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Regenbogen S, Shafizadeh S, Märdian S, Blum P, Osten P, Fuchs T, Jaecker V. Femoroacetabular Variations Are Predisposing Factors for Traumatic Posterior Hip Dislocation. J Bone Joint Surg Am 2024:00004623-990000000-01058. [PMID: 38557970 DOI: 10.2106/jbjs.23.00905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Although high-energy trauma mechanisms are generally considered to cause traumatic posterior hip dislocations, femoroacetabular variations are assumed to contribute to low-impact hip dislocations. Thus, the present study aimed to identify morphologic femoral and acetabular risk factors that may also contribute to posterior hip dislocations in high-energy trauma mechanisms. METHODS The acetabular and femoral morphology of 83 hips with a traumatic posterior dislocation following a high-energy trauma mechanism were analyzed and matched to a control group of 83 patients who sustained high-energy trauma without a hip injury. The lateral center-edge angle, acetabular index, acetabular depth/width ratio, cranial and central acetabular version angles, and the anterior and posterior acetabular sector angles were measured on computed tomography to quantify femoroacetabular impingement (FAI) morphology, acetabular version, and coverage. The caput-collum-diaphyseal angle and the alpha angles in the coronal and axial planes were measured to detect cam-type FAI deformity. A receiver operating characteristic curve was utilized to determine threshold values for an increased risk of hip dislocation. RESULTS Acetabular retroversion and posterior acetabular undercoverage were significantly increased in patients with hip dislocations compared with controls (p < 0.001). The central acetabular version angle and posterior acetabular sector angle that indicated an increased risk of hip dislocation were ≤9° and ≤90°, respectively. Cam-type FAI deformity and coxa valga were significantly increased in the dislocation group (p < 0.001). The anterolateral alpha angle that indicated an increased dislocation risk was ≥47°. CONCLUSIONS Acetabular retroversion, posterior acetabular undercoverage, and cam-type FAI morphology may be risk factors contributing to traumatic posterior hip dislocation in high-energy trauma mechanisms. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stephan Regenbogen
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murna am Staffelsee, Germany
- Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sven Shafizadeh
- Department of Orthopedic Surgery and Sports Traumatology, Sana Medical Centre, Witten/Herdecke University, Cologne, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
| | - Philipp Blum
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murna am Staffelsee, Germany
| | - Philipp Osten
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Thomas Fuchs
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Vera Jaecker
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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Jaecker V, Zocholl M, Friederichs J, Osten P, Fuchs T, Stuby FM, Regenbogen S. Intermediate to Long-Term Results Following Traumatic Hip Dislocation: Characteristics, CT-Based Analysis, and Patient-Reported Outcome Measures. J Bone Joint Surg Am 2024; 106:346-352. [PMID: 38113303 DOI: 10.2106/jbjs.23.00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Traumatic hip dislocation is a rare yet severe injury. As the long-term morbidity, subsequent complications, and clinical outcomes are nearly unknown, we aimed to analyze traumatic hip dislocations and identify specific factors that may predict the clinical outcome. METHODS Data on injury-related characteristics and computed tomographic (CT) scans for all consecutive adult patients who had been managed for traumatic hip dislocation between 2009 and 2021 were analyzed. At the time of follow-up, the patients were assessed with regard to osteonecrosis, posttraumatic osteoarthritis (OA), further operations and complications, return to sports and work, and patient-reported outcome measures (PROMs), including the Tegner Activity Scale and modified Harris hip score. RESULTS One hundred and twelve patients (mean age [and standard deviation], 43.12 ± 16.6 years) were included. Associated acetabular rim and femoral head fractures (Pipkin Type I to IV) were observed in 44% and 40% of patients, respectively. Concomitant injuries occurred in 67% of the patients, most commonly involving the knee (29% of patients). Sixty-nine patients (61.6%) were available for follow-up; the mean duration of follow-up was 6.02 ± 3.76 years. The rates of osteonecrosis and posttraumatic OA were 13% and 31.9%, respectively, and were independent of the timing of hip reduction, leading to subsequent total hip arthroplasty (THA) in 19% of patients. Sciatic nerve injury occurred in 27.5% of the patients who were available for follow-up. Both THA and sciatic nerve injury were associated with posterior acetabular rim or Pipkin Type-IV fractures (p < 0.001). Only 33.3% of the patients returned to their pre-injury level of sports, 24.6% did not return to work, and 27.5% reported having sexual dysfunction. PROMs (Tegner Activity Scale, modified Harris hip score) were significantly worse in patients with osteonecrosis, posttraumatic OA, or residual sciatic nerve injury (p < 0.05). CONCLUSIONS Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up. Patients with associated acetabular rim or Pipkin Type-IV fractures are most likely to require THA for the treatment of osteonecrosis or posttraumatic OA and are at greater risk for sustaining sciatic nerve injury. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vera Jaecker
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Malin Zocholl
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Jan Friederichs
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Philipp Osten
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Thomas Fuchs
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Fabian M Stuby
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Stephan Regenbogen
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Moritz S, Gawęda Ł, Carpenter WT, Aleksandrowicz A, Borgmann L, Gallinat J, Fuchs T. What Kurt Schneider Really Said and What the DSM Has Made of it in Its Different Editions: A Plea to Redefine Hallucinations in Schizophrenia. Schizophr Bull 2024; 50:22-31. [PMID: 37738451 PMCID: PMC10754170 DOI: 10.1093/schbul/sbad131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Kurt Schneider has played a leading role in shaping our current view of schizophrenia, placing certain manifestations of delusions and hallucinations at the center of the disorder, especially ideas of persecution and voice-hearing. The first part of this review summarizes Schneider's original ideas and then traces how the different editions of the DSM merged aspects of Kraepelin's, Bleuler's, and Schneider's historical concepts. Special attention is given to the transition from the DSM-IV to the DSM-5, which eliminated much of Schneider's original concept. In the second part of the article, we contrast the current definition of hallucination in the DSM-5 with that of Schneider. We present empirically derived arguments that favor a redefinition of hallucinations, much in accordance with Schneider's original ideas. We plea for a two-dimensional model of hallucinations that represents the degree of insight and perceptuality, ranging from thoughts with full "mineness" via perception-laden thoughts and intrusions (including "as if" experiences") to hallucinations. While we concur with the DSM-5 that cognitions that are indistinguishable from perceptions should be labeled as hallucinations, we suggest expanding the definition to internally generated sensory phenomena, including those with only partial resemblance to external perceptions, that the individual considers real and that may lie at the heart of a subsequent delusional superstructure.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - William T Carpenter
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Lisa Borgmann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Schnitzler T, Korn C, C Herpertz S, Fuchs T. Emotion recognition in autism spectrum condition during the COVID-19 pandemic. Autism 2023:13623613231203306. [PMID: 37882152 DOI: 10.1177/13623613231203306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT In the COVID-19 pandemic, wearing face masks became mandatory to prevent the spread of the virus. However, they restrict the ability to recognize emotions to the upper part of the face. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they may be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. The current study compared the recognition of facially expressed emotions between individuals with and without autism spectrum condition. Each photo was shown in three types, once uncovered, once with face mask, and once with sunglasses. Our results revealed a reduction in accuracy of individuals with autism spectrum condition at recognizing emotions in all three stimulus types and exhibited more difficulties distinguishing anger, fear, pride, and embarrassment. During the emotion recognition task, there was no difference in which facial areas the groups looked at. We did not find evidence that the disadvantages of individuals with autism spectrum condition in emotion recognition were due to looking at different areas of the face.
