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Neukamm MA, Pollak S, Thoma V, Vogt S, Huppertz LM, Auwärter V. A fatal case of aspiration due to consumption of the hallucinogenic tryptamine derivative dipropyltryptamine (DPT). J Pharm Biomed Anal 2024; 240:115959. [PMID: 38183731 DOI: 10.1016/j.jpba.2023.115959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIM This case involves a 20-year-old man with prior hallucinogen-use experience, who sniffed an unknown amount of dipropyltryptamine in an apartment. Dipropyltryptamine, a hallucinogenic compound belonging to the tryptamine class is recognized for inducing effects similar to dimethyltryptamine (DMT) but with a longer duration. Ten to fifteen minutes later he experienced visual hallucinations, followed by increasing apathy. Two hours post consumption he developed abdominal pain, leading to collapse, seizure, and vomiting. Despite emergency medical resuscitation on site, transport to hospital 2.5 hours post consumption and extracorporeal life support he died 21 hours later. Relevant toxicological and morphological findings are presented. METHODS A serum sample was collected four hours post consumption. Autopsy was performed six days after death. Antemortem serum, as well as postmortem cardiac blood and urine were analyzed for alcohol and psychoactive drugs by systematic toxicological analyses employing gas chromatography-mass spectrometry (Maurer/Pfleger/Weber library among others), liquid chromatography-ion trap mass spectrometry (LC-MSn, Toxtyper™), and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Dipropyltryptamine was quantified by LC-MS/MS after solid-phase extraction. RESULTS Autopsy revealed a state after deep aspiration of gastric contents with consecutive brain edema due to oxygen deprivation. Dipropyltryptamine concentrations were approximately 210 ng/ml, 110 ng/ml and 180 ng/ml in antemortem serum, postmortem cardiac blood and urine, respectively. To the best of our knowledge, these are the first reported concentrations of dipropyltryptamine in a fatal case. CONCLUSION Unlike typical tryptamine overdose reports, this case did not present with agitation, hyperthermia, or tachycardia. Despite the individual's prior experience with tryptamines and the generally low toxicity associated with this class of hallucinogens, death in this case was an indirect consequence of the nasal consumption of a high dose of dipropyltryptamine.
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Affiliation(s)
- Merja A Neukamm
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany.
| | - Stefan Pollak
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany
| | - Vanessa Thoma
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany
| | - Susanne Vogt
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany
| | - Laura M Huppertz
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany
| | - Volker Auwärter
- Institute of Forensic Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Albertstraße 9, Freiburg 79104, Germany
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Lüke C, Kauschke C, Dohmen A, Haid A, Leitinger C, Männel C, Penz T, Sachse S, Scharff Rethfeldt W, Spranger J, Vogt S, Niederberger M, Neumann K. Definition and terminology of developmental language disorders-Interdisciplinary consensus across German-speaking countries. PLoS One 2023; 18:e0293736. [PMID: 37943803 PMCID: PMC10635531 DOI: 10.1371/journal.pone.0293736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
In recent years, there have been intense international discussions about the definition and terminology of language disorders in childhood, such as those sparked by the publications of the CATALISE consortium. To address this ongoing debate, a Delphi study was conducted in German-speaking countries. This study consisted of three survey waves and involved over 400 experts from relevant disciplines. As a result, a far-reaching consensus was achieved on essential definition criteria and terminology, presented in 23 statements. The German term 'Sprachentwicklungsstörung' was endorsed to refer to children with significant deviations from typical language development that can negatively impact social interactions, educational progress, and/or social participation and do not occur together with a potentially contributing impairment. A significant deviation from typical language development was defined as a child's scores in standardized test procedures being ≥ 1.5 SD below the mean for children of the same age. The results of this Delphi study provide a proposal for a uniform use of terminology for language disorders in childhood in German-speaking countries.
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Affiliation(s)
- Carina Lüke
- Faculty of Human Sciences, Department of Special Education and Therapy in Language and Communication Disorders, University of Würzburg, Würzburg, Germany
| | - Christina Kauschke
- Department of German Linguistics, University of Marburg, Marburg, Germany
| | - Andrea Dohmen
- Department of Applied Health Sciences, Speech and Language Therapy, University of Applied Health Sciences (HS Gesundheit), Bochum, Germany
| | - Andrea Haid
- Swiss University of Speech and Language Sciences SHLR, Rorschach, Switzerland
| | - Christina Leitinger
- Logopädieaustria, Professional Association of Austrian Speech-Language Therapists, Vienna, Austria
| | - Claudia Männel
- Department of Audiology and Phoniatrics, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Tanja Penz
- University Hospital for Hearing, Voice and Language Disorders, Innsbruck, Austria
| | - Steffi Sachse
- Institute of Psychology, University of Education Heidelberg, Heidelberg, Germany
| | | | - Julia Spranger
- Department of Research Methods in Health Promotion and Prevention, Institute for Health Sciences, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Susanne Vogt
- Department of Health & Social Affairs, University of Applied Sciences Fresenius Frankfurt, Frankfurt, Germany
| | - Marlen Niederberger
- Department of Research Methods in Health Promotion and Prevention, Institute for Health Sciences, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Münster, Germany
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Mekki L, Sheth NM, Vijayan RC, Rohleder M, Sisniega A, Kleinszig G, Vogt S, Kunze H, Osgood GM, Siewerdsen JH, Uneri A. Surgical navigation for guidewire placement from intraoperative fluoroscopy in orthopaedic surgery. Phys Med Biol 2023; 68:215001. [PMID: 37774711 DOI: 10.1088/1361-6560/acfec4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/29/2023] [Indexed: 10/01/2023]
Abstract
Objective. Surgical guidewires are commonly used in placing fixation implants to stabilize fractures. Accurate positioning of these instruments is challenged by difficulties in 3D reckoning from 2D fluoroscopy. This work aims to enhance the accuracy and reduce exposure times by providing 3D navigation for guidewire placement from as little as two fluoroscopic images.Approach. Our approach combines machine learning-based segmentation with the geometric model of the imager to determine the 3D poses of guidewires. Instrument tips are encoded as individual keypoints, and the segmentation masks are processed to estimate the trajectory. Correspondence between detections in multiple views is established using the pre-calibrated system geometry, and the corresponding features are backprojected to obtain the 3D pose. Guidewire 3D directions were computed using both an analytical and an optimization-based method. The complete approach was evaluated in cadaveric specimens with respect to potential confounding effects from the imaging geometry and radiographic scene clutter due to other instruments.Main results. The detection network identified the guidewire tips within 2.2 mm and guidewire directions within 1.1°, in 2D detector coordinates. Feature correspondence rejected false detections, particularly in images with other instruments, to achieve 83% precision and 90% recall. Estimating the 3D direction via numerical optimization showed added robustness to guidewires aligned with the gantry rotation plane. Guidewire tips and directions were localized in 3D world coordinates with a median accuracy of 1.8 mm and 2.7°, respectively.Significance. The paper reports a new method for automatic 2D detection and 3D localization of guidewires from pairs of fluoroscopic images. Localized guidewires can be virtually overlaid on the patient's pre-operative 3D scan during the intervention. Accurate pose determination for multiple guidewires from two images offers to reduce radiation dose by minimizing the need for repeated imaging and provides quantitative feedback prior to implant placement.
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Affiliation(s)
- L Mekki
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
| | - N M Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
| | - R C Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
| | - M Rohleder
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
| | | | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | - H Kunze
- Siemens Healthineers, Erlangen, Germany
| | - G M Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston TX, United States of America
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
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Blanke F, Trinnes K, Oehler N, Prall WC, Lutter C, Tischer T, Vogt S. Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome. Arch Orthop Trauma Surg 2023; 143:4291-4298. [PMID: 36515708 PMCID: PMC10293391 DOI: 10.1007/s00402-022-04701-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome. METHODS The rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients. RESULTS 14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side. CONCLUSION Spontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing.
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Affiliation(s)
- F Blanke
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany.
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany.
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany.
