable karyotype (P = 0.04) were found in the group with >7% PRR1(+) cells, due to only few cases available a similar correlation, however, could not be found in cases with >78% PRR2(+) cells. We can conclude, that blasts in AML regularly express PRR1 and PRR2. Cases with a high expression of PRR1 or PRR2 are characterized by a more favorable prognosis. With respect to the individual PRR-status the benefit of biological response modifiers as priming agents, differentiation mediators or factors influencing cellular metabolisms inducing factors can be discussed under a new point of view.
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Affiliation(s)
- M Graf
- Medical Department 3, Klinikum Grosshadern, University of Munich, Munich, Germany
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24
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Schmid P, Kiewe P, Kuehnhardt D, Korfel A, Lindemann S, Giurescu M, Reif S, Thiel E, Possinger K. A phase I study of the novel, third generation epothilone ZK-EPO in patients with advanced solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2051] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Schmid
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - P. Kiewe
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - D. Kuehnhardt
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - A. Korfel
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - S. Lindemann
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - M. Giurescu
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - S. Reif
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - E. Thiel
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
| | - K. Possinger
- Charité Campus Mitte, Humboldt Univ Berlin, Berlin, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Schering AG, Berlin, Germany
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Graf M, Reif S, Hecht K, Pelka-Fleischer R, Kroell T, Pfister K, Schmetzer H. High expression of costimulatory molecules correlates with low relapse-free survival probability in acute myeloid leukemia (AML). Ann Hematol 2004; 84:287-97. [PMID: 15592672 DOI: 10.1007/s00277-004-0978-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 10/28/2004] [Indexed: 11/24/2022]
Abstract
Costimulatory molecules such as lymphocyte function-associated antigen (LFA)-1 (CD11a), LFA-3 (CD58), intercellular adhesion molecule (ICAM)-1 (CD54), neuronal cell adhesion molecule (NCAM) (CD56), B7-1 (CD80), or B7-2 (CD86) are important regulatory elements in healthy immunological cascades, but their role in acute myeloid leukemia (AML) has only been rarely investigated. We studied their expression on mononuclear bone marrow (BM) cells from 105 patients with AML at initial diagnosis and evaluated their prognostic significance. Fluorescence-activated cell sorter (FACS) analyses were performed using antibodies directly conjugated with fluorescein. A BM sample was considered positive if more than 20% of the cells in the blast containing gate expressed the respective marker. The surface expression of CD11a (27 of 29 cases positive with an average of 71% positive blasts; 27(+)/29, 71%), CD54 (23(+)/33, 37%), CD56 (24(+)/93, 20%), CD58 (29(+)/29, 95%), CD80 (13(+)/28, 30%), and CD86 (19(+)/29, 39%) was measured. The expression of these markers in different French-American-British (FAB) classification types (M0-M5) was heterogeneous, except for CD56, which showed a higher proportion of positive cells in monocytic subtypes of AML. In addition, cases with a "poor risk" karyotype as well as patients succumbing to "early death" after double induction therapy according to the AML Cooperative Group (CG) protocol were characterized by a high expression of CD56. Relapse-free survival analyses demonstrated that patients with more than 8% CD56(+) cells in the BM relapsed significantly sooner. CD54 was preferentially expressed in AML M4(eo) and in addition in "favorable" cytogenetic risk groups and in cases that had responded to AML-CG therapy. Only very high proportions (>60%) of CD54(+) cells were associated with a lower probability for relapse-free survival. CD80 and CD86 expressions were similar in all FAB types. Patients who had responded to AML-CG therapy showed higher CD80 proportions and lower CD86 proportions compared to the "nonresponder" group. Whereas cases with more than 15% CD80(+) cells had a significantly lower probability for relapse-free survival, only cases with more than 65% CD86(+) were characterized by a significantly lower probability for relapse-free survival. Expression profiles of CD11a and CD58 were not associated with specific FAB types or prognostically relevant groups. We can conclude: (1) Expression of costimulatory molecules in AML is very variable. This reflects the great diversity of immunophenotypes in AML. (2) CD56 is mainly expressed in monocytic subtypes of AML. CD56(+) subtypes of AML seem to be a separate entity with a worse prognosis independent of the karyotype. (3) High expression of some costimulatory molecules correlates with a worse prognosis concerning relapse-free survival times.