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Schnitzler T, Fuchs T. Autism as a Disorder of Affective Empathy. Psychopathology 2023; 57:53-62. [PMID: 37852203 DOI: 10.1159/000533655] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 08/03/2023] [Indexed: 10/20/2023]
Abstract
Since the first description by Leo Kanner, individuals with autism spectrum disorder (ASD) have been attributed a reduced empathy. However, it has not yet been clarified how empathy is specifically impaired in autism. Typically, scholars distinguish between the affective and the cognitive dimensions of empathy. The latter largely overlaps with the concept of the theory of mind (ToM), according to which we need internal inferences or simulations for gaining access to the hidden mental states of others. Since a deficit in ToM is a widely accepted explanation for difficulties of individuals with ASD in social interactions, limitations in cognitive empathy are accordingly assumed. Regarding affective empathy, there are contradictory results using various methods, showing an impaired affective empathy. The main aim of the paper is to present ASD primarily as a disorder of shared interpersonal and interaffective experiences and thus of affective empathy by means of a phenomenological analysis considering empirical studies. In this framework, a deficit of the ToM is accepted but criticized as a central explanatory approach for ASD since (1) it assumes a fundamental inaccessibility of other people, which does not correspond to our everyday social situations, and (2) it manifests developmentally long after the first signs of ASD, which means that its deficit cannot explain the basic autistic difficulties in social interactions.
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Affiliation(s)
- Tim Schnitzler
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Ruëff F, Bauer A, Becker S, Brehler R, Brockow K, Chaker AM, Darsow U, Fischer J, Fuchs T, Gerstlauer M, Gernert S, Hamelmann E, Hötzenecker W, Klimek L, Lange L, Merk H, Mülleneisen NK, Neustädter I, Pfützner W, Sieber W, Sitter H, Skudlik C, Treudler R, Wedi B, Wöhrl S, Worm M, Jakob T. Diagnosis and treatment of Hymenoptera venom allergy: S2k Guideline of the German Society of Allergology and Clinical Immunology (DGAKI) in collaboration with the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (ABD), the Medical Association of German Allergologists (AeDA), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNOKC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Allergy and Environmental Medicine (GPA), German Respiratory Society (DGP), and the Austrian Society for Allergy and Immunology (ÖGAI). Allergol Select 2023; 7:154-190. [PMID: 37854067 PMCID: PMC10580978 DOI: 10.5414/alx02430e] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023] Open
Abstract
Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient's medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 - 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of β-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient's history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer's instructions, every 5 - 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 - 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.
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Affiliation(s)
- Franziska Ruëff
- Department of Dermatology and Allergy, LMU University Hospital, Munich
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tuebingen, Tübingen
| | - Randolf Brehler
- Department of Dermatology, Münster University Hospital, Münster
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Adam M. Chaker
- Department of Otorhinolaryngology Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich
| | - Ulf Darsow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Jörg Fischer
- University Hospital for Dermatology and Allergology, Clinic Oldenburg, Oldenburg
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Michael Gerstlauer
- Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg
| | | | - Eckard Hamelmann
- Children’s Center Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany
| | - Wolfram Hötzenecker
- Department of Dermatology, Kepler University Hospital, Medical Faculty of University Linz, Linz, Austria
| | | | - Lars Lange
- Pediatric Clinic, Marienhospital Bonn, GFO Kliniken, Bonn
| | - Hans Merk
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen University, Aachen
| | | | | | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | | | - Helmut Sitter
- Institute for Theoretical Surgery, Philipps-University Marburg, Marburg
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, and BG Clinic Hamburg, Hamburg
| | | | - Bettina Wedi
- Comprehensive Allergy, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, and
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital Giessen, Justus Liebig University Gießen, Gießen, Germany
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Fusar-Poli P, Estradé A, Stanghellini G, Esposito CM, Rosfort R, Mancini M, Norman P, Cullen J, Adesina M, Jimenez GB, da Cunha Lewin C, Drah EA, Julien M, Lamba M, Mutura EM, Prawira B, Sugianto A, Teressa J, White LA, Damiani S, Vasconcelos C, Bonoldi I, Politi P, Vieta E, Radden J, Fuchs T, Ratcliffe M, Maj M. The lived experience of depression: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2023; 22:352-365. [PMID: 37713566 PMCID: PMC10503922 DOI: 10.1002/wps.21111] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Cecilia Maria Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, University of Chieti and Pescara "G. d'Annunzio", Chieti, Italy
| | - Peter Norman
- Recovery College, South London and Maudsley NHS Foundation Trust, London, UK
- Mosaic Clubhouse Brixton, London, UK
| | | | - Miracle Adesina
- Global Mental Health Peer Network, Ibadan, Nigeria
- Slum and Rural Health Initiative, Ibadan, Nigeria
| | - Gema Benavides Jimenez
- Global Mental Health Peer Network, Madrid, Spain
- Utrecht University, Utrecht, The Netherlands
- Instituto Superior de Estudios Psicológicos, Madrid, Spain
| | - Caroline da Cunha Lewin
- Global Mental Health Peer Network, London, UK
- Patient and Public Involvement Team, NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | | | - Marc Julien
- Global Mental Health Peer Network, Douala, Cameroon
| | | | - Edwin M Mutura
- Global Mental Health Peer Network, Nairobi, Kenya
- Mentally Unsilenced, Nairobi, Kenya
- Psychiatric Disability Organization of Kenya, Nakuru, Kenya
| | - Benny Prawira
- Global Mental Health Peer Network, Jakarta, Indonesia
- Into The Light Indonesia, Jakarta, Indonesia
| | - Agus Sugianto
- Global Mental Health Peer Network, Jakarta, Indonesia
- Indonesian Community Care for Schizophrenia, Jakarta, Indonesia
- University of Manchester, Manchester, UK
| | - Jaleta Teressa
- Global Mental Health Peer Network, Nekemte, Ethiopia
- Nekemte Specialized Hospital, Nekemte, Ethiopia
| | - Lawrence A White
- Global Mental Health Peer Network, Yellowknife, Canada
- Centre for Learning & Teaching Innovation, Aurora College, Yellowknife, Canada
- Advanced Graduate Student, Unicaf University, Lusaka, Zambia
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Candida Vasconcelos
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jennifer Radden
- Philosophy Department, University of Massachusetts, Boston, MA, USA
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Gugelmeier M, Kostron A, Poser T, Schneider LC, Peitsch WK, Fuchs T. [Acute soft Tissue Infection with impending Loss of Finger in amniotic Band Syndrome of a 22-years-old Patient with palmoplantar Keratoderma congenital Alopecia Syndrome Type II]. HANDCHIR MIKROCHIR P 2023; 55:368-372. [PMID: 36972588 DOI: 10.1055/a-2013-2131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
We report on the treatment of a 22-year-old female patient with an acute soft tissue infection in the area of an amniotic band due to palmoplantar keratoderma congenital alopecia syndrome (PPKCA) type II, a very rare genodermatosis with less than 20 cases described in literature. An acute soft tissue infection distal from the pre-existing constriction ring with hyperkeratosis on the right small finger led to a decompensation of the venous and lymphatic drain with imminent loss of the finger. Due to urgent surgical treatment with decompression and debridement of the dorsal soft tissue infection, microsurgical circular resection of the constriction ring and primary wound closure the finger could be preserved. After soft tissue consolidation and hand therapy, the patient achieved free movement of the small finger with subjective freedom of symptoms and good aesthetic results.