| | - K Trinnes
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - N Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - W C Prall
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany
- Department of Orthopedic Surgery, University Hospital of Ludwig Maximilian University (LMU), Munich, Germany
| | - C Lutter
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - T Tischer
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - S Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
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Vogt S, Pfau G, Vielhaber S, Haghikia A, Hachenberg T, Brinkers M. Long-term opioid therapy and mental health comorbidity in chronic pain patients. Pain Med 2023:6994195. [PMID: 36661333 DOI: 10.1093/pm/pnad004] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Evidence suggests that chronic pain patients with mental illness are more likely to receive long-term opioid treatment (LTOT) and at higher doses, but are also at increased risk for opioid-related harm. This study investigates LTOT and its relationship to mental illness in the setting of a university-based outpatient pain clinic with liaison psychiatric care. METHODS Retrospective analysis of chronic pain patients admitted between 2011 and 2015. After a one-year treatment period, patients with non-opioid treatment, guideline-recommended and high-dose LTOT were compared and multiple regression analysis was performed to identify predictors of higher opioid dosage. RESULTS Of 769 patients, 46% received LTOT (opioids >90 consecutive days), 13% at high dosage (≥120 oral morphine milligram equivalents (MME)/day). Two-thirds of all patients had mental illness. The prevalence of psychiatric diagnoses and prescription rate of psychotropic medication did not significantly differ between groups. Pain chronicity stages, antidepressants and sex significantly predicted MME/day but explained only a minor part of the variance. The association with antidepressants can be attributed to the prescription of antidepressants for analgesic purposes rather than for treating depression. No association with any other type of psychiatric disorders was observed. CONCLUSION This study shows that mental health comorbidity is highly prevalent but that the prescribed opioid dosage is independent of it in the clinical setting of this study. The concept of liaison psychiatric care may have essentially contributed to the "detachment" of opioid prescription and psychiatric conditions but cannot be isolated from other potentially contributing factors within this single-center observational study.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Giselher Pfau
- Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Thomas Hachenberg
- Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Michael Brinkers
- Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany
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Song L, Paletta J, Vogt S, Talipov I, Sequeda-Cubides D, Irqsusi M, Rastan A. Cooperative Study to Address Infections and Biofilm Formation of Alloplastic Implants: Respiration of Osteoblasts Matters. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- L. Song
- Center for Orthopedics and Trauma Surgery, Marburg, Allemagne
| | - J. Paletta
- Center for Orthopedics and Trauma Surgery, Marburg, Allemagne
| | - S. Vogt
- Cardiovasc Res Lab, Heart Surgery, Marburg, Allemagne
| | - I. Talipov
- Department of Cardiac Surgery, Philipps University of Marburg, Marburg, Allemagne
| | - D. Sequeda-Cubides
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - M. Irqsusi
- Philipps University Marburg, Marburg, Allemagne
| | - A. Rastan
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
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Ghazy T, Brückner F, Jacob C, Vondran M, Andrasi-Wensauer T, Vogt S, Irqsusi M, Rastan A. Higher Cardiac Mortality and Myocardial Infarction Rates with Venous Compared to Arterial Revascularization of the Right Coronary Artery in BIMA Coronary Surgery: A 20-Year Propensity-Score–Matched Follow-up Study. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- T. Ghazy
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - F. Brückner
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - C. Jacob
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - M. Vondran
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - T. Andrasi-Wensauer
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
| | - S. Vogt
- Cardiovasc Res Lab, Heart Surgery, Marburg, Allemagne
| | - M. Irqsusi
- Philipps-University Marburg, Marburg, Allemagne
| | - A. Rastan
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Allemagne
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Vijayan R, Sheth N, Mekki L, Lu A, Uneri A, Sisniega A, Magaraggia J, Kleinszig G, Vogt S, Thiboutot J, Lee H, Yarmus L, Siewerdsen JH. 3D-2D image registration in the presence of soft-tissue deformation in image-guided transbronchial interventions. Phys Med Biol 2022; 68. [PMID: 36317269 DOI: 10.1088/1361-6560/ac9e3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Purpose. Target localization in pulmonary interventions (e.g. transbronchial biopsy of a lung nodule) is challenged by deformable motion and may benefit from fluoroscopic overlay of the target to provide accurate guidance. We present and evaluate a 3D-2D image registration method for fluoroscopic overlay in the presence of tissue deformation using a multi-resolution/multi-scale (MRMS) framework with an objective function that drives registration primarily by soft-tissue image gradients.Methods. The MRMS method registers 3D cone-beam CT to 2D fluoroscopy without gating of respiratory phase by coarse-to-fine resampling and global-to-local rescaling about target regions-of-interest. A variation of the gradient orientation (GO) similarity metric (denotedGO') was developed to downweight bone gradients and drive registration via soft-tissue gradients. Performance was evaluated in terms of projection distance error at isocenter (PDEiso). Phantom studies determined nominal algorithm parameters and capture range. Preclinical studies used a freshly deceased, ventilated porcine specimen to evaluate performance in the presence of real tissue deformation and a broad range of 3D-2D image mismatch.Results. Nominal algorithm parameters were identified that provided robust performance over a broad range of motion (0-20 mm), including an adaptive parameter selection technique to accommodate unknown mismatch in respiratory phase. TheGO'metric yielded median PDEiso= 1.2 mm, compared to 6.2 mm for conventionalGO.Preclinical studies with real lung deformation demonstrated median PDEiso= 1.3 mm with MRMS +GO'registration, compared to 2.2 mm with a conventional transform. Runtime was 26 s and can be reduced to 2.5 s given a prior registration within ∼5 mm as initialization.Conclusions. MRMS registration via soft-tissue gradients achieved accurate fluoroscopic overlay in the presence of deformable lung motion. By driving registration via soft-tissue image gradients, the method avoided false local minima presented by bones and was robust to a wide range of motion magnitude.
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Affiliation(s)
- R Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - N Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - L Mekki
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | | | | | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | - J Thiboutot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - H Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - L Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Holwein C, Jungmann P, Suchowierski J, Gersing A, Wörtler K, Brucker P, Angele P, Imhoff A, Vogt S. Sandwich Technique for Large Osteochondral Lesions of the Knee. Cartilage 2022; 13:19476035221102571. [PMID: 35906752 PMCID: PMC9340910 DOI: 10.1177/19476035221102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. DESIGN Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). RESULTS Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. CONCLUSION MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
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Affiliation(s)
- C. Holwein
- Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany,Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,C. Holwein, Rohrbachstraße 11, 73337 Bad Überkingen, Germany.
| | - P.M. Jungmann
- Zentrales Röntgeninstitut Kantonsspital Graubünden, Spital Davos AG, Davos, Switzerland
| | - J. Suchowierski
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - A.S. Gersing
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,Institut für Neuroradiologie, Klinikum der Universität München, München, Germany
| | - K. Wörtler
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - P.U. Brucker
- MVZ ATOS Klinik München, München, Germany,Orthopädie in der Ottostraße, München, Germany
| | - P. Angele
- Klinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany,Sporthopaedicum Regensburg, Regensburg, Germany
| | - A.B. Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - S. Vogt
- Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
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Monstrey SJ, Lepelletier D, Simon A, Touati G, Vogt S, Favalli F. Evaluation of the antiseptic activity of 5% alcoholic povidone-iodine solution using four different modes of application: a randomized open-label study. J Hosp Infect 2022; 123:67-73. [PMID: 35271958 DOI: 10.1016/j.jhin.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Before some invasive procedures, such as injections, surgical incision or intravascular catheter insertions, alcoholic antiseptics (e.g., alcoholic povidone-iodine [PVP-I]) are widely used to prevent infection. AIM This randomized, open-label study investigated the impact of mode of application (which includes both application technique and volume) on the antiseptic activity of 5% alcoholic PVP-I solution. METHODS Alcoholic PVP-I was administered on the backs of healthy adults using four modes of application: A, concentric circle method, 3mL; B, concentric circle method, 10 mL; C, back-and-forth friction method, 3 mL; D, back-and-forth friction method, 10 mL. PRIMARY ENDPOINT antiseptic activity of alcoholic PVP-I, assessed via change from baseline in log10/cm2 colony-forming units (CFU) count for total aerobic and facultative anaerobic bacteria. Safety was monitored. FINDINGS 113 healthy participants were screened; 32 were randomized. Alcoholic PVP-I showed significant antiseptic activity with all modes of application (p<0.001 for each), providing an overall mean decrease from baseline in CFU count of >3 log10/cm2 (p<0.001). Significantly greater efficacy was seen with back-and-forth friction (modes C and D) versus concentric circles (modes A and B): covariate adjusted change in log10/cm2 CFU count 0.22; 90% confidence intervals: 0.07, 0.37 (p=0.017). No safety issues were observed. CONCLUSION Alcoholic PVP-I demonstrated high antiseptic activity for all modes of application. Greater efficacy was achieved with back-and-forth friction versus concentric circles, showing that application technique may influence antiseptic activity; these findings suggest that when comparing the efficacy of antiseptic substances (e.g., alcoholic PVP-I and alcoholic chlorhexidine [CHX]), comparable application techniques should be used.
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Affiliation(s)
- Stan J Monstrey
- Burn Care Center, Plastic Surgery Department, University of Ghent, Belgium.
| | - Didier Lepelletier
- Hospital Hygiene Department and Lab EE 1701 S MiHAR, Nantes University Hospital, Nantes, France
| | - Anne Simon
- Infection Control Groupe, Hôpital de Jolimont, La Louvière, Belgium
| | - Gilles Touati
- Cardiovascular Surgery, University Hospital Amiens-Picardie (CHU Amiens-Picardie), Amiens, France
| | - Susanne Vogt
- Meda Pharma GmbH & Co. KG, A Viatris Company, Bad Homburg, Germany
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11
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Wigand B, Schlichte I, Schreiber S, Heitmann J, Meyer T, Dengler R, Petri S, Haghikia A, Vielhaber S, Vogt S. Characteristics of pain and the burden it causes in patients with amyotrophic lateral sclerosis - a longitudinal study. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:284-291. [PMID: 34392762 DOI: 10.1080/21678421.2021.1962354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pain currently plays a subordinate role in the clinical care of patients with ALS. We aim to examine epidemiological and clinical characteristics of pain as well as its impact throughout the disease course. METHODS During a longitudinal follow-up at three time points, 151 ALS patients from three German outpatient clinics completed the Brief Pain Inventory, ALS-Functional Rating Scale-Extension and ALS Depression Inventory. Analysis of variance and covariance with repeated measures were performed. RESULTS Pain was prevalent in 56% of the 151 patients at baseline and in 70% of the remaining 40 patients at the third survey. Of the 28 patients with pain who participated in all three surveys, about two thirds suffered from an average pain intensity corresponding to at least moderate pain on the numerical rating scale (NRS ≥ 4). Patients reported different pain qualities and localized the pain most frequently in the extremities, back and neck. Pain moderately impaired the functions of daily living. Pain intensity, pain quality and pain-related impairment did not significantly change over time. One third of the patients suffered from clinically relevant depressive symptoms. However, there was no conclusive evidence of a link between pain intensity and depressive symptoms. CONCLUSION Pain is frequent and constitutes an additional strain on ALS patients who have to endure a rapidly progressive and severely debilitating disease. This study contributes to better understanding of the characteristics of pain and its impact on ALS patients throughout the disease course and may thus help to more effectively address this symptom.
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Affiliation(s)
- Bernadette Wigand
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Ina Schlichte
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Johanna Heitmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
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12
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Reisinger A, Vogt S, Essl A, Rauch I, Bangerl F, Eller P, Hackl G. Lessons of the month 3: Intravenous poppers abuse: case report, management and possible complications. Clin Med (Lond) 2021; 20:221-223. [PMID: 32188665 DOI: 10.7861/clinmed.2019-0469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poppers are nitrite-containing liquids, which are inhaled for their aphrodisiac and hallucinogenic effects. Despite some cases of severe poisonings, poppers are often perceived as harmless by consumers. Inhalation and ingestion of poppers are well known, but, according to our literature review, intravenous abuse has not been reported before. CASE PRESENTATION A 34-year-old man injected poppers intravenously for recreational purposes. He then suffered from dyspnoea and general discomfort. Upon arrival of emergency medical services, the patient was dyspnoeic with blue-grey skin colour and oxygen saturation was 82% on ambient air. Non-invasive ventilation was necessary, and he was transferred to the intensive care unit. Toluidine blue was administered because of a methaemoglobinaemia of 40% and methaemoglobin levels dropped to 0.4%. He was discharged home after a 24-hour observation. We additionally analysed the contents of the poppers bottle: isopropyl nitrite, isopropanol and acetone were detected. Possible complications and the treatment regarding intravenous administration of poppers are discussed. CONCLUSION We present the first published case of intravenous poppers abuse. Our patient suffered from methaemoglobinaemia and was rapidly discharged after treatment with toluidine blue. No specific treatment regarding the contents of the poppers bottle, apart from isopropyl nitrite, was necessary.
