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Masetti M, Al-Batran SE, Goetze TO, Thuss-Patience P, Knorrenschild JR, Goekkurt E, Folprecht G, Ettrich TJ, Lindig U, Luley KB, Pink D, Dechow T, Sookthai D, Junge S, Loose M, Pauligk C, Lorenzen S. Efficacy of ramucirumab combination chemotherapy as second-line treatment in patients with advanced adenocarcinoma of the stomach or gastroesophageal junction after exposure to checkpoint inhibitors and chemotherapy as first-line therapy. Int J Cancer 2024; 154:2142-2150. [PMID: 38447003 DOI: 10.1002/ijc.34894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
FOLFOX plus nivolumab represents a standard of care for first-line therapy of advanced gastroesophageal cancer (aGEC) with positive PD-L1 expression. The efficacy of second-line VEGFR-2 inhibition with ramucirumab (RAM) plus chemotherapy after progression to immunochemotherapy remains unclear. Medical records of patients with aGEC enrolled in the randomized phase II AIO-STO-0417 trial after treatment failure to first-line FOLFOX plus nivolumab and ipilimumab were retrospectively analyzed. Patients were divided into two groups based on second-line therapy: RAM plus chemotherapy (RAM group) or treatment without RAM (control group). Eighty three patients were included. In the overall population, progression-free survival (PFS) in the RAM group was superior to the control (4.5 vs 2.9 months). Responders (CR/PR) to first-line immunochemotherapy receiving RAM containing second-line therapy had prolonged OS from start of first-line therapy (28.9 vs 16.5 months), as well as second-line OS (9.6 vs 7.5 months), PFS (5.6 vs 2.9 months) and DCR (53% vs 29%) compared to the control. PD-L1 CPS ≥1 was 42% and 44% for the RAM and the control, respectively. Patients with CPS ≥1 in the RAM group showed better tumor control (ORR 25% vs 10%) and improved survival (total OS 11.5 vs 8.0 months; second-line OS 6.5 vs 3.9 months; PFS 4.5 vs 1.6 months) compared to the control. Prior exposure to first-line FOLFOX plus dual checkpoint inhibition followed by RAM plus chemotherapy shows favorable response and survival rates especially in patients with initial response and positive PD-L1 expression and has the potential to advance the treatment paradigm in aGEC.
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Affiliation(s)
- Michael Masetti
- Klinikum rechts der Isar, Technische Universität München, Klinik für Innere Medizin III, Munich, Germany
| | - Salah-Eddin Al-Batran
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany and Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt, Germany
| | - Thorsten O Goetze
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany and Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Eray Goekkurt
- Haematologisch-Onkologische Praxis Eppendorf, Universitäres Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Gunnar Folprecht
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Udo Lindig
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Kim Barbara Luley
- UKSH Campus Lübeck, Klinik für Hämatologie und Onkologie, Lübeck, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald and Klinik für Hämatologie, Onkologie und Palliativmedizin-Sarkomzentrum, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany
| | | | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Sabine Junge
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Maria Loose
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Sylvie Lorenzen
- Klinikum rechts der Isar, Technische Universität München, Klinik für Innere Medizin III, Munich, Germany
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Schwartbeck B, Rumpf C, Hait R, Decker C, Janssen T, Romme K, Dübbers A, Küster P, Graepler-Mainka U, Hebestreit H, Van-Koningsbruggen-Rietschel S, Renner S, Wollschläger B, Naehrig S, Stehling F, Schlegtendahl A, Ballmann M, Junge S, Sutharsan S, Kahl B. 536 Not only 5–base pair deletions in the intergenic region of the intercellular adhesion operon, but also mutations in the repressor of the intercellular adhesion operon lead to a mucoid phenotype in Staphylococcus aureus residing in the airways of people with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01226-7] [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: 11/05/2022]