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Affiliation(s)
- Moritz Gugelmeier
- Zentrum für Muskuloskelettale Medizin Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie , Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Arthur Kostron
- Zentrum für Muskuloskelettale Medizin Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie , Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Poser
- Zentrum für Muskuloskelettale Medizin Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie , Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Lisa C Schneider
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Wiebke K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Fuchs
- Zentrum für Muskuloskelettale Medizin Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie , Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Brockow K, Wurpts G, Trautmann A, Pfützner W, Treudler R, Bircher AJ, Brehler R, Buhl T, Dickel H, Fuchs T, Jakob T, Kurz J, Kreft B, Lange L, Merk HF, Mockenhaupt M, Mülleneisen N, Ott H, Ring J, Ruëff F, Sachs B, Sitter H, Wedi B, Wöhrl S, Worm M, Zuberbier T. Guideline for allergological diagnosis of drug hypersensitivity reactions: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Dermatological Society (DDG), the Association of German Allergologists (ÄDA), the German Society for Pediatric Allergology (GPA), the German Contact Dermatitis Research Group (DKG), the German Society for Pneumology (DGP), the German Society of Otorhinolaryngology, Head and Neck Surgery, the Austrian Society of Allergology and Immunology (ÖGAI), the Austrian Society of Dermatology and Venereology (ÖGDV), the German Academy of Allergology and Environmental Medicine (DAAU), and the German Documentation Center for Severe Skin Reactions (dZh). Allergol Select 2023; 7:122-139. [PMID: 37705676 PMCID: PMC10495942 DOI: 10.5414/alx02422e] [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: 06/14/2023] [Accepted: 07/30/2023] [Indexed: 09/15/2023] Open
Abstract
Not available.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Gerda Wurpts
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Axel Trautmann
- Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg
| | - Regina Treudler
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany
| | - Andreas J. Bircher
- Facoltà di Scienze biomediche, Università della Svizzera italiana, Lugano, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland
| | | | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Heinrich Dickel
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital, Justus-Liebig University, Gießen
| | - Julia Kurz
- Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg
| | - Burkhard Kreft
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale)
| | - Lars Lange
- Pediatric Clinic, Marienhospital Bonn, Bonn
| | - Hans F. Merk
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Maja Mockenhaupt
- Documentation Center for Severe Skin Reactions, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg
| | | | - Hagen Ott
- Children’s and Youth Hospital Auf der Bult, Hanover
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Franziska Ruëff
- Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich
| | - Bernhardt Sachs
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Helmut Sitter
- Institute for Theoretical Surgery, Philipps University of Marburg, Marburg
| | - Bettina Wedi
- Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria, and
| | - Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Zuberbier
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Martin LAL, Melchert D, Knack M, Fuchs T. Relating movement markers of schizophrenia to self-experience-a mixed-methods study. Front Psychiatry 2023; 14:1212508. [PMID: 37415694 PMCID: PMC10319999 DOI: 10.3389/fpsyt.2023.1212508] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Basic self-disorders on the one hand and motor symptoms on the other hand are discussed as endophenotypes of schizophrenia psychopathology. However, the systematic interaction between motor symptoms and the self-experience of patients is rarely studied. Methods In a previous study we defined motor markers of schizophrenia via a data-driven analysis of patients' gait patterns. In this study, we related the movement markers to measures of basic self-disorder obtained with EASE interviews. We substantiated the correlations with a qualitative content analysis of the interviews of a subset of four patients. We related qualitative and quantitative data on an intra- and interpersonal level. Results Our results suggest an association between the previously defined, theory-independent movement markers and basic self-disorders, specifically in the domain of cognition, self-experience and bodily experiences. While movement marker manifestation was not precisely reflected in the individuals' descriptions of anomalous self- and body experience, we found clear trends of more and more intense descriptions with increasing movement marker scores, when looking at specific experiences, such as hyper reflexivity. Discussion These results foster an integrated view of the patient and could stimulate therapeutic approaches aiming at an improvement of self- and body-experience of patients with schizophrenia.
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Affiliation(s)
- Lily A. L. Martin
- Department of Psychology, Faculty of Behavioral and Cultural Studies, University of Heidelberg, Heidelberg, Germany
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, University of Heidelberg, Heidelberg, Germany
- Research Institute for Creative Arts Therapies (RIArT), Department of Therapy Sciences, Alanus University of Arts and Social Sciences, Alfter, Germany
| | - David Melchert
- Department of Educational Science and Psychology, Free University Berlin, Berlin, Germany
| | - Monika Knack
- Department of Philosophy, Faculty of Philosophy, University of Heidelberg, Heidelberg, Germany
| | - Thomas Fuchs
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, University of Heidelberg, Heidelberg, Germany
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Hollstein MM, Matzke SS, Lorbeer L, Traidl S, Forkel S, Möbs C, Fuchs T, Lex C, Buhl T. Skin Tests versus Serology: Specific IgE May Suffice for Diagnosis of Vespid Venom Allergy and Follow-Up of Allergen Immunotherapy. Int Arch Allergy Immunol 2023; 184:744-753. [PMID: 37044077 DOI: 10.1159/000529801] [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: 10/11/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION In adults, allergic reactions to insect stings are among the most frequent causes of anaphylaxis, a potentially life-threatening condition. Recurrent anaphylaxis following vespid stings may be prevented by allergen immunotherapy (AIT). The aim of this study was to evaluate the benefit of measuring venom-induced wheal area in intracutaneous skin tests (ICT), in comparison to various serological and clinical parameters, for the diagnosis of severe vespid venom allergy and during follow-up of AIT. METHODS We conducted a monocentric, retrospective evaluation of 170 patients undergoing AIT against vespid venoms. We scanned ICT wheals at baseline and at three time points after AIT initiation and measured wheal area using objective data analysis software. RESULTS We found that ICT histamine-induced and venom-induced wheal areas did not correlate. In addition, the venom-induced wheal area was independent from the minimal venom concentration required to elicit a wheal in an ICT and all other parameters. No correlation was found between wheal area and the severity of anaphylaxis. Wheal area standardized to the application of 0.1 μg/mL venom inversely correlated with anaphylaxis severity and positively correlated with venom-specific IgE levels. During AIT, mean areas of venom-induced wheals did not change. In contrast, venom-specific IgG and IgG4 levels, and the minimal venom concentration required to induce a positive ICT result increased, while the venom wheal area standardized to 0.1 μg/mL venom application and specific IgE levels decreased over time. CONCLUSION Wheal area evaluation did not provide additional information over specific IgE analysis. We therefore recommend that ICTs are used only as a secondary measure for confirming serological test results.