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Affiliation(s)
- Alexander Reisinger
- Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria
| | | | | | | | | | | | - Gerald Hackl
- Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria
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13
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Blanke F, Boljen M, Lutter C, Oehler N, Tischer T, Vogt S. Does the anterolateral ligament protect the anterior cruciate ligament in the most common injury mechanisms? A human knee model study. Knee 2021; 29:381-389. [PMID: 33711673 DOI: 10.1016/j.knee.2021.02.026] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction still has a risk of re-rupture and persisting rotational instability. Thus, extra-articular structures such as the anterolateral ligament (ALL) are increasingly treated. The ALL however prevents the internal rotation of the tibia and it must be doubted that the ALL protects the ACL in other common injury mechanisms which primarily include tibial external rotation. In this study we aimed to evaluate which extra-articular structures support the ACL in excessive tibial internal and external rotation using a knee finite element (FE) model. METHODS Internal and external rotations of the tibia were applied to an FE model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Three additional anatomic structures (anterolateral ligament, popliteal tendon and posterior oblique ligament) were added to the FE model separately and then all together. The force histories within all structures were measured and determined for each case. RESULTS The ACL was the most loaded ligament both in tibial internal and external rotation. The ALL was the main stabilizer of the tibial internal rotation (46%) and prevented the tibial external rotation by only 3%. High forces were only observed in the LCL with tibial external rotation. The ALL reduced the load on the ACL in tibial internal rotation by 21%, in tibial external rotation only by 2%. The POL reduced the load on the ACL by 8%, the PLT by 6% in tibial internal rotation. In tibial external rotation the POL and PLT did not reduce the load on the ACL by more than 1%. CONCLUSION The ALL protects the ACL in injury mechanisms with tibial internal rotation but not in mechanisms with tibial external rotation. In injury mechanisms with tibial external rotation other structures that support the ACL need to be considered.
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Affiliation(s)
- F Blanke
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany; Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany.
| | - M Boljen
- Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institut, EMI, Freiburg i. Breisgau, Germany
| | - C Lutter
- Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany
| | - N Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - T Tischer
- Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany
| | - S Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
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14
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Vijayan RC, Han R, Wu P, Sheth NM, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH, Uneri A. Fluoroscopic Guidance of a Surgical Robot: Pre-clinical Evaluation in Pelvic Guidewire Placement. Proc SPIE Int Soc Opt Eng 2021; 11598:115981G. [PMID: 36090307 PMCID: PMC9455933 DOI: 10.1117/12.2582188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE A method and prototype for a fluoroscopically-guided surgical robot is reported for assisting pelvic fracture fixation. The approach extends the compatibility of existing guidance methods with C-arms that are in mainstream use (without prior geometric calibration) using an online calibration of the C-arm geometry automated via registration to patient anatomy. We report the first preclinical studies of this method in cadaver for evaluation of geometric accuracy. METHODS The robot is placed over the patient within the imaging field-of-view and radiographs are acquired as the robot rotates an attached instrument. The radiographs are then used to perform an online geometric calibration via 3D-2D image registration, which solves for the intrinsic and extrinsic parameters of the C-arm imaging system with respect to the patient. The solved projective geometry is then be used to register the robot to the patient and drive the robot to planned trajectories. This method is applied to a robotic system consisting of a drill guide instrument for guidewire placement and evaluated in experiments using a cadaver specimen. RESULTS Robotic drill guide alignment to trajectories defined in the cadaver pelvis were accurate within 2 mm and 1° (on average) using the calibration-free approach. Conformance of trajectories within bone corridors was confirmed in cadaver by extrapolating the aligned drill guide trajectory into the cadaver pelvis. CONCLUSION This study demonstrates the accuracy of image-guided robotic positioning without prior calibration of the C-arm gantry, facilitating the use of surgical robots with simpler imaging devices that cannot establish or maintain an offline calibration. Future work includes testing of the system in a clinical setting with trained orthopaedic surgeons and residents.
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Affiliation(s)
- R C Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
| | - R Han
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
| | - P Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
| | - N M Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
| | - P Vagdargi
- Department of Computer Science, Johns Hopkins University, Baltimore MD USA
| | - S Vogt
- Siemens Healthineers, Erlangen Germany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore MD USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
- Department of Computer Science, Johns Hopkins University, Baltimore MD USA
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD USA
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15
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Debska-Vielhaber G, Miller I, Peeva V, Zuschratter W, Walczak J, Schreiber S, Petri S, Machts J, Vogt S, Szczepanowska J, Gellerich FN, Hermann A, Vielhaber S, Kunz WS. Impairment of mitochondrial oxidative phosphorylation in skin fibroblasts of SALS and FALS patients is rescued by in vitro treatment with ROS scavengers. Exp Neurol 2021; 339:113620. [PMID: 33497646 DOI: 10.1016/j.expneurol.2021.113620] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/22/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating, rapidly progressive, neurodegenerative disorder affecting upper and lower motor neurons. Approximately 10% of patients suffer from familial ALS (FALS) with mutations in different ubiquitously expressed genes including SOD1, C9ORF72, TARDBP, and FUS. There is compelling evidence for mitochondrial involvement in the pathogenic mechanisms of FALS and sporadic ALS (SALS), which is believed to be relevant for disease. Owing to the ubiquitous expression of relevant disease-associated genes, mitochondrial dysfunction is also detectable in peripheral patient tissue. We here report results of a detailed investigation of the functional impairment of mitochondrial oxidative phosphorylation (OXPHOS) in cultured skin fibroblasts from 23 SALS and 17 FALS patients, harboring pathogenic mutations in SOD1, C9ORF72, TARDBP and FUS. A considerable functional and structural mitochondrial impairment was detectable in fibroblasts from patients with SALS. Similarly, fibroblasts from patients with FALS, harboring pathogenic mutations in TARDBP, FUS and SOD1, showed mitochondrial defects, while fibroblasts from C9ORF72 associated FALS showed a very mild impairment detectable in mitochondrial ATP production rates only. While we could not detect alterations in the mtDNA copy number in the SALS or FALS fibroblast cultures, the impairment of OXPHOS in SALS fibroblasts and SOD1 or TARDBP FALS could be rescued by in vitro treatments with CoQ10 (5 μM for 3 weeks) or Trolox (300 μM for 5 days). This underlines the role of elevated oxidative stress as a potential cause for the observed functional effects on mitochondria, which might be relevant disease modifying factors.
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Affiliation(s)
- Grazyna Debska-Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Irina Miller
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Viktoriya Peeva
- Institute of Experimental Epileptology and Cognition Research, Life & Brain Center, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Werner Zuschratter
- Leibniz Institute for Neurobiology, Laboratory for Electron- and Laserscanning- Microscopy, Brenneckestr.6, 39118 Magdeburg, Germany
| | - Jaroslaw Walczak
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur St, 02-993 Warsaw, Poland; Institute of Fundamental Technological Research, Polish Academy of Sciences, 5b Pawińskiego St, 02-106 Warsaw, Poland
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE) Magdeburg, Leipziger Str.44, 39120 Magdeburg, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE) Magdeburg, Leipziger Str.44, 39120 Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Joanna Szczepanowska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur St, 02-993 Warsaw, Poland
| | - Frank N Gellerich
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology and Center for Transdisciplinary Neurosciences Rostock (CTNR), University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany; German Centre for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE) Magdeburg, Leipziger Str.44, 39120 Magdeburg, Germany.
| | - Wolfram S Kunz
- Institute of Experimental Epileptology and Cognition Research, Life & Brain Center, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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16
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Ramzan R, Cybulski P, Ruppert V, Weber P, Irqsusi M, Mirow N, Rastan A, Vogt S. Does MRNA Upregulation of Cytochrome C Oxidase Subunit 4 Isoform 2 Sustain Atrial Fibrillation? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Dominik E, Rohrbach S, Li L, Knapp F, Mirow N, Vogt S, Böning A, Niemann B. Ablation for Permanent Atrial Fibrillation: Metabolic Impact of Obesity-Associated Signals. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Han R, Uneri A, Vijayan RC, Wu P, Vagdargi P, Sheth N, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH. Fracture reduction planning and guidance in orthopaedic trauma surgery via multi-body image registration. Med Image Anal 2020; 68:101917. [PMID: 33341493 DOI: 10.1016/j.media.2020.101917] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSES Surgical reduction of pelvic fracture is a challenging procedure, and accurate restoration of natural morphology is essential to obtaining positive functional outcome. The procedure often requires extensive preoperative planning, long fluoroscopic exposure time, and trial-and-error to achieve accurate reduction. We report a multi-body registration framework for reduction planning using preoperative CT and intraoperative guidance using routine 2D fluoroscopy that could help address such challenges. METHOD The framework starts with semi-automatic segmentation of fractured bone fragments in preoperative CT using continuous max-flow. For reduction planning, a multi-to-one registration is performed to register bone fragments to an adaptive template that adjusts to patient-specific bone shapes and poses. The framework further registers bone fragments to intraoperative fluoroscopy to provide 2D fluoroscopy guidance and/or 3D navigation relative to the reduction plan. The framework was investigated in three studies: (1) a simulation study of 40 CT images simulating three fracture categories (unilateral two-body, unilateral three-body, and bilateral two-body); (2) a proof-of-concept cadaver study to mimic clinical scenario; and (3) a retrospective clinical study investigating feasibility in three cases of increasing severity and accuracy requirement. RESULTS Segmentation of simulated pelvic fracture demonstrated Dice coefficient of 0.92±0.06. Reduction planning using the adaptive template achieved 2-3 mm and 2-3° error for the three fracture categories, significantly better than planning based on mirroring of contralateral anatomy. 3D-2D registration yielded ~2 mm and 0.5° accuracy, providing accurate guidance with respect to the preoperative reduction plan. The cadaver study and retrospective clinical study demonstrated comparable accuracy: ~0.90 Dice coefficient in segmentation, ~3 mm accuracy in reduction planning, and ~2 mm accuracy in 3D-2D registration. CONCLUSION The registration framework demonstrated planning and guidance accuracy within clinical requirements in both simulation and clinical feasibility studies for a broad range of fracture-dislocation patterns. Using routinely acquired preoperative CT and intraoperative fluoroscopy, the framework could improve the accuracy of pelvic fracture reduction, reduce radiation dose, and could integrate well with common clinical workflow without the need for additional navigation systems.
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Affiliation(s)
- R Han
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - A Uneri
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - R C Vijayan
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Wu
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Vagdargi
- Department of Computer Science, The Johns Hopkins University, BaltimoreMD, United States
| | - N Sheth
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - S Vogt
- Siemens Healthineers, ErlangenGermany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, BaltimoreMD, United States
| | - J H Siewerdsen
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States.