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Rumpf C, Schwartbeck B, Hait R, Deiwick S, Decker C, Romme K, Dübbers A, Küster P, Graepler-Mainka U, Hebestreit H, van Koningsbruggen-Rietschel S, Renner S, Wollschläger B, Naehrig S, Sterling F, Schlegtendal A, Sutharsan S, Ballmann M, Junge S, Kahl B. ePS3.01 Preliminary results of an ongoing study, which determines the prevalence and possible impact of mucoid Staphylococcus aureus on lung disease of people with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lorenzen S, Thuss-Patience PC, Riera Knorrenschild J, Goekkurt E, Dechow TN, Hofheinz RD, Luley KB, Ettrich TJ, Pink D, Lindig U, Folprecht G, Schuch G, Bitzer M, Bolling C, Homann N, Junge S, Pauligk C, Gaiser T, Goetze TO, Al-Batran SE. FOLFOX versus FOLFOX plus nivolumab and ipilimumab administered in parallel or sequentially versus FLOT plus nivolumab administered in parallel in patients with previously untreated advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction: A randomized phase 2 trial of the AIO. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4043 Background: FOLFOX plus nivolumab (nivo) has become standard of care for first-line therapy of patients (pts) with esophagogastric adenocarcinomas. The aim of Moonlight trial is to generate signals for whether (a) dual checkpoint inhibition or (b) a triplet chemotherapy is beneficial in the context of nivolumab therapy in this setting. Methods: The AIO-STO-0417 trial (Moonlight) is a four-arm investigator-initiated trial. Pts were randomized to FOLFOX alone (Arm B) or FOLFOX plus nivo 240 mg; q2w and ipilimumab (ipi) 1 mg/kg; q6w administered in parallel (Arm A/A1) or sequentially (Arm A2) or pts were treated in a non-randomized fashion with FLOT plus nivo 240 mg; q2w (Arm C). PD-L1 expression was centrally assessed. Primary endpoint is progression-free survival (PFS). Results: The study completed enrollment with 260 pts. Arms A1/A2 and C started later and will be analyzed in Mar 2022 and presented at the meeting. The abstract, therefore, focuses on Arms A (n = 60) vs B (n = 60). Baseline characteristics were: median age 62.5y, GEJ, 55%, intestinal type, 36%. Forty-one percent had PD-L1 CPS≥1 (available in 79% of pts). Pts received a median of 10 and 9 cycles Arms A and B. Adverse events of grade 3/4 were seen in 86% for Arm A and 60% for Arm B, respectively, and serious adverse events (SAE) in 78% in Arm A and 50% in Arm B. Median follow-up was 9.7 mo. No difference in PFS (5.7 and 6.6 mo), OS (10 vs. 12 mo) or objective response rate (45% and 48%) was seen in Arms A and B, respectively. The results were similar in the PD-L1+ group. Conclusions: FOLFOX plus dual checkpoint inhibition administered in parallel is associated with an increase in toxicity but not activity. This portion of the moonlight trial does not generate a signal for further trials on FOLFOX plus nivo and ipi for adenocarcinoma of stomach and GEJ. Clinical trial information: NCT03647969.
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Affiliation(s)
- Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum Rechts der Isar, Technische Universitat München, München, Germany
| | - Peter C. Thuss-Patience
- Charité–Universitätsmedizin Berlin, Med. Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | | | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE) and Universitäres Cancer Center Hamburg (UCCH), Hamburg, Germany
| | | | - Ralf-Dieter Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | - Kim Barbara Luley
- University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | | | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald and Klinik für Hämatologie, Onkologie und Palliativmedizin-Sarkomzentrum, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany
| | - Udo Lindig
- Universitätsklinikum Jena, Klinik für Innere Medizin II (Hämatologie/Onkologie), Jena, Germany
| | - Gunnar Folprecht
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik I, Dresden, Germany
| | - Gunter Schuch
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | - Michael Bitzer
- Universitätsklinikum Tübingen, Medizinische Klinik I, Tuebingen, Germany
| | - Claus Bolling
- Agaplesion Markus Krankenhaus, Hämatologie/Onkologie, Frankfurt, Frankfurt, Germany
| | - Nils Homann
- Klinikum Wolfsburg, Med. Klinik II, Wolfsburg, Germany
| | - Sabine Junge
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt Am Main, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt Am Main, Germany
| | - Timo Gaiser
- University Medical Center Mannheim, Institute of Pathology, Mannheim, Germany
| | - Thorsten Oliver Goetze
- Krankenhaus Nordwest, University Cancer Center Frankfurt and Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt Am Main, Germany
| | - Salah-Eddin Al-Batran
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt Am Main, Germany and Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt Am Main, Germany