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Affiliation(s)
- M Graf
- Med III, Klinikum Grosshadern, University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Lubetzky R, Mandel D, Reif S, Bujanover Y. [Special clinical manifestations of Helicobacter pylori infection in children and adolescents]. Harefuah 2004; 143:554-6, 624. [PMID: 15523803] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
During the period 1989-1996, we retrospectively investigated 104 children and adolescents with Helicobacter pylori infection diagnosed by gastroscopy. The median age was 12.11 +/- 3.31 years, 55% were female and 45% male. The chief complaint of 92% of the children was abdominal pain, mainly epigastric. The typical macroscopic finding was nodular gastritis. The most common microscopic picture was chronic superficial gastritis with lymphatic follicles and the presence of Helicobacter pylori. We demonstrated correlation between these gastroscopic and histological findings. Children who suffered from peptic ulcer were older than those with nodular gastritis. Most of the Helicobacter pylori positive patients were treated with triple drug therapy. The combination of drugs changed throughout the years according to the newly accepted strategies in the treatment of Helicobacter pylori. The majority of children reported a decrease in symptoms on completion of therapy. Urea breath test was an efficient and convenient method for the follow-up of patients with Helicobacter pylori infection.
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Affiliation(s)
- R Lubetzky
- Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv
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27
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Sirisangtragul C, Henke G, Fleischhack G, Reif S, Kloft C, Bode U, Jaehde U. Cerebrospinal fluid pharmacokinetics after different dosage regimens of intraventricular etoposide. Int J Clin Pharmacol Ther 2004; 41:606-7. [PMID: 14692713 DOI: 10.5414/cpp41606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- C Sirisangtragul
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Germany
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Gold Y, Somech R, Mandel D, Peled Y, Reif S. Decreased immune response to hepatitis B eight years after routine vaccination in Israel. Acta Paediatr 2004; 92:1158-62. [PMID: 14632331 DOI: 10.1080/08035250310005756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND AND AIM Although immunization of infants against hepatitis B virus (HBV) is the most effective way to prevent infection, duration of the afforded protection is unknown. Titers of anti-HBV antibodies decline with time, especially during the first few years after vaccination. Anti-HBV antibody levels were measured in the serum of vaccinated children in order to determine the duration of the response afforded by the primary course of HBV vaccine. METHODS The immunity derived from the HBV vaccine was assessed by measuring antibody levels in 122 healthy children who were vaccinated in a routine vaccination program in Israel. RESULTS Ninety-four children (77.1%) had detectable antibodies levels (HBsAb titer > or = 10 mIU/ml): 59 (48.4%) of the children had high antibodies levels (HBsAb titer > 100 mIU/ml). Twenty-eight children (22.9%) had undetectable antibodies levels (HBsAb titer < 10 mIU/ml). When the children were divided into three groups according to the time elapsed since vaccination, it was found that the antibody levels declined with time (p < 0.009). Most of the children with undetectable antibody levels belonged to the 5 to 8-y post-vaccination group (36.1% vs 20% and 14.6% for the 2.5 to 5-y and 1 to 2.5-y groups, respectively, p < 0.01). The mean HBsAb declined in relation to the length of time post-vaccination (226.9 +/- 248.2 mIU/ml for 1-2.5 y post-vaccination, 199.0 +/- 235.7 mIU/ml for 2.5-5 y and 90.4 +/- 138.5 for 5-8 y, p < 0.05). No correlation was found between HBsAb titers and gestational age, birthweight and parental origin, although females generated higher mean antibody levels than males (207.3 +/- 217 mIU/ml vs 141.9 +/- 218.9 mIU/ml, p < 0.05). CONCLUSION Our data demonstrate a steady decline in anti-HBV titers over time after routine vaccination against HBV in Israel. The most significant decline occurred 5-8 y post-vaccination.
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Affiliation(s)
- Y Gold
- Department of Pediatrics,, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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29
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Graf M, Reif S, Hecht K, Pelka-Fleischer R, Pfister K, Nuessler V, Schmetzer H. Low l
-selectin (CD62L) expression in acute myeloid leukemia correlates with a bad cytogenetic risk. Eur J Haematol 2003; 71:366-76. [PMID: 14667200 DOI: 10.1034/j.1600-0609.2003.00140.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Interactions between hemopoietic cells and the stromal microenvironment or immunoreactive cells are mediated by specific cell surface receptors. The expression of those molecules may alter the adhesive qualities (mobility and homing) as well as immune response behavior of leukemic blasts. L-Selectin (CD62L) is suggested to play a role in the redistribution and homing of hemopoietic progenitor cells to the bone marrow (BM). Down-regulation of L-selectin is responsible for mobilization of blasts from the BM into the circulation and ligation of L-selectin stimulates proliferation of progenitor cells. This could have an influence on the process of leukemia. METHOD We have studied the expression of L-selectin on mononuclear BM cells of 36 acute myeloid leukemia (AML) patients at first diagnosis by FACS analysis using a directly fluorescein isothiocyanate conjugated antibody (clone DRE G56). RESULTS On average the patients presented with 88% blasts in the BM. The expression tended to be higher in primary (p) AML compared with secondary (s) AML. L-Selectin was very heterogenously expressed in all FAB groups. Highest expression was found in cases with AML-M4 with four of nine cases presenting with an inv(16) karyotype. Separating our patient cohort in cytogenetic risk groups we could detect a significantly higher expression of L-selectin in cases with a 'good risk' karyotype and a very low expression in cases with a 'bad risk' karyotype (P = 0.037). Comparing patients who achieved remission after double induction therapy (responders) with patients who showed persisting disease (non-responders) we found a higher percentage of L-selectin+ cases or cells in the responder group than in the non-responder group, although the differences were not significant because of only five cases in the 'non-responder' group. Evaluating cut-off points greatest differences in relapse-free survival probabilities were found in patients who presented with > or = 30% L-selectin+ BM cells compared with cases with < 30%: 86% of cases with > or = 30% L-selectin+ cells were still in remission after a mean follow up time of only 8 months compared with only 46% in the group with < 30% L-selectin+ cells. CONCLUSIONS We can conclude that (i) expression of L-selectin on AML blasts is variable. This reveals the great diversitiy of immunophenotypes in AML and might contribute to identify individual blast phenotypes in order to detect minimal residual disease in remission. (ii) Low L-selectin expression correlates with a bad cytogenetic risk, with a lower probability to achieve remission and with a shorter relapse-free survival time. This might reflect a decreased homing of the blasts to the BM as well as an impaired cytotoxic T-cell reaction against leukemic cells. The expression of L-selectin on leukemic blasts might be influenced by different cytokine therapies (e.g. with interferon alpha) and this might result in an altered hematologic reconstitution after cytotoxic therapies as well as in an altered immunologic recognition of blasts.