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Krueger J, Reichert C, Dürschmid S, Krauth R, Vogt S, Huchtemann T, Lindquist S, Lamprecht J, Sailer M, Heinze HJ, Hinrichs H, Sweeney-Reed CM. Rehabilitation nach Schlaganfall: Durch Gehirn-Computer-Schnittstelle
vermittelte funktionelle Elektrostimulation. KLIN NEUROPHYSIOL 2020. [DOI: 10.1055/a-1205-7467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEine Gehirn-Computer-Schnittstelle (BCI) in der Rehabilitation von
Schlaganfallpatienten ermöglicht die Steuerung einer funktionellen
Elektrostimulation (FES), um eine Muskelkontraktion in der gelähmten
Extremität zum Zeitpunkt der Bewegungsintention durch Erkennung
entsprechender Hirnsignale auszulösen. Es wird angenommen, dass eine
genaue zeitliche Kohärenz zwischen Bewegungsintention und visuellem
sowie propriozeptivem Feedback, ausgelöst durch eine reale Bewegung,
neuroplastische Prozesse begünstigen und eine funktionelle
Verbesserung der Parese bewirken kann. In dieser systematischen
Übersichtsarbeit zu randomisierten kontrollierten Studien wurden die
Datenbanken Pubmed, Scopus und Web of Science durchsucht und von 516
berücksichtigten Publikationen 13 ausgewählt, die auf 7
Studienpopulationen basierten. Ein direkter Vergleich der Studien ist durch
Unterschiede im Studiendesign erschwert. Fünf Studien berichten von
einer verbesserten motorischen Funktion in der BCI-FES-Gruppe, davon zeigen
3 signifikante Unterschiede zwischen der BCI-FES- und der
Kontrollgruppe.
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Affiliation(s)
- Johanna Krueger
- Neurokybernetik und Rehabilitation, Klinik für Neurologie,
Otto-von-Guericke Universität, Magdeburg
- Krankenhaus Barmherziger Brüder Regensburg
| | - Christoph Reichert
- Abteilung Verhaltensneurologie, Leibniz Institut für
Neurobiologie (LIN), Magdeburg
| | - Stefan Dürschmid
- Abteilung Verhaltensneurologie, Leibniz Institut für
Neurobiologie (LIN), Magdeburg
| | - Richard Krauth
- Neurokybernetik und Rehabilitation, Klinik für Neurologie,
Otto-von-Guericke Universität, Magdeburg
| | - Susanne Vogt
- Klinik für Neurologie, Otto-von-Guericke Universität,
Magdeburg
| | | | | | - Juliane Lamprecht
- MEDIAN Klinik NRZ Magdeburg, MEDIAN Klinik Flechtingen
- An-Institut für Neurorehabilitation, Otto-von-Guericke
Universität, Magdeburg
| | - Michael Sailer
- MEDIAN Klinik NRZ Magdeburg, MEDIAN Klinik Flechtingen
- An-Institut für Neurorehabilitation, Otto-von-Guericke
Universität, Magdeburg
| | - Hans-Jochen Heinze
- Abteilung Verhaltensneurologie, Leibniz Institut für
Neurobiologie (LIN), Magdeburg
- Klinik für Neurologie, Otto-von-Guericke Universität,
Magdeburg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE),
Magdeburg
| | - Hermann Hinrichs
- Abteilung Verhaltensneurologie, Leibniz Institut für
Neurobiologie (LIN), Magdeburg
- Klinik für Neurologie, Otto-von-Guericke Universität,
Magdeburg
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE),
Magdeburg
- Center for Behavioral Brain Sciences (CBBS), Magdeburg
- Forschungscampus STIMULATE, Magdeburg
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20
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Tischer T, Bode G, Buhs M, Marquass B, Nehrer S, Vogt S, Zinser W, Angele P, Spahn G, Welsch GH, Niemeyer P, Madry H. Platelet-rich plasma (PRP) as therapy for cartilage, tendon and muscle damage - German working group position statement. J Exp Orthop 2020; 7:64. [PMID: 32885339 PMCID: PMC7471237 DOI: 10.1186/s40634-020-00282-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Platelet rich plasma (PRP) is widely used in orthopaedics, but is still heavily debated. Therefore, a survey among the German “Working Group for Clinical Tissue Regeneration” of the German Society of Orthopaedics and Traumatology was conducted to achieve a consensus about the current therapeutical potential of PRP. Methods A first survey (n = 65 experts, all orthopaedic/trauma surgeons) was conducted (n = 13 questions). Following, a second round (n = 40 experts) was conducted with 31 questions to achieve consensus in 5 categories: three most common indications, PRP application, future research areas. Results Therapeutic PRP application was regarded as useful (89%), possibly even more important in the future (90%). Most common indications were tendon pathologies (77%), osteoarthritis (OA) (68%), muscle injuries (57%) and cartilage damage (51%). Consensus was reached in 16/31 statements. The application of PRP for early knee OA (Kellgren-Lawrence grade II) was regarded as potentially useful, as well as for acute and chronic tendinopathies. For chronic lesions (cartilage, tendons), multiple injections (2–4) were seen preferable to singular injections. However, no sufficient data exists on the time interval between the injections. Standardization of PRP preparation, application, frequency, as well as determining the range of indication is strongly recommended. Conclusions There is a need of further standardization of the PRP preparation methods, indication and application protocols for knee OA and other indications, which must be further evaluated in basic science studies and randomized controlled clinical trials. Level of evidence Consensus of expert opinion, Level V.
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Affiliation(s)
- T Tischer
- Department of Orthopaedic Surgery, University medicine Rostock, Doberanerstr. 142, 18057, Rostock, Germany.
| | - G Bode
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - M Buhs
- Norddeutsches Knorpelcentrum, COVZ Quickborn, Quickborn, Germany
| | - B Marquass
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universität Leipzig, Leipzig, Germany
| | - S Nehrer
- Donau University Krems, Krems, Austria
| | - S Vogt
- Klinik für Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
| | - W Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital, Dinslaken, Germany
| | - P Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - G Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach and Jena University Hospital, Jena, Germany
| | - G H Welsch
- UKE Athleticum, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Niemeyer
- OCM Gemeinschaftspraxis, Munich, Germany
| | - H Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
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21
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Wu P, Sheth N, Sisniega A, Uneri A, Han R, Vijayan R, Vagdargi P, Kreher B, Kunze H, Kleinszig G, Vogt S, Lo SF, Theodore N, Siewerdsen JH. C-arm orbits for metal artifact avoidance (MAA) in cone-beam CT. Phys Med Biol 2020; 65:165012. [PMID: 32428891 PMCID: PMC8650760 DOI: 10.1088/1361-6560/ab9454] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Metal artifacts present a challenge to cone-beam CT (CBCT) image-guided surgery, obscuring visualization of metal instruments and adjacent anatomy-often in the very region of interest pertinent to the imaging/surgical tasks. We present a method to reduce the influence of metal artifacts by prospectively defining an image acquisition protocol-viz., the C-arm source-detector orbit-that mitigates metal-induced biases in the projection data. The metal artifact avoidance (MAA) method is compatible with simple mobile C-arms, does not require exact prior information on the patient or metal implants, and is consistent with 3D filtered backprojection (FBP), more advanced (e.g. polyenergetic) model-based image reconstruction (MBIR), and metal artifact reduction (MAR) post-processing methods. The MAA method consists of: (i) coarse localization of metal objects in the field-of-view (FOV) via two or more low-dose scout projection views and segmentation (e.g. a simple U-Net) in coarse backprojection; (ii) model-based prediction of metal-induced x-ray spectral shift for all source-detector vertices accessible by the imaging system (e.g. gantry rotation and tilt angles); and (iii) identification of a circular or non-circular orbit that reduces the variation in spectral shift. The method was developed, tested, and evaluated in a series of studies presenting increasing levels of complexity and realism, including digital simulations, phantom experiment, and cadaver experiment in the context of image-guided spine surgery (pedicle screw implants). The MAA method accurately predicted tilted circular and non-circular orbits that reduced the magnitude of metal artifacts in CBCT reconstructions. Realistic distributions of metal instrumentation were successfully localized (0.71 median Dice coefficient) from 2-6 low-dose scout views even in complex anatomical scenes. The MAA-predicted tilted circular orbits reduced root-mean-square error (RMSE) in 3D image reconstructions by 46%-70% and 'blooming' artifacts (apparent width of the screw shaft) by 20-45%. Non-circular orbits defined by MAA achieved a further ∼46% reduction in RMSE compared to the best (tilted) circular orbit. The MAA method presents a practical means to predict C-arm orbits that minimize spectral bias from metal instrumentation. Resulting orbits-either simple tilted circular orbits or more complex non-circular orbits that can be executed with a motorized multi-axis C-arm-exhibited substantial reduction of metal artifacts in raw CBCT reconstructions by virtue of higher fidelity projection data, which are in turn compatible with subsequent MAR post-processing and/or polyenergetic MBIR to further reduce artifacts.