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Kasper S, Goetze TO, Stintzing S, Hofheinz RD, Sinn M, Dechow TN, Ettrich TJ, Keitel V, Graeven U, Fischer von Weikersthal L, Kolov A, Edelmann T, Stein A, Trarbach T, Junge S, Pauligk C, Virchow I, Siveke JT, Al-Batran SE, Schuler MH. RAMucirumab in combination with TAS102 versus TAS102 monotherapy in metastatic colorectal cancer: Safety results from the phase IIb part of the RAMTAS phase II/III trial of the German AIO (AIO-KRK-0316). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3566 Background: Patients (pts) with mCRC progressing on standard chemotherapy have limited therapeutic options. Trifluridine/tipiracil (TAS102) significantly improved survival in patients with refractory mCRC. Ramucirumab (ram) is approved in combination with FOLFIRI for second-line treatment. There is a strong rationale to evaluate the efficacy and safety of ram in combination with TAS102 in pts with refractory mCRC. Methods: This is a randomized, open-label, multicenter, starting as phase IIb and extended to a phase III study in pts with advanced mCRC. Eligible pts were randomized to receive either ram (8 mg/kg on d1+15, q4w) and TAS102 (35 mg/m² on d1-5 and d8-12, q4w, arm A) or TAS102 alone (arm B). The primary endpoint is overall survival. A total of 145 pts were enrolled into phase IIb. Here, we present the data from an interim safety analysis comprising the first 80 treated pts. The trial was extended to phase III including a total of 426 pts. Enrolment of additional 281 pts started in Dec 2020. The trial endpoints remained unchanged. Results: Pts (40 arm A, 40 arm B) received a median of 2.5 treatment cycles in arm A and 2 cycles in arm B; 31 pts in treatment arm A and 32 pts in arm B discontinued participation prematurely, mainly due to cancer progression. Most patients developed adverse events (AEs): grade 3 AEs were observed in 28 pts (70%) in arm A (24 treatment-related) and 27 pts (67%, 17 treatment-related) in arm B. More grade 4 AEs were seen in arm A (13 pts, 32.5%) than in arm B (5 pts, 12.5%). In total, 46 Serious AEs (SAEs) occurred, 27 in arm A (10 treatment-related) and 19 in Arm B (2 treatment-related). Five SAEs (3 in arm A, 2 in arm B) had a fatal outcome (one in arm A treatment-related). Within the analyzed population, no SUSAR occurred. Conclusions: This safety analysis demonstrates a minor increase in AEs in the experimental arm but no unexpected events. There were no excessive toxicity or unacceptable risks. In summary, a favorable risk-benefit-profile was confirmed. Based on these safety results and the ongoing need for efficient treatment in the tested population, the trial was extended to phase III. Clinical trial information: NCT03520946.
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Affiliation(s)
- Stefan Kasper
- University Hospital Essen, West German Cancer Center, Essen, Germany
| | - Thorsten Oliver Goetze
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Sebastian Stintzing
- Medical Department, Division of Hematology, Oncology, and Tumor Immunology (CCM), Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marianne Sinn
- Universitätsklinikum Hamburg-Eppendorf II. Medizinische Klinik, Hamburg, Germany
| | | | | | - Verena Keitel
- University of Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie Gastroonkologisches Studienzentrum, Düsseldorf, Germany
| | - Ullrich Graeven
- Kliniken Maria Hilf GmbH, Klinik für Hämatologie, Onkologie und Gastroenterologie, Mönchengladbach, Germany
| | | | - Alexander Kolov
- VIDIA Christliche Kliniken Karlsruhe Medizinische Klinik 2, Karlsruhe, Germany
| | | | - Alexander Stein
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Facharztzentrum Eppendorf, Hamburg, Germany
| | | | - Sabine Junge
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) GmbH at Krankenhaus Nordwest, Frankfurt, Germany
| | - Isabel Virchow
- University Hospital Essen, West German Cancer Center, Essen, Germany
| | - Jens T Siveke
- University Hospital Essen, West German Cancer Center, Essen, Germany
| | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Martin H. Schuler
- University Hospital Essen, West German Cancer Center, Essen, Germany
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Grewendorf S, Dopfer C, Kontsendorn J, Schütz K, Rudolf I, Klemann C, Happle C, Junge S, Hansen G, Dittrich AM. EPS3.08 Evaluation of a fixed-step eradication regime in children with cystic fibrosis and detection of Pseudomonas aeruginosa. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01025-0] [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]
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Kasper S, Hofheinz R, Stintzing S, Götze T, Sinn M, Dechow T, Ettrich T, Keitel V, Graeven U, Fischer von Weikersthal L, Kolov A, Edelmann T, Stein A, Trarbach T, Junge S, Pauligk C, Virchow I, Siveke J, Al-Batran SE, Schuler M. 438P Interim safety analysis of the phase IIb study of ramucirumab in combination with TAS102 vs. TAS102 monotherapy in metastatic colorectal cancer: The RAMTAS trial of the German AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.549] [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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Lorenzen S, Pauligk C, Götze T, Michael C, Mahlberg R, Schmalenberg H, Biederstädt A, Frost G, Heidel S, Treschl A, Junge S, Hofheinz R, Moehler M, Al-Batran SE. 1502TiP Paclitaxel + ramucirumab versus paclitaxel alone in patients with squamous-cell carcinoma of the esophagus, refractory or intolerant to combination therapy with fluoropyrimidine and platinum-based drugs - RAMOS, a randomized phase II trial of the