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Affiliation(s)
- Moritz M Hollstein
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Silke S Matzke
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Lisa Lorbeer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan Traidl
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Möbs
- Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Christiane Lex
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology with Pediatric Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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12
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Fuchs T, Pälchen A, Jupke A. Influence of Mixed Salts on Retention Behavior of Model Proteins in Cation Exchange Chromatography. J Chromatogr A 2023; 1696:463968. [PMID: 37054639 DOI: 10.1016/j.chroma.2023.463968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Mobile phase composition is an important factor for a further improvement of ion exchange chromatography steps of proteins. In this work, the effects of mixed salts on the retention factors of the two model proteins lysozyme (LYZ) and bovine serum albumin (BSA) in cation exchange chromatography (CEC) were investigated and compared to effects previously observed in hydrophobic interaction chromatography (HIC). The model equation describing the effects in HIC was adjusted for linear gradient elution experiments in CEC. The investigated salts were sodium chloride, sodium sulfate, ammonium chloride and ammonium sulfate. By varying binary salt mixtures as well as using pure salts, model parameters were determined. The normalized root mean square error (NRMSE) of the predicted retention factors for the calibration runs was 4.1% for BSA and 3.1% for LYZ. Additional validation experiments proved the ability of the model to describe and predict retention behavior of the proteins for further salt compositions. Hereby, the NRMSE values for BSA and LYZ were 2.0% and 1.5%, respectively. While the retention factors of LYZ changed linearly with the salt composition, non-linearities in the impact of the anion composition were found for BSA. This was contributed to an overlay of a synergetic salt effect on a protein-specific effect by sulfate on BSA with non-specific effects of the ions for CEC. However, the impact of the synergetic effects on protein separation is lower for CEC than for HIC, as mixed salts do not increase the separation of these proteins. The best salt composition for separating BSA and LYZ is pure ammonium sulfate. Thus, synergetic salt effects can also occur in CEC, but they have a lower impact than in HIC.
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Affiliation(s)
- Thomas Fuchs
- Fluid Process Engineering (AVT.FVT), RWTH Aachen University, Forckenbeckstr. 51, Aachen 52074, Germany.
| | - Alina Pälchen
- Fluid Process Engineering (AVT.FVT), RWTH Aachen University, Forckenbeckstr. 51, Aachen 52074, Germany
| | - Andreas Jupke
- Fluid Process Engineering (AVT.FVT), RWTH Aachen University, Forckenbeckstr. 51, Aachen 52074, Germany
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13
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Wendler H, Fuchs T. Understanding incomprehensibility: Misgivings and potentials of the phenomenological psychopathology of schizophrenia. Front Psychol 2023; 14:1155838. [PMID: 37057153 PMCID: PMC10086155 DOI: 10.3389/fpsyg.2023.1155838] [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] [Received: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Hannes Wendler
- Department of Philosophy, University of Cologne, Cologne, Germany
- *Correspondence: Hannes Wendler
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychiatry, University Clinic Heidelberg, Heidelberg, Germany
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14
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Bauer PR, Bronnec MLA, Schulze-Bonhage A, Altenmüller DM, Fuchs T. Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery. Psychopathology 2023; 56:417-429. [PMID: 36927809 DOI: 10.1159/000528924] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. METHODS To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers' concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one's aspirations. RESULTS In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. CONCLUSION Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.
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Affiliation(s)
- Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
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15
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Bronnec MLA, Altenmüller DM, Fuchs T, Lahmann C, Schulze-Bonhage A, Bauer PR. "What is this strange sensation?" A qualitative exploration of metaphors used to verbalise hard-to-describe experiences by people with epilepsy. Epilepsy Behav 2023; 138:108963. [PMID: 36403424 DOI: 10.1016/j.yebeh.2022.108963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/18/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Mental health comorbidities are frequent in epilepsy. Consequently, psychotherapy is becoming increasingly important. To address the psychological needs of people with epilepsy (PwE) it is essential to understand the subjective experiences of seizures better. There is little research on how people report seizures, and which psychological representations they have. We conducted a thematic analysis based on 42 (micro-phenomenological) interviews with 15 participants on their experiences of seizures. In these interviews, we identified three categories of seizure descriptions: (1) phenomena related to the body and emotions; (2) the moments that are difficult to describe; and (3) the use of figurative language and metaphors. Paroxysmal physical and psychological sensations were often reported spontaneously by the participants. The moments that were difficult to describe were expressed, among other things, through the use of paradoxes or the report of a 'strange' feeling and led participants to use figurative language. As these metaphors can reveal important information about people's subjective experiences, they were analyzed in detail. We identified the three main types of metaphors that the participants used most frequently: (1) perception, (2) nature, and (3) battle. The theme of battle was most frequently used in different forms and was closely related to the metaphors from the fields of perception and nature, thus representing a key point in the personal experience of seizures. These findings can contribute to developing psychotherapeutic approaches for the treatment of seizure disorders.
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Affiliation(s)
- Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
| | - Claas Lahmann
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
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16
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Moskalewicz M, Fuchs T. Psychotic disorders of space and time - A contribution of Erwin W. Straus. Front Psychiatry 2023; 14:1150005. [PMID: 37113543 PMCID: PMC10126461 DOI: 10.3389/fpsyt.2023.1150005] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Abstract
This paper presents and discusses a manuscript by one of the core founders of phenomenological psychopathology, Erwin W. Straus, concerning psychotic disorders of space and time (see attached Supplementary material). Written in June 1946, the manuscript is published for the first time as supplementary material to this paper. It is a clinical case-study of a patient with psychotic depression from Henry Phipps Clinic. It contains themes known from both Straus' earlier and later work on lived time and mental illness, in particular a critique of physicalism in psychology, a vindication of primary sensing, a description of the spatiotemporal unity of lived experience, and the notion of temporal becoming. However, it is the only work by Straus that explores in such detail a patient's case and shows how the lived experience is spatiotemporally structured and intrinsically related to affectivity, embodiment, and action. The manuscript is yet another piece of evidence of Straus' significance in developing the field of phenomenological psychiatry in both Germany and the United States.