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Affiliation(s)
- P Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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22
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Vogt S, Schreiber S, Pfau G, Kollewe K, Heinze HJ, Dengler R, Petri S, Vielhaber S, Brinkers M. Dyspnea as a Fatigue-Promoting Factor in ALS and the Role of Objective Indicators of Respiratory Impairment. J Pain Symptom Manage 2020; 60:430-438.e1. [PMID: 32145336 DOI: 10.1016/j.jpainsymman.2020.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT There is no evidence-based treatment for fatigue in amyotrophic lateral sclerosis (ALS), and identification of treatable causes determines management strategies. Although dyspnea is a key symptom of ALS and effectively treatable, it has not been sufficiently investigated whether dyspnea may be a fatigue-promoting factor. OBJECTIVES To determine the level of fatigue in dyspneic ALS patients and whether fatigue is promoted by dyspnea. We further evaluated the correlation of fatigue with respiratory function tests. METHODS About 101 dyspneic patients and 20 matched controls completed the ALS Functional Rating Scale-Extension and the Fatigue Severity Scale. Dyspneic patients additionally completed the Dyspnea-ALS Scale and the ALS Assessment Questionnaire and underwent respiratory function tests (forced vital capacity, sniff nasal inspiratory pressure, mean inspiratory and expiratory pressure with respective relaxation rates, and blood gases). Multiple regression and correlation analyses were conducted. RESULTS Dyspneic patients had significantly higher fatigue scores than nondyspneic patients, and their fatigue significantly affected quality of life. Dyspnea alone explained up to 24% of the variance in fatigue. No associations were observed between fatigue and respiratory function tests. Patients with noninvasive ventilation reported significantly more dyspnea and fatigue. CONCLUSION Fatigue is a frequent and bothersome symptom in dyspneic ALS patients. Dyspnea-related distress is, in contrast to objective indicators of respiratory impairment, a determining factor of experienced fatigue. There is an urgent need for further symptom relief beyond noninvasive ventilation. Adequate treatment of dyspnea has the potential for synergies in symptom management arising from the association between fatigue and dyspnea.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Giselher Pfau
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Michael Brinkers
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany
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23
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Han R, Uneri A, Ketcha M, Vijayan R, Sheth N, Wu P, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH. Multi-body 3D-2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery. Phys Med Biol 2020; 65:135009. [PMID: 32217833 PMCID: PMC8647002 DOI: 10.1088/1361-6560/ab843c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Surgical reduction of pelvic dislocation is a challenging procedure with poor long-term prognosis if reduction does not accurately restore natural morphology. The procedure often requires long fluoroscopic exposure times and trial-and-error to achieve accurate reduction. We report a method to automatically compute the target pose of dislocated bones in preoperative CT and provide 3D guidance of reduction using routine 2D fluoroscopy. A pelvic statistical shape model (SSM) and a statistical pose model (SPM) were formed from an atlas of 40 pelvic CT images. Multi-body bone segmentation was achieved by mapping the SSM to a preoperative CT via an active shape model. The target reduction pose for the dislocated bone is estimated by fitting the poses of undislocated bones to the SPM. Intraoperatively, multiple bones are registered to fluoroscopy images via 3D-2D registration to obtain 3D pose estimates from 2D images. The method was examined in three studies: (1) a simulation study of 40 CT images simulating a range of dislocation patterns; (2) a pelvic phantom study with controlled dislocation of the left innominate bone; (3) a clinical case study investigating feasibility in images acquired during pelvic reduction surgery. Experiments investigated the accuracy of registration as a function of initialization error (capture range), image quality (radiation dose and image noise), and field of view (FOV) size. The simulation study achieved target pose estimation with translational error of median 2.3 mm (1.4 mm interquartile range, IQR) and rotational error of 2.1° (1.3° IQR). 3D-2D registration yielded 0.3 mm (0.2 mm IQR) in-plane and 0.3 mm (0.2 mm IQR) out-of-plane translational error, with in-plane capture range of ±50 mm and out-of-plane capture range of ±120 mm. The phantom study demonstrated 3D-2D target registration error of 2.5 mm (1.5 mm IQR), and the method was robust over a large dose range, down to 5 [Formula: see text]Gy/frame (an order of magnitude lower than the nominal fluoroscopic dose). The clinical feasibility study demonstrated accurate registration with both preoperative and intraoperative radiographs, yielding 3.1 mm (1.0 mm IQR) projection distance error with robust performance for FOV ranging from 340 × 340 mm2 to 170 × 170 mm2 (at the image plane). The method demonstrated accurate estimation of the target reduction pose in simulation, phantom, and a clinical feasibility study for a broad range of dislocation patterns, initialization error, dose levels, and FOV size. The system provides a novel means of guidance and assessment of pelvic reduction from routinely acquired preoperative CT and intraoperative fluoroscopy. The method has the potential to reduce radiation dose by minimizing trial-and-error and to improve outcomes by guiding more accurate reduction of joint dislocations.
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Affiliation(s)
- R Han
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - A Uneri
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - M Ketcha
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - R Vijayan
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - N Sheth
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - P Wu
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - P Vagdargi
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
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24
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Hensiek N, Schreiber F, Wimmer T, Kaufmann J, Machts J, Fahlbusch L, Garz C, Vogt S, Prudlo J, Dengler R, Petri S, Nestor PJ, Vielhaber S, Schreiber S. Sonographic and 3T-MRI-based evaluation of the tongue in ALS. Neuroimage Clin 2020; 26:102233. [PMID: 32171167 PMCID: PMC7068685 DOI: 10.1016/j.nicl.2020.102233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 02/29/2020] [Indexed: 10/27/2022]
Abstract
A few systematic imaging studies employing ultrasound (HRUS) and magnetic resonance imaging (MRI) have suggested tongue measures to aid in diagnosis of amyotrophic lateral sclerosis (ALS). The relationship between structural tongue alterations and the ALS patients' bulbar and overall motor function has not yet been elucidated. We here thus aimed to understand how in-vivo tongue alterations relate to motor function and motor function evolution over time in ALS. Our study included 206 ALS patients and 104 age- and sex-matched controls that underwent HRUS and 3T MRI of the tongue at baseline. Sonographic measures comprised coronal tongue echointensity, area, height, width and height/width ratio, while MRI measures comprised sagittal T1 intensity, tongue area, position and shape. Imaging-derived markers were related to baseline and longitudinal bulbar and overall motor function. Baseline T1 intensity was lower in ALS patients with more severe bulbar involvement at baseline. Smaller baseline coronal (HRUS) and sagittal (MRI) tongue area, smaller coronal height (HRUS) and width (HRUS) as well as more rounded sagittal tongue shape predicated more rapid functional impairment - not only of bulbar, but also of overall motor function - in ALS. Our results suggest that in-vivo sonography und MRI tongue measures could aid as biomarkers to reflect bulbar and motor function impairment.
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Affiliation(s)
- Nathalie Hensiek
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Thomas Wimmer
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Laura Fahlbusch
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Cornelia Garz
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - Johannes Prudlo
- Department of Neurology, Rostock University Medical Center, Germany; German Center for Neurodegenerative Diseases (DNZE) within the Helmholtz Association, Rostock, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Peter J Nestor
- Queensland Brain Institute, University of Queensland, Brisbane 4072, Australia
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany; Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany; Center for behavioral brain sciences (CBBS), Magdeburg, Germany.
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25
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Kieninger-Gräfitsch A, Vogt S, Ribi C, Dubler D, Chizzolini C, Huynh-Do U, Osthoff M, Trendelenburg M. No association of complement mannose-binding lectin deficiency with cardiovascular disease in patients with Systemic Lupus Erythematosus. Sci Rep 2020; 10:3693. [PMID: 32111865 PMCID: PMC7048794 DOI: 10.1038/s41598-020-60523-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/10/2020] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular (CV) morbidity is the major cause of death in patients with Systemic Lupus Erythematosus (SLE). Previous studies on mannose-binding lectin (MBL) gene polymorphisms in SLE patients suggest that low levels of complement MBL are associated with cardiovascular disease (CVD). However, as large studies on MBL deficiency based on resulting MBL plasma concentrations are lacking, the aim of our study was to analyze the association of MBL concentrations with CVD in SLE patients. Plasma MBL levels SLE patients included in the Swiss SLE Cohort Study were quantified by ELISA. Five different CV organ manifestations were documented. Of 373 included patients (85.5% female) 62 patients had at least one CV manifestation. Patients with MBL deficiency (levels below 500 ng/ml or 1000 ng/ml) had no significantly increased frequency of CVD (19.4% vs. 15.2%, P = 0.3 or 17.7% vs. 15.7%, P = 0.7). After adjustment for traditional CV risk factors, MBL levels and positive antiphospholipid serology (APL+) a significant association of CVD with age, hypertension, disease duration and APL+ was demonstrated. In our study of a large cohort of patients with SLE, we could not confirm previous studies suggesting MBL deficiency to be associated with an increased risk for CVD.
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Affiliation(s)
- A Kieninger-Gräfitsch
- Division of Internal Medicine and Clinical Immunology Lab, Department of Biomedicine, University Hospital and University, Basel, Switzerland.
| | - S Vogt
- Division of Internal Medicine and Clinical Immunology Lab, Department of Biomedicine, University Hospital and University, Basel, Switzerland
| | - C Ribi
- Department of Immunology and Allergy, University Hospital, Lausanne, Switzerland
| | - D Dubler
- Division of Internal Medicine and Clinical Immunology Lab, Department of Biomedicine, University Hospital and University, Basel, Switzerland
| | - C Chizzolini
- Department of Internal Medicine Specialties, Clinical Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland
| | - U Huynh-Do
- Department of Nephrology and Hypertension, University Hospital, Bern, Switzerland
| | - M Osthoff
- Division of Internal Medicine and Clinical Immunology Lab, Department of Biomedicine, University Hospital and University, Basel, Switzerland
| | - M Trendelenburg
- Division of Internal Medicine and Clinical Immunology Lab, Department of Biomedicine, University Hospital and University, Basel, Switzerland
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26
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Vijayan RC, Han R, Wu P, Sheth NM, Ketcha MD, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH, Uneri A. Image-Guided Robotic K-Wire Placement for Orthopaedic Trauma Surgery. Proc SPIE Int Soc Opt Eng 2020; 11315:113151A. [PMID: 36082206 PMCID: PMC9450105 DOI: 10.1117/12.2549713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE We report the initial development of an image-based solution for robotic assistance of pelvic fracture fixation. The approach uses intraoperative radiographs, preoperative CT, and an end effector of known design to align the robot with target trajectories in CT. The method extends previous work to solve the robot-to-patient registration from a single radiographic view (without C-arm rotation) and addresses the workflow challenges associated with integrating robotic assistance in orthopaedic trauma surgery in a form that could be broadly applicable to isocentric or non-isocentric C-arms. METHODS The proposed method uses 3D-2D known-component registration to localize a robot end effector with respect to the patient by: (1) exploiting the extended size and complex features of pelvic anatomy to register the patient; and (2) capturing multiple end effector poses using precise robotic manipulation. These transformations, along with an offline hand-eye calibration of the end effector, are used to calculate target robot poses that align the end effector with planned trajectories in the patient CT. Geometric accuracy of the registrations was independently evaluated for the patient and the robot in phantom studies. RESULTS The resulting translational difference between the ground truth and patient registrations of a pelvis phantom using a single (AP) view was 1.3 mm, compared to 0.4 mm using dual (AP+Lat) views. Registration of the robot in air (i.e., no background anatomy) with five unique end effector poses achieved mean translational difference ~1.4 mm for K-wire placement in the pelvis, comparable to tracker-based margins of error (commonly ~2 mm). CONCLUSIONS The proposed approach is feasible based on the accuracy of the patient and robot registrations and is a preliminary step in developing an image-guided robotic guidance system that more naturally fits the workflow of fluoroscopically guided orthopaedic trauma surgery. Future work will involve end-to-end development of the proposed guidance system and assessment of the system with delivery of K-wires in cadaver studies.