German Gastric Group of the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pauligk C, Götze T, Thuss-Patience P, Riera-Knorrenschild J, Goekkurt E, Ettrich T, Pink D, Lindig U, Luley K, Dechow T, Bitzer M, Angermeier S, Homann N, Kullmann F, Schuch G, Bolling C, Junge S, Hofheinz R, Lorenzen S, Al-Batran SE. 1443P Modified FOLFOX versus modified FOLFOX plus nivolumab and ipilimumab in patients with previously untreated advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction – Safety Results from AIO-STO-0417: A randomized phase II trial of the German Gastric Group of the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Junge F, Hellmuth T, Stein L, Junge S. P293 Physical activity in children and adolescents with cystic fibrosis – do they move enough? J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hellmuth T, Junge F, Dittrich AM, Junge S. P321 Respiratory physiotherapy for children and adolescents with cystic fibrosis – is there a link between adherence and clinical health status? J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30650-0] [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: 11/26/2022]
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Lorenzen S, Pauligk C, Goetze T, Riera Knorrenschild J, Goekkurt E, Kullmann F, Pink D, Ettrich T, Homann N, Angermeier S, Thuss-Patience P, Lindig U, Bitzer M, Dechow T, Schuch G, Schmalenberg H, Junge S, Hofheinz R, Al-Batran SE. Modified FOLFOX versus modified FOLFOX plus nivolumab and ipilimumab in patients with previously untreated advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction: Moonlight, a randomized phase II trial of the German Gastric Group of the AIO. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hellmuth T, Schlüter K, Junge S. P469 From paediatric to adult care - improvement of a structural program of transition at the Cystic Fibrosis Centre of Hannover Medical School. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Junge S, Reimpell P, Hellmuth T, Fuchs C. P201 Adherence in nebulisation therapy of paediatric patients with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30495-3] [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: 10/26/2022]
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Al-Batran SE, Pauligk C, Goetze TO, Riera-Knorrenschild J, Goekkurt E, Angermeier S, Kullmann F, Thuss-Patience PC, Homann N, Ettrich TJ, Junge S, Hofheinz R, Lorenzen S. Modified FOLFOX versus modified FOLFOX plus nivolumab and ipilimumab in patients with previously untreated advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction: Moonlight, a randomized phase 2 trial of the German Gastric Group of the AIO. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps4144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4144 Background: The majority of patients (pts) with gastroesophageal cancer present with inoperable or metastatic disease and there is a strong need for efficient and tolerable first-line (1L) treatment. Oxaliplatin-based regimens like FOLFOX have become one standard of care. However, median survival is still below 12 months. Results from trials using nivolumab plus ipilimumab treatment of subjects with advanced/metastatic GC and GEJ cancers demonstrated clinical activity, in pts whose tumors did or did not express PD-L1; in addition, nivolumab alone and in combination with ipilimumab demonstrated clinical benefits in various other tumor types. Based on this clinical experience, the AIO-STO-0417 trial (Moonlight) has been designed to evaluate the combination of chemotherapy with two checkpoint inhibitors in first-line therapy of pts with gastroesophageal adenocarcinoma. Methods: This is a prospective, multicenter, randomized, investigator-initiated phase II trial. Pts with Her2-negative, inoperable, advanced or metastatic gastric or esophagogastric junction cancer will be randomized 1:1 to 1L treatment with FOLFOX (Oxaliplatin 85 mg/m²; Leucovorin 400 mg/m²; 5FU 400 mg/m² on d1 of each treatment cycle and 5FU 1200 mg/m² continuous infusion over 24 hrs d1 and d2) every 2 weeks plus Nivolumab 240 mg every 2 weeks and Ipilimumab 1mg/kg every 6 weeks (Arm A) or FOLFOX alone (Arm B). Primary endpoint of the trial is progression-free survival based on the ITT population. Main secondary endpoints are overall survival, objective response rate, Safety and Quality of life (EORTC QLQ-C30). 118 pts (59 per arm) will be enrolled to provide 80% power for detecting an average HR of 0.68 using the log rank test at a one-sided type I error of 10%. At the date of submission, (Feb 2019), 28 of planned 118 pts are randomized. Clinical trial information: NCT03647969.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Goetze
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Facharztzentrum Eppendorf, Hamburg, Germany
| | | | - Frank Kullmann
- Department of Internal Medicine I, Academic Teaching Hospital Weiden, Weiden, Germany
| | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Nils Homann