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Affiliation(s)
- Marcin Moskalewicz
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, University of Heidelberg, Heidelberg, Germany
- Philosophy of Mental Health Unit, Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
- Department of Ontology and Epistemology, Institute of Philosophy, Marie Curie-Sklodowska University, Lublin, Poland
- *Correspondence: Marcin Moskalewicz,
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, University of Heidelberg, Heidelberg, Germany
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17
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Jeon BB, Fuchs T, Chase SM, Kuhlman SJ. Visual experience has opposing influences on the quality of stimulus representation in adult primary visual cortex. eLife 2022; 11:80361. [PMID: 36321876 PMCID: PMC9629826 DOI: 10.7554/elife.80361] [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] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
Transient dark exposure, typically 7–10 days in duration, followed by light reintroduction is an emerging treatment for improving the restoration of vision in amblyopic subjects whose occlusion is removed in adulthood. Dark exposure initiates homeostatic mechanisms that together with light-induced changes in cellular signaling pathways result in the re-engagement of juvenile-like plasticity in the adult such that previously deprived inputs can gain cortical territory. It is possible that dark exposure itself degrades visual responses, and this could place constraints on the optimal duration of dark exposure treatment. To determine whether eight days of dark exposure has a lasting negative impact on responses to classic grating stimuli, neural activity was recorded before and after dark exposure in awake head-fixed mice using two-photon calcium imaging. Neural discriminability, assessed using classifiers, was transiently reduced following dark exposure; a decrease in response reliability across a broad range of spatial frequencies likely contributed to the disruption. Both discriminability and reliability recovered. Fixed classifiers were used to demonstrate that stimulus representation rebounded to the original, pre-deprivation state, thus dark exposure did not appear to have a lasting negative impact on visual processing. Unexpectedly, we found that dark exposure significantly stabilized orientation preference and signal correlation. Our results reveal that natural vision exerts a disrupting influence on the stability of stimulus preference for classic grating stimuli and, at the same time, improves neural discriminability for both low and high-spatial frequency stimuli.
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Affiliation(s)
- Brian B Jeon
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, United States.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, United States.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, United States
| | - Thomas Fuchs
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, United States.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, United States.,Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, United States
| | - Steven M Chase
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, United States.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, United States.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, United States
| | - Sandra J Kuhlman
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, United States.,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, United States.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, United States.,Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, United States
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18
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Broschmann D, Fuchs T. Vertrauen und Vertrauensstörungen. PDP - Psychodynamische Psychotherapie 2022. [DOI: 10.21706/pdp-21-4-369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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19
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Fuchs T, Jupke A. Impact of Salt Selection on Ion‐Exchange Chromatography of Model Proteins. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T. Fuchs
- RWTH Aachen University Fluid Process Engineering (AVT. FVT) Forckenbeckstr. 51 52074 Aachen Germany
| | - A. Jupke
- RWTH Aachen University Fluid Process Engineering (AVT. FVT) Forckenbeckstr. 51 52074 Aachen Germany
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Ho DJ, D'Alfonso T, Tan L, Agaram N, Hameed M, Chang J, Vanderbilt C, Travis W, Fuchs T. DEEP LEARNING-BASED WHOLE SLIDE IMAGE SEGMENTATION FOR EFFICIENT AND REPRODUCIBLE ASSISTANCE IN PATHOLOGY. J Pathol Inform 2022. [DOI: 10.1016/j.jpi.2022.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hollstein MM, Matzke SS, Lorbeer L, Forkel S, Fuchs T, Lex C, Buhl T. Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies. J Asthma Allergy 2022; 15:907-918. [PMID: 35836970 PMCID: PMC9274911 DOI: 10.2147/jaa.s367272] [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] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allergies against Hymenoptera venoms are a major cause of severe anaphylaxis. Risk assessment for subjects with suspected allergy is difficult because there are currently no biomarkers that predict the likelihood of high-grade anaphylaxis other than several associated comorbidities. Objective We investigated the relationship between the severity of anaphylaxis and the results of intracutaneous skin tests (ICTs) together with serum levels of tryptase, total IgE, and venom-specific IgE, IgG, and IgG4. Methods We performed a retrospective evaluation of 194 patients who presented to a single medical center with allergies to bee venoms (Apis mellifera, Bombus spp.; n=24, 12.4%), vespid venoms (Vespula spp., Vespa spp., Polistes spp.; n=169, 87.1%), or both (n=1, 0.5%). Results Index bee stings occurred earlier in the year than vespid stings, although the latter were reported more frequently overall. On average, subjects who previously experienced grade IV anaphylaxis required higher dosages of venom to yield positive ICTs than those who exhibited lower grade responses. Patients diagnosed with grade IV anaphylaxis exhibited significantly lower levels of venom-specific IgE and IgG and trended toward elevated levels of tryptase. No significant differences in average levels of venom-specific IgG4 and total IgE were observed. Conclusion Our findings reveal that intracutaneous skin testing and levels of venom-specific IgE do not predict the degree of anaphylaxis that develops in patients with venom allergy. Furthermore, the month of the index sting is not a reliable means to differentiate bee from vespid stings in patients presenting with an uncertain history.
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Affiliation(s)
- Moritz M Hollstein
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Silke S Matzke
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Lisa Lorbeer
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Christiane Lex
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology with Pediatric Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
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22
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Manders E, Koch SC, Fuchs T. A Case for Playful Engagement: Synchrony and Interaction Quality During Mirroring in ASD. Conceptual Framework and Case Study. Am J Dance Ther 2022. [DOI: 10.1007/s10465-022-09359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractThe social challenges in autism spectrum disorders (ASD) can present as qualitative differences in interactions that make individuals on the autism spectrum appear less engaged with others. Limited interactional synchrony and other nonverbal movement patterns may contribute to these qualitative differences. This article uses the case of Hans, an adult on the autism spectrum, to describe patterns of synchrony and interaction quality during mirroring activities in dance/movement therapy. Raters scored videos of Hans and his partners on affective engagement, flow of the interaction, and interpersonal synchrony. They also qualitatively described his movements and interactions. Hans consistently participated in mirroring, but showed different patterns of attention and engagement when leading, following, interacting, or dancing in an open-ended dance. Hans was able to move in synchrony with partners, showed positive affect, and increased his movement repertoire by returning to others’ movements in later sessions. He was the most engaged when following a playful movement theme with a dance/movement therapy student partner. His affective engagement increased, but only in the less structured open-ended dance and only across the five sessions with this same dance/movement therapy student partner, and not when the sessions with his other partners, including others on the autism spectrum, were included. This points to a potential need to have dance/movement therapists model developing a movement relationship using flexible and playful contexts to emotionally engage the individual and reflect the complexity of everyday social situations. We present clinical recommendations and suggestions for future studies.
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Abstract
„Nichts ist, wie es scheint“, „nichts geschieht zufällig“, und „alles ist miteinander verbunden“ – diese drei Grundannahmen charakterisieren Verschwörungstheorien unterschiedlicher Provenienz. Damit zeigen sie eine deutliche Parallelität zur Struktur von paranoidem Bedeutungserleben und Wahn. Dem stehen jedoch wichtige Unterschiede gegenüber, etwa die Bildung ausgedehnter Gruppen von Verschwörungsgläubigen, denen keine paranoiden „Wahngemeinschaften“ entsprechen. Der Aufsatz untersucht zunächst beide Phänomene vergleichend und wendet sich dann der Frage zu, wie die Virtualisierung der Kommunikation in den sozialen Medien die Bildung von verschwörungstheoretischen Gemeinschaften begünstigt.