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Affiliation(s)
- R. C. Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - R. Han
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - P. Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - N. M. Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - M. D. Ketcha
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
| | - P. Vagdargi
- Department of Computer Science, Johns Hopkins University, Baltimore MD
| | - S. Vogt
- Siemens Healthineers, Forchheim, Germany
| | | | - G. M. Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore MD
| | - J. H. Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
- Department of Computer Science, Johns Hopkins University, Baltimore MD
| | - A. Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD
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27
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Salzmann-Djufri M, Giessler T, Rohrbach S, Knapp F, Ling L, Vogt S, Mirow N, Böning A, Niemann B. New-Onset Atrial Fibrillation—Metabolic Markers, Cytokines, and Remodeling Anticipating Paroxysmal Atrial Fibrillation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Ramzan R, Rhiel A, Weber P, Irqsusi M, Vondran M, Rastan A, Vogt S. Papaverine Blocks Vasospasm but Induces ROS in Cardiac Mitochondria. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Giorgetti A, Mogler L, Halter S, Haschimi B, Alt A, Rentsch D, Schmidt B, Thoma V, Vogt S, Auwärter V. Four cases of death involving the novel synthetic cannabinoid 5F-Cumyl-PEGACLONE. Forensic Toxicol 2019. [DOI: 10.1007/s11419-019-00514-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Purpose
Cumyl-PEGACLONE was the first synthetic cannabinoid (SC) with a γ-carbolinone core structure detected in forensic casework and, since then, it has dominated the German SC-market. Here the first four cases of death involving its fluorinated analog, 5F-Cumyl-PEGACLONE, a recently emerged γ-carbolinone derived SC, are reported.
Methods
Complete postmortem examinations were performed. Postmortem samples were screened by immunoassay, gas chromatography mass spectrometry (GC–MS) or liquid chromatography tandem mass spectrometry. For quantification of SCs, the standard addition method was employed. Herbal blends were analyzed by GC–MS. In each case of death, the Toxicological Significance Score (TSS) was assigned to the compound.
Results
5F-Cumyl-PEGACLONE was identified at concentrations ranging 0.09–0.45 ng/mL in postmortem femoral blood. In case 1, signs of hypothermia and kidney bleedings were noted. Despite a possible tolerance due to long term SC use, a TSS of 3 was assigned. In case 2, an acute heroin intoxication occurred and a contributory role (TSS = 1) of 5F-Cumyl-PEGACLONE was suggested. In case 3, a prisoner was found dead. GC–MS analysis of herbal blends, retrieved in his cell together with paraphernalia, confirmed the presence of 5F-Cumyl-PEGACLONE and a causative role was deemed probable (TSS = 2). In case 4, the aspiration of gastric content due to a SC-induced coma was observed (TSS = 3).
Conclusions
5F-Cumyl-PEGACLONE is an emerging and extremely potent SC which raises serious public health concerns. A comprehensive analysis of circumstantial, clinical, and postmortem findings, as well as an in-depth toxicological analysis is necessary for a valid interpretation and for the assessment of the toxicological significance.
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30
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Morris EK, Morris DJP, Vogt S, Gleber SC, Bigalke M, Wilcke W, Rillig MC. Visualizing the dynamics of soil aggregation as affected by arbuscular mycorrhizal fungi. ISME J 2019; 13:1639-1646. [PMID: 30742058 PMCID: PMC6775962 DOI: 10.1038/s41396-019-0369-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/30/2018] [Accepted: 01/19/2019] [Indexed: 11/09/2022]
Abstract
Stable soils provide valuable ecosystem services and mechanical soil stability is enhanced by the presence of arbuscular mycorrhizal fungi (AMF). Soil aggregation, which is the major driver of mechanical soil stability, is often treated as a static phenomenon, even though aggregate turnover is continually ongoing. In fact, some breakdown of macroaggregates is necessary to allow new aggregate formation and inclusion of new organic matter into microaggregates. We determined how aggregate turnover times were affected by AMF by tracking movement of rare earth elements (REE), applied as their immobile oxides, between aggregate size classes, and using X-ray fluorescence microscopy to spatially localize REEs in a sample of aggregates. Here we show that AMF increased large macroaggregate formation and slowed down disintegration of large and small macroaggregates. Microaggregate turnover was increased in the presence of AMF. Internal aggregate organization suggested that although formation of microaggregates by accretion of soil to particulate organic matter is common, it is not the only mechanism in operation.
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Affiliation(s)
- E K Morris
- Department of Biology, Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207, USA.
- Institut für Biologie, Pflanzenökologie, Freie Universität Berlin, Altensteinstr. 6, 14195, Berlin, Germany.
| | - D J P Morris
- Department of Physics, Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207, USA
| | - S Vogt
- Advanced Photon Source, Argonne National Laboratory, 9700 South Cass Ave., Lemont, IL, 60439, USA
| | - S-C Gleber
- Advanced Photon Source, Argonne National Laboratory, 9700 South Cass Ave., Lemont, IL, 60439, USA
- Institut für Röntgenphysik, Georg-August-Universität Göttingen, Friedrich-Hund-Platz 1, 37077, Göttingen, Germany
| | - M Bigalke
- Institute of Geography, University of Bern, Hallerstrasse 12, 3012, Bern, Switzerland
| | - W Wilcke
- Institut für Geographie und Geoökologie, Karlsruher Institut für Technologie (KIT), Reinhard-Baumeister-Platz 1, 76131, Karlsruhe, Germany
| | - M C Rillig
- Institut für Biologie, Pflanzenökologie, Freie Universität Berlin, Altensteinstr. 6, 14195, Berlin, Germany
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Vogt S, Schreiber S, Kollewe K, Körner S, Heinze HJ, Dengler R, Petri S, Vielhaber S. Dyspnea in amyotrophic lateral sclerosis: The Dyspnea-ALS-Scale (DALS-15) essentially contributes to the diagnosis of respiratory impairment. Respir Med 2019; 154:116-121. [PMID: 31234039 DOI: 10.1016/j.rmed.2019.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/29/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dyspnea is a cardinal but often underestimated symptom in amyotrophic lateral sclerosis (ALS). The newly developed Dyspnea-ALS-Scale (DALS-15) is highly relevant for therapeutic decisions because dyspnea is a separate criterion to consider noninvasive ventilation (NIV) in ALS. In comparison to the limited effects of neuroprotective compounds, NIV has the greatest impact on survival and improves quality of life. OBJECTIVE To investigate whether dyspnea corresponds to parameters of respiratory status mainly used in clinical neurological practice. We also investigated if the DALS-15 could help identify patients for consideration of NIV in whom neither spirometry nor blood gas parameters indicate the need for NIV (forced vital capacity (FVC) < 50% or probable <75%, pCO2 ≥45 mmHg). METHODS Seventy ALS patients with dyspnea according to the DALS-15 obtained blood gas analysis and spirometry (FVC in sitting and supine positions). The supine decline in FVC was calculated. RESULTS There was no linear relationship between dyspnea and spirometry as well as blood gases. 83% of our patients had an upright FVC still greater than 50% and no daytime hypercapnia. CONCLUSIONS Our study clearly shows that dyspnea can occur independently of objective indicators of respiratory impairment like spirometry or blood gases. Hence, the DALS-15 covers another aspect of respiratory impairment than these tests and refers to the subjective component of respiratory impairment. It detects dyspnea in a considerable proportion of patients in whom NIV should thus be considered although their spirometric and blood gas results do not point towards NIV. The DALS-15 therefore may help to improve the stratification of patients with respiratory impairment for more efficient symptom management and timely coordination of care.
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Affiliation(s)
- S Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - K Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H-J Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - R Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - S Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
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Vogt S, Schreiber S, Heinze HJ, Dengler R, Petri S, Vielhaber S. The Dyspnea-ALS-Scale (DALS-15) optimizes individual treatment in patients with amyotrophic lateral sclerosis (ALS) suffering from dyspnea. Health Qual Life Outcomes 2019; 17:95. [PMID: 31159830 PMCID: PMC6547457 DOI: 10.1186/s12955-019-1167-0] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dyspnea is frequent in amyotrophic lateral sclerosis (ALS) and one of the most bothersome symptoms. The recently developed Dyspnea-ALS-Scale (DALS-15) is a disease-specific patient-reported outcome to detect and quantify dyspnea. OBJECTIVES To analyze in a case-based approach the diagnostic and clinical implications and the benefit of the DALS-15 for individual patients in daily clinical routine. METHODS Dyspnea was assessed by the 15-item comprising DALS-15 in two patients with ALS. Spirometry was performed and blood gases were analyzed. Results were evaluated in the clinical context of the respective patients. RESULTS In one patient the presence of dyspnea detected by the DALS-15 indicated noninvasive ventilation (NIV) although forced vital capacity (FVC) and blood gas analysis were well preserved. After NIV implementation, the DALS-15 was helpful to determine the patient's need for medication, the timing of NIV titration and the adaptation of NIV sessions. In another patient, who was anarthric and no longer able to perform spirometry due to severe bulbar impairment, the DALS-15 allowed a standardized assessment of dyspnea-related distress independently of bulbar dysfunction. CONCLUSION The DALS-15 provides a deeper insight into the respiratory status of individual patients. It helps to diagnose respiratory impairment in patients in whom NIV should be considered although FVC and blood gas results do not reveal indication for NIV. It is also valuable for the guidance of patients in later stages of respiratory impairment when NIV is already implemented, and in patients with severe bulbar dysfunction. The DALS-15 can improve specific symptom management and coordination of care and therefore has the potential to optimize individual treatment in ALS patients with dyspnea.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases, Leipziger Str. 44, D-39120 Magdeburg, Germany
- Leibniz Institute for Neurobiology, Brenneckestraße 6, D-39118 Magdeburg, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases, Leipziger Str. 44, D-39120 Magdeburg, Germany
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Han R, Uneri A, De Silva T, Ketcha M, Goerres J, Vogt S, Kleinszig G, Osgood G, Siewerdsen JH. Atlas-based automatic planning and 3D–2D fluoroscopic guidance in pelvic trauma surgery. ACTA ACUST UNITED AC 2019; 64:095022. [DOI: 10.1088/1361-6560/ab1456] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Blanke F, Vogt S. Regeneration artikulärer Knorpeldefekte am Kniegelenk. Arthroskopie 2019. [DOI: 10.1007/s00142-019-0277-3] [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: 11/28/2022]
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Krauth R, Schwertner J, Vogt S, Lindquist S, Sailer M, Sickert A, Lamprecht J, Perdikis S, Corbet T, Millán JDR, Hinrichs H, Heinze HJ, Sweeney-Reed CM. Cortico-Muscular Coherence Is Reduced Acutely Post-stroke and Increases Bilaterally During Motor Recovery: A Pilot Study. Front Neurol 2019; 10:126. [PMID: 30842752 PMCID: PMC6391349 DOI: 10.3389/fneur.2019.00126] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 09/10/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Motor recovery following stroke is believed to necessitate alteration in functional connectivity between cortex and muscle. Cortico-muscular coherence has been proposed as a potential biomarker for post-stroke motor deficits, enabling a quantification of recovery, as well as potentially indicating the regions of cortex involved in recovery of function. We recorded simultaneous EEG and EMG during wrist extension from healthy participants and patients following ischaemic stroke, evaluating function at three time points post-stroke. EEG–EMG coherence increased over time, as wrist mobility recovered clinically, and by the final evaluation, coherence was higher in the patient group than in the healthy controls. Moreover, the cortical distribution differed between the groups, with coherence involving larger and more bilaterally scattered areas of cortex in the patients than in the healthy participants. The findings suggest that EEG–EMG coherence has the potential to serve as a biomarker for motor recovery and to provide information about the cortical regions that should be targeted in rehabilitation therapies based on real-time EEG.