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Affiliation(s)
- M Graf
- Medical Department III, Klinikum Grosshadern, University of Munich, Munich, Germany
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Wilde S, Jetter A, Zaigier M, Rietbrock S, Menzel H, Sieber M, Tesch H, Hempel G, Busse D, Schwab M, Reif S, Jaehde U, Diehl V, Fuhr U. Population pharmacokinetics of cyclophosphamide, doxorubicin and etoposide in 30 patients with BEACOPP chemotherapy. Int J Clin Pharmacol Ther 2002; 40:586-8. [PMID: 12503825 DOI: 10.5414/cpp40586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- S Wilde
- Institut für Pharmakologie, Universität zu Köln, Klinische Pharmakologie, Germany.
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Reif S, Jetter A, Fuhr U, McLeod H, Kingreen D, Siegert W, Jaehde U. Population pharmacokinetics of etoposide. Int J Clin Pharmacol Ther 2002; 40:578-9. [PMID: 12503821 DOI: 10.5414/cpp40578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- S Reif
- Institute of Pharmacy, Freie Universität Berlin, Germany
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Abstract
Medicaid managed care programs are now operating in more than half of all rural counties in the United States. This study examines how rural health departments that have historically provided clinical services have responded to and been affected by the implementation of Medicaid managed care. To the extent that rural health departments have changed, the effect of this change on the health department and the rural populations that these providers serve is assessed. Site visits were made to four rural public health departments in each of five study states, for a total of 20 case studies. At each site, in-person interviews of county public health department directors were conducted using semistructured interview protocols. In recent years, the majority of health departments decreased or discontinued provision of well-child services, causing many to lose Medicaid revenue. None of the health departments appeared to be in danger of closing, but most lost income security. Medicaid managed care appeared to have increased the number of children with medical homes in the private sector, but adequacy and continuity of care remains an issue. Privatizing Medicaid managed care has not decreased fragmentation, as public health functions such as tracking and screening represent an important facet of comprehensive health services for poor rural populations.
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Affiliation(s)
- R T Slifkin
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599-7590, USA.
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Abstract
Examination of organizational and financial characteristics of the specialty substance abuse treatment system allows an understanding of how to meet the needs of clients in the system. Further, this assessment may afford insights into how the specialty sector may adapt in the changing environment of managed care. Data from Phase I of the Alcohol and Drug Services Study (ADSS) describe the specialty substance abuse treatment system in terms of type of care, setting, level of affiliation, licensure/accreditation, ownership, revenue sources, client referral sources, client's primary substance of abuse, and managed care. Although the system is largely outpatient and remains substantially two tiered in terms of public/private funding mix, it varies along a number of organizational and financial dimensions which have implications for system structure and facility viability in the changing environment of substance abuse treatment service delivery.