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Affiliation(s)
- Thomas Fuchs
- Karl-Jaspers-Professur für Philosophie und Psychiatrie, Psychiatrische Universitätsklinik, Ruprecht-Karls-Universität Heidelberg, Voßstr. 4, 69115 Heidelberg, Deutschland
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24
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Hanna MG, Raciti P, Bozkurt A, Godrich R, Viret J, Lee D, Mathieu P, Lee M, Vorontsov E, Sabo T, Geyer FC, Reis-Filho JS, Grady L, Fuchs T, Kanan C. Abstract PD11-02: Subtyping invasive carcinomas and high-risk lesions for machine learning based breast pathology. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. The female mammary gland can develop a myriad of epithelial proliferative lesions including, high risk lesions, in-situ and invasive carcinomas. Identification of these pre-neoplastic and neoplastic conditions in biopsy specimens is crucial for proper patient management and may sometimes pose diagnostic challenges for pathologists. Recent research has shown that machine learning algorithms applied to whole slide images (WSI) can accurately detect and grade various cancers; herein, we devise and test a system that classifies the most common preneoplastic and neoplastic conditions of the female breast from WSIs. Design. De-identified slides were scanned on Leica AT2 whole slide scanners (20x; 0.5 µm/pixel) from MSK database were retrieved. Clinical diagnostic metadata were extracted from the pathology reports. Using a multi-label multiple-instance learning (ML-MIL) approach, a SE-ResNet50 Convolutional Neural Network (CNN) was trained to classify atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), invasive lobular carcinoma (ILC), invasive ductal carcinoma (IDC). In additional morphological subtypes including apocrine, mucinous, solid papillary, micropapillary, and tubular carcinoma were trained. The system uses the WSI as an input and outputs a slide level class and heatmap for the presence of the trained classes. A validation dataset separate from the training set was used to assess performance of the trained model. Results. The CNN was trained on 9,751 surgical specimens (biopsy, 6,289; excision, 3,462) comprising 40,637 slides. The system was validated on 3,183 breast specimens (biopsy, 1,934; excision, 1,249) comprising 11,447 digital slides that were not included in the training of the CNN model. Validation performance in terms of Area Under Receiver Operating Characteristic Curve (AUROC) for each class is shown in Table 1. Conclusion. The trained CNN had a high performance in identifying the presence of ADH, ALH, DCIS, IDC, ILC, LCIS, and, apocrine, micropapillary, mucinous, solid papillary, and tubular carcinomas. Further studies expanding classes to include all clinically relevant lesions and morphologies are underway. In addition, the same approach can be used to detect microinvasions and calcifications in breast tissue.
Table 1.Area Under Receiver Operating Characteristic Curve for Breast Lesion ClassesClassNum. Positive (specimens)Num. Negative (specimens)AUROCADH24718640.903ALH20918860.950LCIS17520080.958DCIS81920920.956IDC52126620.956ILC7131120.934Apocrine2431590.931Micropapillary17230110.927Mucinous1231710.994Solid Papillary1531680.908Tubular carcinoma831750.990
Citation Format: Matthew G Hanna, Patricia Raciti, Alican Bozkurt, Ran Godrich, Julian Viret, Donghun Lee, Philippe Mathieu, Matthew Lee, Eugene Vorontsov, Tomer Sabo, Felipe C Geyer, Jorge S Reis-Filho, Leo Grady, Thomas Fuchs, Christopher Kanan. Subtyping invasive carcinomas and high-risk lesions for machine learning based breast pathology [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD11-02.
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Abstract
Anorexia nervosa is often regarded primarily as a disorder of the body image, with affected individuals submitting themselves to the dictate of a predominant model of slenderness. However, even though this frequently functions as a gateway to the disorder, the paper intends to show that the actual conflict in anorexia consists in a fundamental alienation of the self from the body. In order to analyze this alienation from a phenomenological point of view, the paper introduces the polarity of lived body (body-as-subject) and physical body (body-as-object). It then explores the phenomenology of anorexia, drawing on characteristic self-reports as well as on the phenomenological, psychoanalytic and cultural science literature. The anorexic conflict of embodiment arises in adolescence, where the body becomes an object of the other's gaze in a special way. Starting with an attempt to comply with the ideal body image, the anorexic patient increasingly fights against her dependency on her body and its uncontrollable nature, above all its hunger and femininity. To be in total control of her body and to gain independence from it, becomes the source of a narcissistic triumph. Thus, in striving for autonomy and perfection, the anorexic patient alienates herself from her embodiment. This results in a radical dualism of 'mind' and 'body': pursuing the ideal of an asexual, angelic, even disappearing body. Anorexia is thus conceived as a fundamental conflict of embodiment.
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Affiliation(s)
- Thomas Fuchs
- Psychiatrische Universitätsklinik, Voss-Str. 4, 69115, Heidelberg, Germany.
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26
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Richter DC, Heininger A, Chiriac U, Frey OR, Rau H, Fuchs T, Röhr AC, Brinkmann A, Weigand MA. Antibiotic Stewardship and Therapeutic Drug Monitoring of β-Lactam Antibiotics: Is There a Link? An Opinion Paper. Ther Drug Monit 2022; 44:103-111. [PMID: 34857694 DOI: 10.1097/ftd.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In critically ill patients, changes in the pharmacokinetics (PK) of β-lactams can lead to significant variations in serum concentrations, with possibly detrimental effects on outcomes. The utilization of individually calculated doses, extended infusion regimen, and therapeutic drug monitoring (TDM)-guided dose adjustments can mitigate the PK changes and help to achieve and attain an individual PK target. METHODS We reviewed relevant literature from 2004 to 2021 using 4 search engines (PubMed, Web of Science, Scopus, and Google Scholar). Unpublished clinical data were also examined. RESULTS TDM-guided, individualized dosing strategies facilitated PK target attainment and improved patient outcomes. TDM-guided therapy is a core concept of individualized dosing that increases PK target attainment and identifies possible toxic β-lactam concentrations. CONCLUSIONS Individualized dosing and TDM facilitate the rational use of β-lactams and are integral for antibiotic stewardship interventions in critical care, affording the optimal exposure of both pathogen and drugs, along with enhanced treatment efficacy and reduced emergence of antimicrobial resistance.
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Affiliation(s)
- Daniel C Richter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg
| | - Alexandra Heininger
- Department of Infectious Diseases and Hygiene, Mannheim University Hospital, Mannheim
| | - Ute Chiriac
- Department of Pharmacy, Heidelberg University Hospital, Heidelberg; and
| | | | - Heike Rau
- Departments of Clinical Pharmacy, and
| | - Thomas Fuchs
- Anesthesiology, Heidenheim Hospital, Heidenheim, Germany
| | | | | | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg
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27
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Stolberg-Stolberg J, Fuchs T, Lodde MF, Roßlenbroich S, Garcia P, Raschke M, Everding J. Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing. J Orthop Traumatol 2022; 23:4. [PMID: 34997869 PMCID: PMC8742797 DOI: 10.1186/s10195-021-00620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions. Materials and methods 49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union. Results Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009). Conclusions Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone. Level of evidence Level 3.