- MED. Klinik II, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Sabine Junge
- IKF Klinische Krebsforschung GmbH at Krankenhaus Nordwest, Frankfurt, Germany
| | - Ralf Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | - Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany
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Dahl A, Iversen K, Tonder N, Hoest N, Arpi M, Dalsgaard M, Chehri M, Soerensen LL, Fanoe S, Junge S, Hoest U, Valeur N, Lauridsen TK, Fosbol E, Bruun NE. 237Prevalence of infective endocarditis in enterococcus faecalis bacteraemia: a prospective multicenter screening study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Dahl
- Copenhagen University Hospital Gentofte, Department of Cardiology, Copenhagen, Denmark
| | - K Iversen
- Herlev Hospital - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - N Tonder
- Hillerod Hospital, Cardiology, Hillerod, Denmark
| | - N Hoest
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - M Arpi
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | - M Dalsgaard
- Herlev Hospital - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - M Chehri
- Hvidovre UniversityHospital, Clinical microbiology, Copenhagen, Denmark
| | - L L Soerensen
- Copenhagen University Hospital Gentofte, Department of Cardiology, Copenhagen, Denmark
| | - S Fanoe
- Hvidovre University Hospital, Cardiology, Hvidovre, Denmark
| | - S Junge
- Glostrup University Hospital, Cardiology, Glostrup, Denmark
| | - U Hoest
- Glostrup University Hospital, Cardiology, Glostrup, Denmark
| | - N Valeur
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - T K Lauridsen
- Copenhagen University Hospital Gentofte, Department of Cardiology, Copenhagen, Denmark
| | - E Fosbol
- Hvidovre University Hospital, Cardiology, Hvidovre, Denmark
| | - N E Bruun
- Copenhagen University Hospital Gentofte, Department of Cardiology, Copenhagen, Denmark
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17
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Junge S, Gutenbrunner C, Stein L, Hellmuth T. IPD2.12 Respiratory physiotherapy for children with cystic fibrosis at infancy and early childhood – an actual state-target-analysis in consideration of parental influences on therapy adherence. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Goldbeck L, Fidika A, Heuer HE, Junge S, Smaczny C, Reimann A. WS09.3 Professional quality of life among CF healthcare providers. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Junge S, Dopfer C, Stein L, Kueck M, Schlüter K, Stetefeld A. ePS05.7 Individual caloric intake in cystic fibrosis (CF) – how to calculate? J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Junge S, Dittrich AM, Dopfer C, Sauer-Heilborn A, Berger C, Fritsch S, Hansen G, Welte T, Tümmler B. Die Mukoviszidose Transitionsambulanz an der Medizinischen Hochschule Hannover. Pneumologie 2014. [DOI: 10.1055/s-0034-1368030] [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: 10/25/2022]
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21
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Junge S, Wiedemann B, Tümmler B, Dübbers A, Küster P, Nofer J, Ellemunter H, Mainz J, Heuer E, Sextro W, Körner-Rettberg C, Ballmann M, Mellies U, Hammermann J, Teschler H, Szczepanski R, Tegtmeyer F, Graepler-Mainka U, Riethmueller J, Wald A, Wollschläger B, Staab D, Schuster A, Becker K, Peters G, Kahl B. WS19.9 A prospective multicenter study to dissect Staphylococcus aureus-colonization from infection in cystic fibrosis patients. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60122-8] [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: 11/26/2022]
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22
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Junge S, Stein L, Schluter K, Hoyng C. 253 Phase angle (PA) from bioelectrical impedance analysis (BIA) in children with cystic fibrosis (CF). J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60422-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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van Barneveld A, Zander I, Hyde R, Länger F, Simon A, Junge S, Ballmann M, Derichs N, Tümmler B. 52 Protein analysis of mutant CFTR in human tissues. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Junge S, Hartmann P, Beck JF, Hübler A. Effekt einer zusätzlich geplanten Flüssigkeitssubstitution bei Frühgeborenen ≤32 SSW mit fototherapiepflichtiger Hyperbilirubinämie. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Junge S, Hartmann P, Beck JF, Hübler A. Dopplersonografische Flussmuster bei Frühgeborenen ≤32 SSW mit unterschiedlichen Flüssigkeitsregimes während fototherapiepflichtiger Hyperbilirubinämie. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Riethmueller J, Junge S, Schroeter TW, Kuemmerer K, Franke P, Ballmann M, Claass A, Broemme S, Jeschke R, Hebestreit A, Staab D, Koetz K, Doering G, Stern M. Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis. Infection 2009; 37:418-23. [DOI: 10.1007/s15010-009-8116-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 01/08/2009] [Indexed: 10/20/2022]