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Affiliation(s)
- C M Horgan
- Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, Massachusetts 02454-9110, USA
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34
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Lavy A, Broide E, Reif S, Keter D, Niv Y, Odes S, Eliakim R, Halak A, Ron Y, Patz J, Fich A, Villa Y, Arber N, Gilat T. Measles is more prevalent in Crohn's disease patients. A multicentre Israeli study. Dig Liver Dis 2001; 33:472-6. [PMID: 11572573 DOI: 10.1016/s1590-8658(01)80024-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The question whether there is a transmissible pathogenetic agent as a cause for Crohn's disease, remains unanswered. Measles virus has been the subject of many intensive studies, in the attempt to find a role for it in the pathogenesis of inflammatory bowel disease. Whether an early infection with measles virus may predispose to Crohn's disease in later life is still not clear. We conducted a large scale multicentre study, in order to obtain sufficient data to answer this question. To do so, we compared inflammatory bowel disease patients, with Crohn's disease or ulcerative colitis, with two matched control groups: clinical controls, and community controls. A total of 531 patients, 271 with ulcerative colitis and 260 with Crohn's disease were interviewed, as well as 903 matched controls. Blood from 104 inflammatory bowel disease patients and 50 controls was tested for antibodies to measles virus. We did not find any differences related to measles vaccination, either in Crohn's disease or in ulcerative colitis. Exposure to measles in childhood was more frequent in Crohn's disease patients than in their controls, the difference being statistically significant (p < 0.05) in relation to community controls. The presence of IgG antibodies to measles virus was higher in patients with Crohn's disease than in patients with ulcerative colitis or controls (p = 0.084). Another observation of interest was the finding that Crohn's disease patients who had measles in childhood, more frequently had large bowel disease than those who had not had measles. These data lead us to postulate that there may be a role for measles infection in Crohn's disease, even if, at present, this role remains unclear.
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Affiliation(s)
- A Lavy
- Department of Gastroenterology, Asaf Center, Isreal.
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35
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Reif S, Kingreen D, Kloft C, Grimm J, Siegert W, Schunack W, Jaehde U. Bioequivalence investigation of high-dose etoposide and etoposide phosphate in lymphoma patients. Cancer Chemother Pharmacol 2001; 48:134-40. [PMID: 11561779 DOI: 10.1007/s002800100280] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare etoposide pharmacokinetics following administration of high-dose etoposide and etoposide phosphate, a water-soluble prodrug of etoposide. Bioequivalence was assessed using a two-treatment randomized crossover design. METHODS Ten patients with high-risk or relapsed lymphoma were treated with a sequential high-dose chemotherapy. They were randomized to receive either 3 x 400 mg/m2 etoposide or an equimolar amount of etoposide phosphate (as 1-h infusions on three consecutive days) in the first course and the alternative drug in the second course. Serial plasma and ultrafiltered plasma samples were collected and analysed for etoposide by a reversed-phase HPLC method with UV and electrochemical detection. Pharmacokinetic parameters were estimated using a two-compartment model. Bioequivalence was assessed calculating the 90% confidence intervals (CI) for the ratios of the geometric means of AUC(0-infinity) and additionally of Cmax of etoposide derived from etoposide phosphate relative to etoposide in plasma and ultrafiltered plasma as point estimates (level of significance alpha < 0.05). RESULTS Pharmacokinetic parameters of etoposide were comparable in both treatment arms except that terminal half-life was significantly shorter and apparent Vss in ultrafiltered plasma was significantly larger following administration of the prodrug. The point estimates for AUC(0-infinity) of etoposide derived from etoposide phosphate relative to etoposide were 102.9% and 88.4% for plasma and ultrafiltered plasma, respectively. The 90% CIs were in the range from 80% to 125% where bioequivalence can be assumed. The point estimates of Cmax on day 3 of chemotherapy were 96.5% and 81.7% in plasma and ultrafiltrate with the 90% CI in ultrafiltered plasma being out of the range from 80% to 125%. CONCLUSION With respect to total drug exposure, represented by AUC(0-infinity), high-dose etoposide phosphate is bioequivalent to high-dose etoposide.
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Affiliation(s)
- S Reif
- Institute of Pharmacy, Department of Clinical Pharmacy, Freie Universitaet Berlin, Germany
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36
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Odes HS, Fich A, Reif S, Halak A, Lavy A, Keter D, Eliakim R, Paz J, Broide E, Niv Y, Ron Y, Villa Y, Arber N, Gilat T. Effects of current cigarette smoking on clinical course of Crohn's disease and ulcerative colitis. Dig Dis Sci 2001; 46:1717-21. [PMID: 11508673 DOI: 10.1023/a:1010609722315] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cigarette smoking worsens Crohn's disease (CD) but ameliorates ulcerative colitis (UC). In Israel, where there is no epidemiological association of smoking with CD, we examined the effects of current smoking on the course of CD and UC. Patients at nine public hospitals completed a questionnaire detailing their smoking history, disease course and treatments; subjects altering their smoking habit after the onset of disease were excluded. Sixty-four smokers and 144 nonsmokers had CD, and 34 smokers and 158 nonsmokers had UC. No differences were found between CD smokers and nonsmokers for hospitalizations, operations, and requirement for corticosteroid and immunosuppressive treatment. By contrast, UC smokers had less extensive disease than nonsmokers (P < 0.02) and fewer hospitalizations (P = 0.01) and operations (P = 0.025). Our results agree with a minority of studies showing no adverse effect of smoking on the course of CD, and confirm the protective effect of smoking in UC.