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Affiliation(s)
- Josef Stolberg-Stolberg
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Thomas Fuchs
- Department of Trauma and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Moritz F Lodde
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Steffen Roßlenbroich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Patric Garcia
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Michael Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany.
| | - Jens Everding
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
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28
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Galbusera L, Fuchs T, Holm-Hadulla RM, Thoma S. Person-Centered Psychiatry as Dialogical Psychiatry: The Significance of the Therapeutic Stance. Psychopathology 2022; 55:1-9. [PMID: 34753146 DOI: 10.1159/000519501] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
In this article, we present holistic and person-centered perspectives in psychiatry, with the aim of better understanding what a focus on personhood might really mean and what clinical implications it might have. We first introduce classical and philosophical concepts of personhood, in order to then outline person-centered approaches in psychiatry, which mainly focus on the person of the patient. We then argue that, for it to really be person-centered, psychiatry must necessarily also focus on the person of professionals. We thus explore the notion of stance, as the expression of the therapist's personhood. By unpacking the effects that a professional's stance can have on patients, we finally turn to a consideration of the interpersonal sphere. More specifically, we propose clinical considerations on a therapeutic stance that strives to support and to help the person of the patient unfold. Such a stance must - we argue - necessarily be a dialogical one. Drawing on these considerations, we thus claim that a truly person-centered approach in psychiatry must necessarily and automatically be interperson-centered and dialogical. In the concluding remarks, we finally discuss broader societal implications and outline future research perspectives.
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Affiliation(s)
- Laura Galbusera
- Department for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, Berlin, Germany
| | - Thomas Fuchs
- Clinic for General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Samuel Thoma
- Department for Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, Berlin, Germany
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29
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Bader O, Bizzari V, Fuchs T. Space, Social Perception, and Mental Disorders: Phenomenological and Empirical Approaches. Psychopathology 2022; 55:129-131. [PMID: 35580564 DOI: 10.1159/000524754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Oren Bader
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Humanities and Arts, Technion - Israel Institute of Technology, Haifa, Israel
| | - Valeria Bizzari
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Husserl Archives, Catholic University of Leuven, Leuven, Belgium
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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30
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Fuchs T, Herpertz SC, Kaess M, Lenzenweger MF. 125 Years of Psychopathology. Psychopathology 2022; 55:127-128. [PMID: 35640547 DOI: 10.1159/000525084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Mark F Lenzenweger
- Department of Psychology, The State University of New York at Binghamton, Binghamton, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
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31
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Maleitzke T, Zocholl D, Topp T, Dimitrov-Discher A, Daus E, Reaux G, Zocholl M, Conze RN, Kolster M, Weber P, Fleckenstein FN, Scheutz Henriksen L, Stöckle U, Fuchs T, Gümbel D, Spranger N, Ringk A, Märdian S. Quality and quantity of serious violent suicide attempts during the COVID-19 pandemic. Front Psychiatry 2022; 13:927696. [PMID: 35928775 PMCID: PMC9343723 DOI: 10.3389/fpsyt.2022.927696] [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] [Received: 04/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While repeated shutdown and lockdown measures helped contain the spread of SARS-CoV-2 during the COVID-19 pandemic, social distancing and self-isolation negatively impacted global mental health in 2020 and 2021. Although suicide rates did reportedly not increase during the first months of the pandemic, long-term data, and data on the quality of serious violent suicide attempts (SVSAs) are not available to date. MATERIALS AND METHODS Orthopaedic trauma patient visits to the emergency department (ED), ED trauma team activations, and SVSAs were retrospectively evaluated from January 2019 until May 2021 in four Level-I Trauma Centers in Berlin, Germany. SVSAs were assessed for suicide method, injury pattern and severity, type of treatment, and length of hospital stay. RESULTS Significantly fewer orthopaedic trauma patients presented to EDs during the pandemic (n = 70,271) compared to the control (n = 84,864) period (p = 0.0017). ED trauma team activation numbers remained unchanged. SVSAs (corrected for seasonality) also remained unchanged during control (n = 138) and pandemic (n = 129) periods, and no differences were observed for suicide methods, injury patterns, or length of hospital stay. CONCLUSION Our data emphasize that a previously reported rise in psychological stress during the COVID-19 pandemic does not coincide with increased SVSA rates or changes in quality of SVSAs.
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Affiliation(s)
- Tazio Maleitzke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Dario Zocholl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Tobias Topp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Berlin, Germany
| | - Annika Dimitrov-Discher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Elly Daus
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Gabriel Reaux
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Malin Zocholl
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Rolf Nicolas Conze
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Moritz Kolster
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Philipp Weber
- Center for Orthopaedics and Trauma Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Florian Nima Fleckenstein
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.,Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Louise Scheutz Henriksen
- International Centre for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Stöckle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Thomas Fuchs
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Nikolai Spranger
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Alexander Ringk
- Center for Orthopaedics and Trauma Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Sven Märdian
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
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32
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Martin L, Stein K, Kubera K, Troje NF, Fuchs T. Movement markers of schizophrenia: a detailed analysis of patients' gait patterns. Eur Arch Psychiatry Clin Neurosci 2022; 272:1347-1364. [PMID: 35362775 PMCID: PMC9508056 DOI: 10.1007/s00406-022-01402-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
Motor abnormalities occur in the majority of persons with schizophrenia but are generally neglected in clinical care. Psychiatric diagnostics fail to include quantifiable motor variables and few assessment tools examine full-body movement. We assessed full-body movement during gait of 20 patients and 20 controls with motion capture technology, symptom load (PANSS, BPRS) and Neurological Soft Signs (NSS). In a data-driven analysis, participants' motion patterns were quantified and compared between groups. Resulting movement markers (MM) were correlated with the clinical assessment. We identified 16 quantifiable MM of schizophrenia. While walking, patients and controls display significant differences in movement patterns related to posture, velocity, regularity of gait as well as sway, flexibility and integration of body parts. Specifically, the adjustment of body sides, limbs and movement direction were affected. The MM remain significant when controlling for medication load. They are systematically related to NSS. Results add assessment tools, analysis methods as well as theory-independent MM to the growing body of research on motor abnormalities in schizophrenia.
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Affiliation(s)
- Lily Martin
- Department of Psychology, Faculty of Behavioural and Cultural Studies, Heidelberg University, Heidelberg, Germany.