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27
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Hebestreit H, Kieser S, Junge S, Ballmann M, Hebestreit A, Schindler C, Schenk T, Posselt HG, Kriemler S. Long-term effects of a partially supervised conditioning programme in cystic fibrosis. Eur Respir J 2009; 35:578-83. [DOI: 10.1183/09031936.00062409] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Bartig H, Ammon M, Wünderich R, Junge S, Ballmann M, Ullrich G. TIDES-CF Study: Who participates in psychosocial trials? J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60347-7] [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: 10/20/2022]
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29
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Eberle P, Berger C, Junge S, Dougoud S, Büchel EV, Riegel M, Schinzel A, Seger R, Güngör T. Persistent low thymic activity and non-cardiac mortality in children with chromosome 22q11.2 microdeletion and partial DiGeorge syndrome. Clin Exp Immunol 2008; 155:189-98. [PMID: 19040613 DOI: 10.1111/j.1365-2249.2008.03809.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A subgroup of patients with 22q11.2 microdeletion and partial DiGeorge syndrome (pDGS) appears to be susceptible to non-cardiac mortality (NCM) despite sufficient overall CD4(+) T cells. To detect these patients, 20 newborns with 22q11.2 microdeletion and congenital heart disease were followed prospectively for 6 years. Besides detailed clinical assessment, longitudinal monitoring of naive CD4(+) and cytotoxic CD3(+)CD8(+) T cells (CTL) was performed. To monitor thymic activity, we analysed naive platelet endothelial cell adhesion molecule-1 (CD31(+)) expressing CD45RA(+)RO(-)CD4(+) cells containing high numbers of T cell receptor excision circle (T(REC))-bearing lymphocytes and compared them with normal values of healthy children (n = 75). Comparing two age periods, low overall CD4(+) and naive CD4(+) T cell numbers were observed in 65%/75%, respectively, of patients in period A (< 1 year) declining to 22%/50%, respectively, of patients in period B (> 1/< 7 years). The percentage of patients with low CTLs (< P10) remained robust until school age (period A: 60%; period B: 50%). Low numbers of CTLs were associated with abnormally low naive CD45RA(+)RO(-)CD4(+) T cells. A high-risk (HR) group (n = 11) and a standard-risk (SR) (n = 9) group were identified. HR patients were characterized by low numbers of both naive CD4(+) and CTLs and were prone to lethal infectious and lymphoproliferative complications (NCM: four of 11; cardiac mortality: one of 11) while SR patients were not (NCM: none of nine; cardiac mortality: two of nine). Naive CD31(+)CD45RA(+)RO(-)CD4(+), naive CD45RA(+)RO(-)CD4(+) T cells as well as T(RECs)/10(6) mononuclear cells were abnormally low in HR and normal in SR patients. Longitudinal monitoring of naive CD4(+) and cytotoxic T cells may help to discriminate pDGS patients at increased risk for NCM.
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Affiliation(s)
- P Eberle
- Division of Immunology/Hematology/BMT, University Children's Hospital, Zürich, Switzerland
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Abstract
OBJECTIVE Inert gas multiple breath washout (MBW) for measuring Lung Clearance Index using mass spectrometry and 4% sulfur hexafluoride (SF(6)) as the tracer gas has been shown to be sensitive for detecting early Cystic Fibrosis (CF) lung disease. However, mass spectrometry requires bulky equipment and is expensive to buy and maintain. A novel sidestream ultrasonic device may overcome this problem. The aims of this study were to assess the feasibility and clinical validity of measuring lung volume (functional residual capacity, FRC) and the LCI using the sidestream ultrasonic flow sensor in children and adolescents with CF in relation to spirometry and plain chest radiographs. PATIENTS AND METHODS MBW using the sidestream ultrasonic device and conventional spirometry were performed in 26 patients with CF and 22 healthy controls. RESULTS In the controls (4.7-17.7 years) LCI was similar to that reported using mass spectrometry (mean (SD) 6.7 (0.5)). LCI was elevated in 77% of the CF children (6.8-18.9 years), whereas spirometry was abnormal in only 38.5%, 61.5%, and 26.9% for FEV(1), MEF(25), and FEV(1)/FVC, respectively. This was more marked in children <10 years. LCI correlated with the Crispin-Norman score, whereas FEV(1) did not. CONCLUSIONS Sidestream ultrasonic MBW is a valid and simple alternative to mass spectrometry for assessing ventilation homogeneity in children.
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Affiliation(s)
- Susanne I Fuchs
- Department of Paediatric Pulmonology and Neonatology, Medizinische Hochschule Hannover, Hannover, Germany.