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Affiliation(s)
- H S Odes
- Department of Gastroenterology at Soroka Medical Center, Beer Sheva, Israel
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Kingreen D, Beyer J, Kleiner S, Reif S, Huhn D, Siegert W. ICE--an efficient drug combination for stem cell mobilization and high-dose treatment of malignant lymphoma. Eur J Haematol Suppl 2001; 64:46-50. [PMID: 11486402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Between 1989 and 1999 we studied the ICE regimen in sequential trials in 290 patients with malignant lymphoma and germ-cell tumours. For patients with relapsed or refractory lymphoma we could demonstrate a comparable efficacy of ICE to other high-dose chemotherapy (HDCT) regimens but with a toxicity profile in favour of ICE. From a retrospective comparative analysis of ICE as HDCT regimen in patients with malignant lymphoma and germ-cell tumours we conclude that the characteristic toxicity profile of ICE varies depending on prior drug exposure of individual patients. Further dose intensification of ICE may be achieved with acceptable toxicity by adding further drugs (e.g. anthracyclines) or by treatment with sequential cycles of ICE (Tandem-HDCT). More convenient drug formulations (e.g. etoposide phosphate) might further improve the therapeutic index of ICE.
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Affiliation(s)
- D Kingreen
- Klinik für Innere Medizin m.S. Hämatologie/Onkologie Charité, Campus Virchow Klinikum Augustenburgerplatz 1 D-13353 Berlin, Germany.
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38
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Somech R, Belson A, Assia A, Jurgenson U, Spirer Z, Reif S. First generation cephalosporins as therapy for uncomplicated pyelonephritis in children. A retrospective analysis. J Med 2001; 31:195-203. [PMID: 11280451] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
There is no consensus opinion for the optimal management of pyelonephritis in children. We summarized our experience with first generation cephalosporins by a retrospective analysis of 129 pediatric patients with pyelonephritis who were treated either by first generation cephalosporins (97 patients, group 1) or broad-spectrum antibiotics (32 patients, group 2). Group 1 patients were less likely to have reported previous urinary infections or anatomical urinary tract abnormalities (16.2% vs. 53.1%, p= 0.002) and pathogens other than E. coli (7.3% vs. 25%, p=0.02). Resistance to first generation cephalosporins was identified in 22.6% of pathogens cultured, however, only 7.5% of them had poor clinical responses and required alternative treatment replacement. Our findings show that first generation cephalosporins could be used in our region to treat pyelonephritis in an otherwise healthy child, and that they can provide therapeutic success even in the face of apparent bacterial resistance.
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Affiliation(s)
- R Somech
- Department of Pediatrics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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39
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Fleischhack G, Reif S, Hasan C, Jaehde U, Hettmer S, Bode U. Feasibility of intraventricular administration of etoposide in patients with metastatic brain tumours. Br J Cancer 2001; 84:1453-9. [PMID: 11384092 PMCID: PMC2363656 DOI: 10.1054/bjoc.2001.1841] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As the systemic administration of etoposide is effective in the treatment of relapsed and metastatic brain tumours, a pilot trial was designed to study the feasibility of intraventricular administration of etoposide in such patients. 14 patients aged 2.1 to 33.2 years were treated with intraventricular etoposide simultaneously with either oral or intravenous chemotherapy with trofosfamide or carboplatin and etoposide. In 59 courses (1-12/patient) 0.5 mg etoposide was administered daily via an indwelling subcutaneous reservoir for 5 consecutive days every 2-5 weeks over a period of 0-11 months. During 15 courses in 5 patients serial CSF samples were obtained and etoposide levels were determined by reversed-phase HPLC. Side effects included transient headache and bacterial meningitis, each during 2 courses. Pharmacokinetic data analysis in the CSF (11 courses, 4 patients) revealed a terminal half-life of 7.4+/-1.2 hours and an AUC of 25.0 +/- 9.5 microg h ml(-1)(mean +/- standard deviation). The volume of distribution at steady state and total clearance exhibited a large interindividual variability with mean values of 0.16 l and 0.46 ml min(-1)respectively. Intraventricularly administered etoposide is well tolerated. CSF peak levels exceed more than 100-fold those achieved with intravenous infusions. Further studies should be focused on optimizing the dose and schedule and on determining the effectiveness of intraventricularly administered etoposide.