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Affiliation(s)
- Richard Krauth
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Johanna Schwertner
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Michael Sailer
- MEDIAN Klinik, Neurological Rehabilitation Center, Magdeburg, Germany.,Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Magdeburg, Germany
| | - Almut Sickert
- MEDIAN Klinik, Neurological Rehabilitation Center, Magdeburg, Germany
| | - Juliane Lamprecht
- Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Magdeburg, Germany
| | - Serafeim Perdikis
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.,Brain-Computer Interfaces and Neural Engineering Laboratory, School of Computer Science and Electronic Engineering, University of Essex, Colchester, United Kingdom
| | - Tiffany Corbet
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Hermann Hinrichs
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Centre for Neurodegenerative Diseases, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Centre for Neurodegenerative Diseases, Magdeburg, Germany
| | - Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
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Irqsusi M, Mansouri L, Ramaswamy A, Ramzan R, Vogt S, Mirow N, Rastan A. Differential Expression of Matrix Metalloproteinases 1 and 9 and Tissue Inhibitors 1 and 2 in Mitral Valve Disease—Indicators for Progression of the Disease? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Irqsusi
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - L. Mansouri
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Ramaswamy
- Institute for Pathology, Philipps-University, Marburg, Germany
| | - R. Ramzan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - S. Vogt
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - N. Mirow
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Rastan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
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37
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Van Laethem J, Figiel J, Mahnken H, Ramzan R, Irqsusi M, Mirow N, Vogt S, Rastan A. Predictive Value of Anatomic Papillary Muscle Positioning for the Development of Mitral Valve Insufficiency. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - J. Figiel
- Philipps-University, Klinik für Diagnostische und Interventionelle Radiologie, Marburg, Germany
| | - H. Mahnken
- Philipps-University, Klinik für Diagnostische und Interventionelle Radiologie, Marburg, Germany
| | - R. Ramzan
- Philipps-University, Heart Surgery, Marburg, Germany
| | - M. Irqsusi
- Philipps-University, Heart Surgery, Marburg, Germany
| | - N. Mirow
- Philipps-University, Heart Surgery, Marburg, Germany
| | - S. Vogt
- Philipps-University, Heart Surgery, Marburg, Germany
| | - A. Rastan
- Philipps-University, Heart Surgery, Marburg, Germany
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38
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Ramzan R, Michels S, Weber P, Rhiel A, Irqsusi M, Rastan A, Culmsee C, Vogt S. Protamine Sulfate Used in Cardiac Surgery Influences Mitochondrial Bioenergetics Profile and Induces Reactive Oxygen Species Production. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Ramzan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - S. Michels
- Institute of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany
| | - P. Weber
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Rhiel
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - M. Irqsusi
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Rastan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - C. Culmsee
- Institute of Pharmacology and Clinical Pharmacy, Philipps-University, Marburg, Germany
| | - S. Vogt
- Department of Heart Surgery, Philipps-University, Marburg, Germany
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Volevski L, Andrási B, Irqsusi M, Vondran M, Vogt S, Mirow N, Rastan A. Impact of Aortic Pathology on Stent-Graft-Induced Postimplantation Syndrome. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Volevski
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - B. Andrási
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - M. Irqsusi
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - M. Vondran
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - S. Vogt
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - N. Mirow
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - A. Rastan
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
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40
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Vogt S, Petri S, Dengler R, Heinze HJ, Vielhaber S. Dyspnea in Amyotrophic Lateral Sclerosis: Rasch-Based Development and Validation of a Patient-Reported Outcome (DALS-15). J Pain Symptom Manage 2018; 56:736-745.e2. [PMID: 30145215 DOI: 10.1016/j.jpainsymman.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Dyspnea is a cardinal but often underestimated symptom in amyotrophic lateral sclerosis (ALS). The lack of a satisfying assessment tool leads to diagnostic uncertainty and bears the risk that established life-prolonging and symptom-relieving therapeutic options will not be adequately applied. OBJECTIVES The objective of this study was to develop and validate a German language disease-specific patient-reported outcome measure to assess dyspnea in ALS by combination of a qualitative and quantitative approach using Rasch analysis. METHODS Based on input from clinical experts and patients, a preliminary 35-item questionnaire was developed and completed by 94 patients with ALS having dyspnea. Data were subjected to Rasch analysis and tested for required measurement issues such as appropriate response categories, the absence of differential item functioning, local independence, and unidimensionality. RESULTS After iterative Rasch analyses, the final 15-item Dyspnea-ALS-Scale (DALS-15) was obtained. The scale satisfies the axioms of the Rasch model with good fit statistics, the absence of local dependency, and differential item functioning as well as acceptable unidimensionality. The DALS-15 is optimally targeted and suitable for group and individual use. It shows excellent test-retest reliability and convergent validity. CONCLUSION The DALS-15 satisfies strictest modern measurement criteria and has interval scale properties. It fills an important gap in assessment and could be most helpful to optimize symptom management in patients with ALS.
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Affiliation(s)
- Susanne Vogt
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases, Magdeburg, Germany
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De Silva T, Uneri A, Zhang X, Ketcha M, Han R, Sheth N, Martin A, Vogt S, Kleinszig G, Belzberg A, Sciubba DM, Siewerdsen JH. Real-time, image-based slice-to-volume registration for ultrasound-guided spinal intervention. Phys Med Biol 2018; 63:215016. [PMID: 30372418 DOI: 10.1088/1361-6560/aae761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Real-time fusion of magnetic resonance (MR) and ultrasound (US) images could facilitate safe and accurate needle placement in spinal interventions. We develop an entirely image-based registration method (independent of or complementary to surgical trackers) that includes an efficient US probe pose initialization algorithm. The registration enables the simultaneous display of 2D ultrasound image slices relative to 3D pre-procedure MR images for navigation. A dictionary-based 3D-2D pose initialization algorithm was developed in which likely probe positions are predefined in a dictionary with feature encoding by Haar wavelet filters. Feature vectors representing the 2D US image are computed by scaling and translating multiple Haar basis filters to capture scale, location, and relative intensity patterns of distinct anatomical features. Following pose initialization, fast 3D-2D registration was performed by optimizing normalized cross-correlation between intra- and pre-procedure images using Powell's method. Experiments were performed using a lumbar puncture phantom and a fresh cadaver specimen presenting realistic image quality in spinal US imaging. Accuracy was quantified by comparing registration transforms to ground truth motion imparted by a computer-controlled motion system and calculating target registration error (TRE) in anatomical landmarks. Initialization using a 315-length feature vector yielded median translation accuracy of 2.7 mm (3.4 mm interquartile range, IQR) in the phantom and 2.1 mm (2.5 mm IQR) in the cadaver. By comparison, storing the entire image set in the dictionary and optimizing correlation yielded a comparable median accuracy of 2.1 mm (2.8 mm IQR) in the phantom and 2.9 mm (3.5 mm IQR) in the cadaver. However, the dictionary-based method reduced memory requirements by 47× compared to storing the entire image set. The overall 3D error after registration measured using 3D landmarks was 3.2 mm (1.8 mm IQR) mm in the phantom and 3.0 mm (2.3 mm IQR) mm in the cadaver. The system was implemented in a 3D Slicer interface to facilitate translation to clinical studies. Haar feature based initialization provided accuracy and robustness at a level that was sufficient for real-time registration using an entirely image-based method for ultrasound navigation. Such an approach could improve the accuracy and safety of spinal interventions in broad utilization, since it is entirely software-based and can operate free from the cost and workflow requirements of surgical trackers.
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Affiliation(s)
- T De Silva
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States of America
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Bachlechner U, Boeing H, Haftenberger M, Schienkiewitz A, Scheidt-Nave C, Vogt S, Thorand B, Peters A, Schipf S, Ittermann T, Völzke H, Nöthlings U, Neamat-Allah J, Greiser KH, Kaaks R, Steffen A. Predicting risk of substantial weight gain in German adults-a multi-center cohort approach. Eur J Public Health 2018; 27:768-774. [PMID: 28013243 PMCID: PMC5881755 DOI: 10.1093/eurpub/ckw216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background A risk-targeted prevention strategy may efficiently utilize limited resources available for prevention of overweight and obesity. Likewise, more efficient intervention trials could be designed if selection of subjects was based on risk. The aim of the study was to develop a risk score predicting substantial weight gain among German adults. Methods We developed the risk score using information on 15 socio-demographic, dietary and lifestyle factors from 32 204 participants of five population-based German cohort studies. Substantial weight gain was defined as gaining ≥10% of weight between baseline and follow-up (>6 years apart). The cases were censored according to the theoretical point in time when the threshold of 10% baseline-based weight gain was crossed assuming linearity of weight gain. Beta coefficients derived from proportional hazards regression were used as weights to compute the risk score as a linear combination of the predictors. Cross-validation was used to evaluate the score's discriminatory accuracy. Results The cross-validated c index (95% CI) was 0.71 (0.67-0.75). A cutoff value of ≥475 score points yielded a sensitivity of 71% and a specificity of 63%. The corresponding positive and negative predictive values were 10.4% and 97.6%, respectively. Conclusions The proposed risk score may support healthcare providers in decision making and referral and facilitate an efficient selection of subjects into intervention trials.