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31
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Rebmann K, Junge S, Wiehlmann L, Ballmann M. Recurrence of PSA after early treatment: a long-term follow-up study. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Junge S, Pfister E, Schlüter K, Becker T, Melter M, Ballmann M. 197 Clinical follow up after liver transplantation in children with cystic fibrosis. J Cyst Fibros 2007. [DOI: 10.1016/s1569-1993(07)60180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Hebestreit H, Kieser S, Rüdiger S, Schenk T, Junge S, Hebestreit A, Ballmann M, Posselt HG, Kriemler S. Physical activity is independently related to aerobic capacity in cystic fibrosis. Eur Respir J 2006; 28:734-9. [PMID: 16807261 DOI: 10.1183/09031936.06.00128605] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [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: 11/05/2022]
Abstract
It is unclear whether a relationship between physical activity (PA) and maximal oxygen uptake (V'(O2,max)) exists in cystic fibrosis (CF) and, if so, whether the relationship reflects a direct effect or is mediated by the effects of confounding variables, such as pulmonary or muscle function. The objective of the present study was to determine the relationship between PA and V'(O2,max) in CF while adjusting for possible influences of confounding factors. In total, 36 female and 35 male patients with CF from Germany and Switzerland (aged 12-40 yrs, forced expiratory volume in one second (FEV1) 25-107% predicted) were studied. A Wingate test was employed to measure muscle power. PA was monitored for 7 days and expressed in two ways: 1) average daily accelerometer count (ADAC) and 2) time spent in moderate-to-vigorous PA (MVPA). V'(O2,max) was determined during an incremental cycle exercise test to volitional fatigue. PA was positively related to V'(O2,max). In a multiple linear regression analysis, height, sex, FEV1, muscle power and ADAC (additionally explained variance 2.5%) or time spent in MVPA (additionally explained variance 3.7%) were identified as independent predictors of V'(O2,max). In conclusion, high levels of physical activity in addition to good muscular and pulmonary functions are associated with a high aerobic capacity in cystic fibrosis.
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Affiliation(s)
- H Hebestreit
- University Children's Hospital, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
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34
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Abstract
UNLABELLED Inflammation is a hallmark in the pathogenesis of pulmonary destruction in cystic fibrosis (CF). There is no proven effective systemic anti-inflammatory treatment for CF patients with advanced pulmonary disease. Methotrexate (MTX) is known as an effective anti-inflammatory treatment in asthma and in juvenile rheumatoid arthritis. The question was: Is an improvement in pulmonary function achievable with low-dose MTX in patients with cystic fibrosis and advanced pulmonary disease.? METHODS We treated five CF patients with advanced pulmonary disease, who deteriorated in spite of intensive conventional therapy on an individual basis with low-dose MTX. FEV1% and immunoglobulin G (IgG) serum levels were followed from the year before to the year after starting with MTX. RESULTS In the year before starting with MTX, FEV1% decreased (median: 10% FEV1; range 9-15% FEV1; P<0.005) after starting with MTX, FEV1% increased (median: 9% FEV1; range: 2-15% FEV1; P<0.05). IgG changed (median: -2 g/l; range: 0.2 to -7.3 g/l) in the first year with MTX. CONCLUSION These preliminary data suggest a beneficial effect of MTX even in advanced pulmonary disease in CF patients and supports the need for a controlled prospective study.
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Affiliation(s)
- M Ballmann
- Paediatric Department, Medical School Hannover, Hannover, Germany.
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35
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Abstract
Future trends in magnetic resonance imaging (MRI) lead to higher magnetic field strengths of the static magnetic fields and as an implication of that to much higher frequencies. Nowadays a common model of a send-receive coil is the birdcage resonator. However it is very difficult to find an optimal L/C-relation for the capacities and inductivities at frequencies above 300 MHz. The idea is to build a completely new send-receive resonator without discrete network elements. The solution presented in this work is the development of a fully ceramic resonator with a high dielectric constant (between 30-100) and a low loss factor (tan delta approximately 10(3)). This approach has shown to produce a stable transversal magnetic field at the desired MR-frequencies above 300 MHz.
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Affiliation(s)
- P Daleiden
- Institut für Biomedizinische Technik, IBT, Universität Karlsruhe (TH), Deutschland. ,
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36
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Eriksen E, Golombeck MA, Junge S, Dössel O. Simulation of a birdcage and a ceramic cavity HF-resonator for high magnetic fields in magnetic resonance imaging. BIOMED ENG-BIOMED TE 2003; 47 Suppl 1 Pt 2:754-7. [PMID: 12465294 DOI: 10.1515/bmte.2002.47.s1b.754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this work was the 3D-simulation of a dielectric resonator for high-field-MRI. A 12-rod-bird-cage-resonator was simulated in a first step, in order to verify the capability of the commercial simulation software MAFIA to simulate homogeneous, transversal B-fields in resonators. The second step was the simulation of frequency-independent dielectric ceramic resonators for static magnetic field strengths of 7 T and 12 T (294 MHz and 504 MHz respectively). The results were compared to the measured results of a manufactured TiO2- and a Al2O3-resonator. Only minor deviations showed up. These results led to the conclusion that dielectric resonators for high field MRI can be optimised using numerical field calculation software.