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Affiliation(s)
- G Fleischhack
- Department of Paediatric Haematology/Oncology, University of Bonn, Adenauerallee 119, Bonn, D-53113, Germany
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40
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Dotan I, Yeshurun D, Hallak A, Horowitz N, Tiomny E, Reif S, Halpern Z, Rachmilewitz D. [Treatment of Crohn's disease with anti TNF alpha antibodies--the experience in the Tel Aviv Medical Center]. Harefuah 2001; 140:289-93, 368. [PMID: 11303390] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
TNF alpha is a pro-inflammatory cytokine in Crohn's disease and it's neutralization is beneficial in patients with active disease. Remicade is a chimeric monoclonal anti-TNF antibody. Remicade is used in our center since December 1998 in 13 patients who were treated for active disease or fistula. We followed the patients and treatment results in order to estimate the efficacy and safety of this preparation. Response to treatment was measured by the Crohn's Disease Activity Index (CDAI) in patients treated due to active disease, or by the presence of discharge from external fistulae. Five out of seven patients with fistulae had less or no discharge after completing a course of 3 infusions. Four out of 6 patients treated due to active disease improved significantly after a single infusion. Five out of the six needed additional injections due to symptom recurrence. Intervals between infusions were 2 weeks--for fistulae patients to 32 weeks for patients with active disease. Adverse events for the 13 patients were usually mild except for 4 patients that suffered from anaphylactic shock, disseminated eruption (2) and eosinophilic pneumonitis. In summary, treatment of patients with active Crohn's disease or fistulae with monoclonal anti-TNF antibodies is an effective and relatively safe option after established treatment has failed. Analyzing the results of on going clinical trials and of the patients treated off-protocol will enable to establish new treatment strategies for patients with active Crohn's disease and fistulae.
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Affiliation(s)
- I Dotan
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center
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41
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Affiliation(s)
- R Somech
- Department of Pediatrics, Dana Children's Hospital, Tel Aviv, Israel
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Reif S, Lavy A, Keter D, Broide E, Niv Y, Halak A, Ron Y, Eliakim R, Odes S, Patz J, Fich A, Villa Y, Arber N, Gilat T. Appendectomy is more frequent but not a risk factor in Crohn's disease while being protective in ulcerative colitis: a comparison of surgical procedures in inflammatory bowel disease. Am J Gastroenterol 2001; 96:829-32. [PMID: 11280559 DOI: 10.1111/j.1572-0241.2001.03529.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Appendectomy was shown to be protective in patients with ulcerative colitis (UC). There are fewer data in Crohn's disease (CD). Other operations were less studied. The aim of this study was to investigate the prevalence of appendectomy, cholecystectomy, and tonsillectomy, including their timing, in patients with inflammatory bowel disease in comparison to controls. METHODS Two hundred seventy-one patients with UC and 260 with CD, 475 clinic controls, and 428 community controls were interviewed. RESULTS Appendectomy was found in 5.5% patients with UC, in 11% of clinic controls (p < 0.05), and 7.7% of community controls (p = not significant). The differences were more significant for appendectomy before onset of disease. Appendectomy was performed in 19.2% of patients with CD, in 10.9% of clinic controls, and in 10.1% of community controls (p < 0.01). However, there were no significant differences when only appendectomy before onset of disease was considered. Cholecystectomy was found in 1.5% of patients with UC, in 6.1% of clinic controls (p < 0.01), and in 4.5% of community controls (p = not significant). The difference remained significant when confined to operations performed before disease onset. No such difference was found in patients with CD. No significant difference was found in the prevalence of tonsillectomy between patients and controls. CONCLUSIONS Appendectomy is protective in UC; it is more frequent, but not a risk factor in CD. The role of cholecystectomy should be investigated further.
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Affiliation(s)
- S Reif
- Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Israel
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Levin Y, Mandelberg A, Gornstein A, Srour F, Reif S. [The effect of gastro-esophageal reflux therapy on respiratory diseases in children]. Harefuah 2001; 140:207-13, 287. [PMID: 11303344] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
UNLABELLED In order to examine the effect of reflux therapy on Hyper Reactive Airway Disease (HRAD) and apnea severity, 107 children, 78 with HRAD and 29 with apnea, underwent pH monitoring in the Pediatric Surgery Unit of Wolfson Hospital and the Dana Children's Hospital during the years 1995-1998. Pathological reflux was defined by means of the Boix-Ochoa and RI (Reflux Index) scores. In patients with positive reflux, anti-reflux treatment was initiated. Prior to and following pH monitoring, the respiratory status of all patients (both with and without reflux) was evaluated by a pediatric pulmonologist employing commonly used scores to determine severity. RESULTS Subject age ranged between one day and 15 years (mean: 15.44 +/- 29 months, median: 6.37 months). In HRAD, following anti-reflex treatment the reflux positive group showed a significant score improvement, from an average of 2.9 +/- 1.1 units to 1.54 +/- 1.2 units (p < 0.0001); a decrease in the number of patients treated with oral corticosteroids (p < 0.01); a close to significant decrease (p = 0.069) in the average dose of inhaled corticosteroids; and a decrease in the number of patients using bronchodilators (p = 0.042). The reflux-negative group, not treated for reflux, displayed no significant improvement, with only a decrease in the severity scores from 2.44 +/- 1.0 to 1.78 +/- 1.2 units (p = 0.14), and no change on any of the other parameters. In apnea, all patients improved, from an average score of 2.34 +/- 0.77 to 0.03 +/- 0.19 units (p < 0.0001), with no significant difference between the reflux positive and the reflux negative groups. In view of these findings, it is postulated that anti-reflux therapy may have an additive effect on HRAD severity, beyond that of spontaneous respiratory improvement. We therefore find it appropriate for every severe HRAD patient (frequent exacerbations or high corticosteroid dose) to undergo pH monitoring in order to treat those with proven reflux. In respect to apnea, we cannot attribute any significance to the existence of reflux or to anti-reflux treatment.