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Affiliation(s)
- Ursula Bachlechner
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Marjolein Haftenberger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Susanne Vogt
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Diabetes Research, Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Diabetes Research, Site Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Ute Nöthlings
- Department of Nutrition and Food Science, Institute for Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Jasmine Neamat-Allah
- Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Karin-Halina Greiser
- Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Annika Steffen
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
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Jacobson MW, Ketcha MD, Capostagno S, Martin A, Uneri A, Goerres J, De Silva T, Reaungamornrat S, Han R, Manbachi A, Stayman JW, Vogt S, Kleinszig G, Siewerdsen JH. A line fiducial method for geometric calibration of cone-beam CT systems with diverse scan trajectories. Phys Med Biol 2018; 63:025030. [PMID: 29116058 PMCID: PMC5868366 DOI: 10.1088/1361-6560/aa9910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Modern cone-beam CT systems, especially C-arms, are capable of diverse source-detector orbits. However, geometric calibration of these systems using conventional configurations of spherical fiducials (BBs) may be challenged for novel source-detector orbits and system geometries. In part, this is because the BB configurations are designed with careful forethought regarding the intended orbit so that BB marker projections do not overlap in projection views. Examples include helical arrangements of BBs (Rougee et al 1993 Proc. SPIE 1897 161-9) such that markers do not overlap in projections acquired from a circular orbit and circular arrangements of BBs (Cho et al 2005 Med. Phys. 32 968-83). As a more general alternative, this work proposes a calibration method based on an array of line-shaped, radio-opaque wire segments. With this method, geometric parameter estimation is accomplished by relating the 3D line equations representing the wires to the 2D line equations of their projections. The use of line fiducials simplifies many challenges with fiducial recognition and extraction in an orbit-independent manner. For example, their projections can overlap only mildly, for any gantry pose, as long as the wires are mutually non-coplanar in 3D. The method was tested in application to circular and non-circular trajectories in simulation and in real orbits executed using a mobile C-arm prototype for cone-beam CT. Results indicated high calibration accuracy, as measured by forward and backprojection/triangulation error metrics. Triangulation errors on the order of microns and backprojected ray deviations uniformly less than 0.2 mm were observed in both real and simulated orbits. Mean forward projection errors less than 0.1 mm were observed in a comprehensive sweep of different C-arm gantry angulations. Finally, successful integration of the method into a CT imaging chain was demonstrated in head phantom scans.
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Affiliation(s)
- M W Jacobson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, United States of America
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Niemann B, Salzmann M, Giesler T, Rohrbach S, Mirow N, Vogt S, Grieshaber P, Roth P, Böning A. New Onset Postoperative Atrial Fibrillation: Relevance of Peri- and Intraoperative Characteristics for Incidence of Atrial Fibrillation and Patient Outcome? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Niemann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - M. Salzmann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - T. Giesler
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - S. Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Giessen, Germany
| | - N. Mirow
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - S. Vogt
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - P. Grieshaber
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
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45
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Goerres J, Uneri A, Jacobson M, Ramsay B, De Silva T, Ketcha M, Han R, Manbachi A, Vogt S, Kleinszig G, Wolinsky JP, Osgood G, Siewerdsen JH. Planning, guidance, and quality assurance of pelvic screw placement using deformable image registration. Phys Med Biol 2017; 62:9018-9038. [PMID: 29058687 PMCID: PMC5868367 DOI: 10.1088/1361-6560/aa954f] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Percutaneous pelvic screw placement is challenging due to narrow bone corridors surrounded by vulnerable structures and difficult visual interpretation of complex anatomical shapes in 2D x-ray projection images. To address these challenges, a system for planning, guidance, and quality assurance (QA) is presented, providing functionality analogous to surgical navigation, but based on robust 3D-2D image registration techniques using fluoroscopy images already acquired in routine workflow. Two novel aspects of the system are investigated: automatic planning of pelvic screw trajectories and the ability to account for deformation of surgical devices (K-wire deflection). Atlas-based registration is used to calculate a patient-specific plan of screw trajectories in preoperative CT. 3D-2D registration aligns the patient to CT within the projective geometry of intraoperative fluoroscopy. Deformable known-component registration (dKC-Reg) localizes the surgical device, and the combination of plan and device location is used to provide guidance and QA. A leave-one-out analysis evaluated the accuracy of automatic planning, and a cadaver experiment compared the accuracy of dKC-Reg to rigid approaches (e.g. optical tracking). Surgical plans conformed within the bone cortex by 3-4 mm for the narrowest corridor (superior pubic ramus) and >5 mm for the widest corridor (tear drop). The dKC-Reg algorithm localized the K-wire tip within 1.1 mm and 1.4° and was consistently more accurate than rigid-body tracking (errors up to 9 mm). The system was shown to automatically compute reliable screw trajectories and accurately localize deformed surgical devices (K-wires). Such capability could improve guidance and QA in orthopaedic surgery, where workflow is impeded by manual planning, conventional tool trackers add complexity and cost, rigid tool assumptions are often inaccurate, and qualitative interpretation of complex anatomy from 2D projections is prone to trial-and-error with extended fluoroscopy time.
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Affiliation(s)
- J Goerres
- Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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46
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Vogt S, Kauschke C. Observing iconic gestures enhances word learning in typically developing children and children with specific language impairment. J Child Lang 2017; 44:1458-1484. [PMID: 28112055 DOI: 10.1017/s0305000916000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Research has shown that observing iconic gestures helps typically developing children (TD) and children with specific language impairment (SLI) learn new words. So far, studies mostly compared word learning with and without gestures. The present study investigated word learning under two gesture conditions in children with and without language impairment. Twenty children with SLI (age four), twenty age-matched TD children, and twenty language-matched TD children were taught words that were presented with either iconic or non-iconic gestures. Results showed that children of all groups benefited more successfully from observing iconic gestures for word learning. The iconic gesture advantage was similar across groups. Thus, observing iconic gestures prompts richer encoding and makes word learning more efficient in TD and language impaired children.
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Affiliation(s)
- Susanne Vogt
- University of Applied Sciences Fresenius,Germany
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Phillips A, Strobl R, Vogt S, Ladwig KH, Thorand B, Grill E. Sarcopenia is associated with disability status-results from the KORA-Age study. Osteoporos Int 2017; 28:2069-2079. [PMID: 28386704 DOI: 10.1007/s00198-017-4027-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/29/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED We estimated the prevalence of sarcopenia and its impact on disability in older people. Sarcopenia was found to contribute to higher disability scores. However, our study was not able to show any influence of sarcopenia on the rate of functional decline. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not. INTRODUCTION The objectives of this study using data from a population-based cohort were to estimate the prevalence of sarcopenia in older people in Germany and to test the hypothesis that sarcopenia is associated with disability in older adults. METHODS Cross-sectional (n = 927) and longitudinal analyses (n = 859) of participants aged ≥65 years at baseline from southern Germany enrolled in the Cooperative Health Research in the Region Augsburg (KORA)-Age study (2009-2012). Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm which includes the presence of both low muscle mass and low muscle function (strength or performance). Disability status was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). The presence of disability was defined as HAQ-DI >0. Directed acyclic graphs (DAGs) were constructed to identify potential confounders. The effect of sarcopenia on disability was analyzed using linear mixed effect models with disability values as a continuous outcome. RESULTS The overall prevalence of sarcopenia was 5.7% (men 4.0%, women 7.5%) and increased with age. The 3-year incidence of disability was 32.7%. After adjustment for potential confounders, presence of sarcopenia was significantly associated with higher disability scores (0.142 [confidence interval 0.029-0.254]). CONCLUSION The prevalence of sarcopenia is consistent with estimates from other European studies using this algorithm. Our results suggest that sarcopenia can contribute to higher disability scores in older adults. However, our study was not able to show any influence of sarcopenia on the rate of functional decline using the EWGSOP diagnostic algorithm for sarcopenia. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not.
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Affiliation(s)
- A Phillips
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - R Strobl
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Vogt
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - E Grill
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
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48
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Ketcha MD, De Silva T, Uneri A, Jacobson MW, Goerres J, Kleinszig G, Vogt S, Wolinsky JP, Siewerdsen JH. Multi-stage 3D-2D registration for correction of anatomical deformation in image-guided spine surgery. Phys Med Biol 2017; 62:4604-4622. [PMID: 28375139 PMCID: PMC5755708 DOI: 10.1088/1361-6560/aa6b3e] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A multi-stage image-based 3D-2D registration method is presented that maps annotations in a 3D image (e.g. point labels annotating individual vertebrae in preoperative CT) to an intraoperative radiograph in which the patient has undergone non-rigid anatomical deformation due to changes in patient positioning or due to the intervention itself. The proposed method (termed msLevelCheck) extends a previous rigid registration solution (LevelCheck) to provide an accurate mapping of vertebral labels in the presence of spinal deformation. The method employs a multi-stage series of rigid 3D-2D registrations performed on sets of automatically determined and increasingly localized sub-images, with the final stage achieving a rigid mapping for each label to yield a locally rigid yet globally deformable solution. The method was evaluated first in a phantom study in which a CT image of the spine was acquired followed by a series of 7 mobile radiographs with increasing degree of deformation applied. Second, the method was validated using a clinical data set of patients exhibiting strong spinal deformation during thoracolumbar spine surgery. Registration accuracy was assessed using projection distance error (PDE) and failure rate (PDE > 20 mm-i.e. label registered outside vertebra). The msLevelCheck method was able to register all vertebrae accurately for all cases of deformation in the phantom study, improving the maximum PDE of the rigid method from 22.4 mm to 3.9 mm. The clinical study demonstrated the feasibility of the approach in real patient data by accurately registering all vertebral labels in each case, eliminating all instances of failure encountered in the conventional rigid method. The multi-stage approach demonstrated accurate mapping of vertebral labels in the presence of strong spinal deformation. The msLevelCheck method maintains other advantageous aspects of the original LevelCheck method (e.g. compatibility with standard clinical workflow, large capture range, and robustness against mismatch in image content) and extends capability to cases exhibiting strong changes in spinal curvature.
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Affiliation(s)
- M D Ketcha
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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Criquet A, Mai E, Saucourt C, Vogt S, Giganti P, Baron S, Roncalli J, Lairez O, Lagente C, Lebrin M, Ioannides K, Manrique A, Saloux E, Leroux L, Goin V, Roubille F, Lefèvre T, Hovasse T, Vanzetto G, Derenne S, Tertrais K, Newby D, Cruden N, Mills N, Greenwood J, Wheatcroft S, Dickinson A, Black A, Henon P. Challenges between clinical sites and cell therapy facilities in the excellent trial (expanded cell endocardiac transplantation), a phase I/IIb clinical trial. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.037] [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: 10/19/2022]
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50
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Saucourt C, Vogt S, Mai E, Criquet A, Harmand L, Birebent B, Rouard H, Chartois-Leauté A, Derenne S, Black A, Salem J, Douay L, Henon P. Design and validation of a consistent and reproducible manufacture process for the production of clinical-grade CD34+ expanded stem cells. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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