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Affiliation(s)
- E Eriksen
- Institut für Biomedizinische Technik, IBT, Universität Karlsruhe (TH), Deutschland. ,
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Junge S. [Numerical calculation of HF antennas and their interaction with dielectric media in MRI]. BIOMED ENG-BIOMED TE 2003; 47 Suppl 1 Pt 1:408-11. [PMID: 12451878 DOI: 10.1515/bmte.2002.47.s1a.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
At high field MRI the wavelength within the object under investigation is comparable to the dimensions of the human head or body. The development of MR coils, under notice of all safety aspects, can be speed up dramatically by the use of numerical analysis instead of experimental methods. We use the commercially available software packages CONCEPT and MAFIA. We developed new methods for calculating the rf-fields in given structures driven by current, voltage or power sources. With the use of new NMR-methods the amplitude- and phase distribution of the magnetic rf-field and the distribution of the SAR inside the rf-coils, loaded with phantoms, are measured and compared with simulations. The results of the measurements and the simulations of the magnetic rf-field distribution and SAR distribution show a good correspondence.
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Affiliation(s)
- S Junge
- Bruker BioSpin MRI GmbH, Ettlingen 76275, Deutschland.
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Abstract
Intraalveolar leukocyte accumulation is one of the hallmarks during respiratory distress. In the intraalveolar space, leukocyte activation is mediated by pathogens, cytokines, and different ligands binding to adhesion molecules. Leukocyte stimulation via the adhesion molecule L-selectin is specifically induced by ligands expressed on leukocytes, platelets, endothelial cells, or lipopolysaccharide. Recently, we have demonstrated that leukocyte activation by L-selectin transmits several intracellular signaling cascades resulting in capping and cytoskeletal changes, the activation of kinases and neutral sphingomyelinase, the recruitment of adaptor proteins to the cell membrane, the activation of the small G-proteins Ras and Rac, and the release of oxygen. In the present study, we examined the effects of surfactant on L-selectin-induced signal transduction in leukocytes. Using fluorescence microscopy, we provide evidence that preincubation of leukocytes with surfactant significantly inhibits receptor capping; 28+/-7% of cells show capping after L-selectin stimulation versus 8+/-5% and 3+/-1% of cells after preincubation with Exosurf and Curosurf, respectively (p < 0.05). The activity of the neutral sphingomyelinase in cell lysates is also modulated by surfactant. In addition, we show that the activation of the tyrosine kinase p56lck is diminished by approximately 50% after surfactant treatment. This results in inhibition in tyrosine phosphorylation of certain intracellular proteins. The interaction of the L-selectin molecule with its antibody was not influenced by surfactant as shown by flow cytometry. Surfactant inhibits intracellular signaling events of the L-selectin receptor in leukocytes and might therefore contribute to the modulatory effects of surfactant on immune function.
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Affiliation(s)
- B Brenner
- Department of Pediatrics, Im Neuenheimer Feld 150, Heidelberg, Germany
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39
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Abstract
Leucocyte adhesion to endothelial cells is a tightly regulated process involving selectins, integrins and immunoglobulin-like proteins. Cell adhesion and communication are controlled by membrane dynamics like receptor capping. Capping of surface receptors is an ubiquitous mechanism but still not well understood. Employing immunofluorescence techniques, we demonstrate that L-selectin triggering results in receptor capping of the L-selectin molecules in lymphocytes. Using pharmacological inhibitors and genetic deficient cell lines we show that this process involves intracellular signalling molecules. L-Selectin capping seems to be independent on activation of p56lck-kinase, but requires the neutral sphingomyelinase, small G proteins and the cytoskeleton. Therefore, capping of L-selectin upon stimulation might play an important role in the very early phase of lymphocyte trafficking.
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Affiliation(s)
- S Junge
- Department of Physiology, University of Tuebingen, Germany
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40
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Höhn N, Junge S. [The relationship of maternal obesity, excessive weight gain in pregnancy and pre-eclampsia]. Geburtshilfe Frauenheilkd 1979; 39:1079-82. [PMID: 520790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The records of 2,671 pregnancies were reviewed regarding maternal obesity, excessive weight gain in pregnancy and pre-eclampsia. Pre-eclampsia is significantly more frequent in maternal obesity. Correlation between excessive weight gain in pregnancy and pre-eclampsia is only found for the signs of edema and hypertension. Edema and excessive weight gain in pregnancy are related to each other, since edema frequently induces the excessive weight gain. Overall, maternal obesity perior to pregnancy is much more important in the development of pre-eclampsia than excessive weight gain during pregnancy.
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