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Affiliation(s)
- Y Levin
- Sackler Faculty of Medicine, Tel-Aviv University
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Lee MT, Reif S, Ritter GA, Levine HJ, Horgan CM. Access to services in the substance abuse treatment system. Variations by facility characteristics. Recent Dev Alcohol 2001; 15:137-56. [PMID: 11449739 DOI: 10.1007/978-0-306-47193-3_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In view of the importance of type and intensity of services during substance abuse treatment, this chapter looks at treatment and support services that substance abuse clients have access to during treatment. Trends in services over recent years are described. Services available to clients in the current treatment system are reviewed. Several facility characteristics affecting access to services are examined. Different ways of defining access to services are discussed. Findings from the Alcohol and Drug Services Study are used to illustrate service patterns in the national substance abuse treatment system. Variations in service patterns by facility characteristics such as type of care, treatment setting, ownership, percent of facility dependence on public revenue, and level of affiliation are analyzed. The implication is that clients who enter into treatment at different types of facilities are likely to have access to certain types of services.
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Affiliation(s)
- M T Lee
- Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, Massachusetts 02454-9110, USA
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Affiliation(s)
- S Reif
- Institut für Biochemie und Molekularbiologie, Universität Freiburg, Hermann-Herder-Strasse 7, Freiburg, D-79104, Germany
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Somech R, Shefer N, Reif S. [Tissue transglutaminase--the main enzyme in pathogenesis and diagnosis of celiac disease (ileus)]. Harefuah 2000; 139:442-4. [PMID: 11341191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Eliakim R, Reif S, Lavy A, Keter D, Odes S, Halak A, Broide E, Niv Y, Ron Y, Paz J, Fich A, Villa Y, Gilat T. Passive smoking in patients with inflammatory bowel disease: an Israeli multicentre case-control study. Eur J Gastroenterol Hepatol 2000; 12:975-9. [PMID: 11007132 DOI: 10.1097/00042737-200012090-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The association between smoking and inflammatory bowel disease (IBD) is well established. There are, however, no large scale studies of passive smoking in inflammatory bowel disease and this has never been surveyed in the Jewish population of Israel. AIM To study the passive smoking exposure of Jewish IBD patients in Israel in a large scale multicentre study. METHODS Patients with established IBD, aged 18-70 years, were interviewed regarding smoking and other habits. Two controls, one clinic and one neighbourhood, matched by age, sex, community group, and education, were sought for each subject. RESULTS Five hundred and thirty-four patients (273 ulcerative colitis (UC) and 261 Crohn's disease (CD)), 478 clinic controls and 430 community controls were interviewed. There were no significant differences in the passive smoking habits between IBD patients and their controls. Fifty-one percent of UC patients, 50% of the clinic controls and 58% of the community controls were exposed to passive smoking at home (NS); similar results were found among CD patients (50%, 55% and 56%, respectively). When a quantitative exposure index was used UC patients were significantly less exposed to passive smoking than were their community controls (7.46 +/- 8.40 vs 9.36 +/- 9.46, n = 229, P< 0.031). There was no difference in the exposure to passive smoking among CD patients and their controls. No differences in exposure to passive smoking were found when UC patients who had never smoked were compared with their controls. When the quantitative index was used 'never-smoked' CD patients tended to be less exposed to passive smoking at home than their community controls (5.40 +/- 7.60 vs 8.04 +/- 8.72, P < 0.05). CONCLUSION There is a lack of association between passive smoking and IBD in Jewish patients in Israel. When a quantitative exposure index was used UC patients were found to be less exposed to passive smoking than their community controls.
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Affiliation(s)
- R Eliakim
- Department of Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
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Stav K, Reif S. [Gastrointestinal bleeding in children--etiology and diagnosis. Survey of patients in a Tel Aviv medical center, in the years 1990 to 1997]. Harefuah 2000; 138:534-8, 615. [PMID: 10883177] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
During 1990-1997 we investigated 201 children with gastrointestinal bleeding. Average age was 3.9 +/- 6 years; 57.2% were males. There were 129 (64.2%) cases of lower and 72 (35.8%) of upper GI bleeding. Complications of upper GI bleeding were more severe than those of the lower: 6 of 8 (75%) patients who deteriorated into hypovolemic shock had upper GI bleeding; 40 of 50 (80%) who required i.v. fluids (crystaloids and/or blood) had also bled from the upper GI tract; but anemia was more frequent (27.7% vs 17%) in lower GI bleeding. The main etiology for upper GI bleeding was peptic ulcer, and for lower GI bleeding anal fissure. Mean hospital stay for upper GI bleeding was 3.87 +/- 2.61 days vs 3.40 +/- 3.51 for lower (not significant). In 34% the etiology of bleeding was undetermined. Although current literature refers to intussusception as a common cause of GI bleeding in infancy, we had no such cases. This difference might have resulted from our diagnoses being made earlier, before mucosal damage could have caused bleeding. We found polyps the second most frequent cause for lower GI bleeding in children. Endoscopy was of more benefit than any other diagnostic method, while barium enema and ultrasound had no diagnostic value. Stool culture did not contribute to diagnosis: only 3 of 36 were positive, so it is only necessary when there is bloody diarrhea.
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Affiliation(s)
- K Stav
- Pediatric Gastrointestinal Unit, Dana Children's Hospital, Souraski Medical Center, Tel Aviv
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Neudorf-Grauss R, Bujanover Y, Dinari G, Broide E, Neveh Y, Zahavi I, Reif S. Chronic hepatitis B virus in children in Israel: clinical and epidemiological characteristics and response to interferon therapy. Isr Med Assoc J 2000; 2:164-8. [PMID: 10804945] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To describe the clinical and epidemiological features of hepatitis B virus infection in Israeli children, and to evaluate their response and compliance to therapy. METHODS We retrospectively studied 51 patients (34 males, 17 females), aged 2-18 years, from several medical centers in Israel. RESULTS Of the 51 patients, 38 with elevated transaminase, positive hepatitis B e antigen and/or HBV DNA, and histologic evidence of liver inflammation were treated. Interferon was administered by subcutaneous injections three times a week for 3-12 months (dosage range 3-6 MU/m2). Only 16% were native Israelis, while 78% of the children were of USSR origin. A family history of HBV infection was recorded in 25 of the 51 patients (9 mothers, 16 fathers or siblings). Five children had a history of blood transfusion. The histological findings were normal in 3 patients, 24 had chronic persistent hepatitis, 14 had chronic active hepatitis and 2 had chronic lobular hepatitis. Five children also had anti-hepatitis D virus antibodies. Twelve of the 38 treated patients (31.5%) responded to IFN completely, with normalization of the transaminase levels and disappearance of HBeAg and HBV DNA. In no patient was there a loss of hepatitis B surface antigen. The main side effects of IFN were fever in 20 children, weakness in 10, headaches in 9, and anorexia in 6; nausea, abdominal pain, and leukopenia were present in 3 cases each. The response rate was not affected by age, country of origin, alanine/aspartate aminotransferase levels, or histological findings. However, a history of blood transfusion was a predictor of good response, 60% vs 27% (P < 0.05). CONCLUSIONS We found IFN to be a safe and adequate mode of treatment in children with chronic HBV infection, regardless of their liver histology and transaminase levels. Therefore, in view of the transient side effects associated with this drug, we recommend considering its use in all children with chronic hepatitis B.
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Affiliation(s)
- R Neudorf-Grauss
- Department of Pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Israel
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Levine A, Bujanover Y, Reif S, Gass S, Vardinon N, Reifen R, Lehmann D. Comparison of assays for anti-endomysial and anti-transglutaminase antibodies for diagnosis of pediatric celiac disease. Isr Med Assoc J 2000; 2:122-5. [PMID: 10804933] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Anti-endomysial antibodies are sensitive and specific markers for celiac disease. This antibody has recently been identified as an antibody to tissue transglutaminase, an enzyme that cross-links and stabilizes extracellular matrix proteins. OBJECTIVES To evaluate the clinical usefulness of an enzyme-linked immunoassay for anti-transglutaminase antibodies, and to compare the results with those of AEA, the current gold standard serological test for celiac disease. METHODS Serum samples were collected from 33 patients with biopsy-proven celiac disease and AEA tests were performed. Control samples for anti-transglutaminase were obtained from 155 patients. An ELISA test for immunoglobulin A anti-transglutaminase utilizing guinea pig liver transglutaminase was developed and performed on all sera. Cutoff values for the test were performed using logistic regression and receiver operating curves analysis. RESULTS An optical density cutoff value of 0.34 was established for the assay. The mean value was 0.18 +/- 0.19 optical density for controls, and 1.65 +/- 1.14 for patients with celiac disease (P < 0.001). Sensitivity and specificity of the assay were both 90%, while AEA had a sensitivity and specificity of 100% and 94%, respectively. CONCLUSIONS A tissue transglutaminase-based ELISA test is both sensitive and specific for detection of celiac disease.
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Affiliation(s)
- A Levine
- Department of Pediatrics, Wolfson Medical Center, Holon, Israel.
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