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany.
| | - Kevin Stein
- Optimization, Robotics and Biomechanics, ZITI-Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Katharina Kubera
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
| | - Nikolaus F Troje
- BioMotionLab, Department of Biology, Centre for Vision Research, York University, Toronto, Canada
| | - Thomas Fuchs
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
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Abstract
Phenomenological approaches suggest that the bodily presence of others has a profound influence on the experience of social spaces. This intimate relationship is particularly evident in mental disorders. Investigations into the nature of intersubjectivity in various pathologies indicate that modifications to the capacity for social perception play a key role in determining the manners in which the social space is experienced and felt. This paper aims to examine the interviewing relation of social perception and the experience of space and its consequences in autism spectrum disorder (ASD). This is done through a phenomenologically informed analysis of the functioning of social perception in ASD. Our account proposes that the atypical socio-perceptual patterns exhibited by people with autism significantly reduce the capacity to grasp the context of the situation, which facilitates and intensifies negative feelings that are intertwined with the experience of social spaces. This novel understanding draws on the idea that ASD involves a fundamental difficulty to establish a gestalt perception of social scenes. The evidence we discuss suggests that this anomaly in the operation of social perception also modulates the experience of the social space. Failing to perceive the wholeness of the situation means that people with autism often experience the social space as unfamiliar, confusing, uncertain, and unsafe, rather than feeling familiar and understood in the embodied presence of others. As a result, autistic subjects may experience difficulty evaluating the outcomes of hazardous circumstances, which poses a risk to their well-being, particularly in borderline situations. This suggestion is elaborated through the tragic occurrences that led to the killing of Eyad al-Hallaq, a 32-year-old Palestinian with autism.
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Affiliation(s)
- Oren Bader
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Humanities and Arts, Technion - Israel Institute of Technology, Haifa, Israel
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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34
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Lange L, Klimek L, Beyer K, Blümchen K, Novak N, Hamelmann E, Bauer A, Merk HF, Rabe U, Jung K, Schlenter WW, Ring J, Chaker AM, Wehrmann W, Becker S, Mülleneisen NK, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Zuberbier T, Spindler T, Vogelberg C. White Paper Erdnussallergie - Teil 1: Epidemiologie, Burden of Disease, gesundheitsökonomische Aspekte. Allergo J 2021. [DOI: 10.1007/s15007-021-4935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Ring J, Beyer K, Bircher A, Biedermann T, Fischer M, Fuchs T, Heller AR, Hoffmann F, Huttegger I, Jakob T, Klimek L, Kopp MV, Kugler C, Lange L, Pfaar O, Rietschel E, Ruëff F, Schnadt S, Seifert R, Stöcker B, Treudler R, Vogelberg C, Werfel T, Worm M, Sitter H, Brockow K. Kurzfassung der Leitlinie "Akuttherapie und Management der Anaphylaxie - Update 2021" für Patienten und Angehörige. Allergo J 2021; 30:24-31. [PMID: 34744321 PMCID: PMC8560215 DOI: 10.1007/s15007-021-4907-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Johannes Ring
- Haut- und Laserzentrum an der Oper, Perusastraße 5, 80333 München, Germany
| | - Kirsten Beyer
- Charité Universitätsmedizin Berlin, Klinik für Pädiatrie - Pneumologie und Immunologie, Augustenburger Platz 1, 13353 Berlin, Korea
| | - Andreas Bircher
- Allergologische Poliklinik, Klinik für -Dermatologie,, Universitätsspital Basel, Basel, Schweiz
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Germany
| | - Matthias Fischer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ALB FILS Kliniken Göppingen, Göppingen, Germany
| | - Thomas Fuchs
- Klinik f. Dermatologie, Venerologie u. Allergologie, Georg-August-Universität, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Axel R Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Hauner'schen Kinderspital, Ludwig-Maximilians-Universität München, München, Germany
| | - Isidor Huttegger
- Klinik für Pädiatrie, Universitätsklinikum Salzburg, Salzburg, Österreich
| | - Thilo Jakob
- Universitätsklinikum Gießen, Klinik für Dermatologie, Venerologie und Allergologie, Gaffkystraße 14, 35392 Gießen, Germany
| | - Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Matthias V Kopp
- Klinik für Kinder- und Jugendmedizin, UKSH Campus Lübeck, Lübeck, Germany
| | - Claudia Kugler
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Germany
| | - Lars Lange
- Abteilung für Kinder- und Judendmedizin, GFO-Kliniken Bonn - Betriebsstätte St. Marien, Robert-Koch-Str. 1, 53115 Bonn, Germany
| | - Oliver Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Sektion Rhinologie und Allergo-logie,, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Ernst Rietschel
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Ludwig--Maximilians-Universität München, München, Germany
| | - Sabine Schnadt
- Deutscher Allergie- und Asthmabund (DAAB), An der Eickesmühle 15 - 19, 41238 Mönchengladbach, Germany
| | - Roland Seifert
- Institut für Pharmakologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Britta Stöcker
- Praxis für Kinderheilkunde und Jugendmedizin, Bonn, Germany
| | - Regina Treudler
- Universitätsklinikum Leipzig, Klinik f. Dermatologie u. Allergologie, Philipp-Rosenthal-Str. 23, 4103 Leipzig, Germany
| | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Univ.-Klinikum Carl Gustav Carus, Fetscherstraße 74, 1307 Dresden, Germany
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Med. Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Margitta Worm
- Klinik für Dermatologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helmut Sitter
- Haut- und Laserzentrum an der Oper, Perusastraße 5, 80333 München, Germany
| | - Knut Brockow
- Technische Universität München, Klinik f. Dermatologie und Allergologie am Biederstein, Biedersteiner Str. 29, 80802 München, Germany
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36
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Manders E, Goodill S, Koch SC, Giarelli E, Polansky M, Fisher K, Fuchs T. The Mirroring Dance: Synchrony and Interaction Quality of Five Adolescents and Adults on the Autism Spectrum in Dance/Movement Therapy. Front Psychol 2021; 12:717389. [PMID: 34721165 PMCID: PMC8551749 DOI: 10.3389/fpsyg.2021.717389] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals on the autism spectrum are often described as having atypical social interactions. Ideally, interactional synchrony helps any interaction flow smoothly with each individual responding verbally, non-verbally, and/or emotionally within a short timeframe. Differences in interactional synchrony may impact how individuals on the autism spectrum experience social encounters. Method: This mixed methods pilot study examined interactional synchrony in five cases of adolescents and adults on the autism spectrum through secondary analysis of video of the participants in movement-based mirroring tasks during dance/movement therapy. Raters described the movement and interactions of the participants while they were leading and following mirroring and engaged in open-ended free dances with a partner. Videos were also scored on measures of affective engagement, flow of the interaction, and synchrony. Results: One of the most striking findings of this study was the difference between engagement in the instructions of the task and engagement with the partner: participants often followed the instructions for the mirroring tasks with little further social engagement with their partner. When participants did engage in moments of social initiation, attunement to the partner, and interactive behaviors, these did not develop into longer interactions. A paired t-test of the correlation coefficients for each participant showed that scores on synchrony and affective engagement were more strongly positively correlated in the less structured open-ended dance and in video clips of interactive behaviors, than in the videos of simply leading or following mirroring. Synchrony was also significantly more strongly positively correlated with the observed flow of the interaction than with observed affective engagement. With the small sample size, however, most of the correlation coefficients were not significant and should be tested on a larger sample. Discussion: Interpersonal synchrony may not be sufficient to effectively support social engagement when individuals on the autism spectrum simply follow instructions to synchronize their movements. Synchrony-based interventions may therefore need to include more complex open-ended social scenarios as interactional synchrony may then be more correlated with perceived interaction quality. Therapists may also need to partner with participants to model using non-verbal social behaviors to develop interactions within mirroring tasks.
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Affiliation(s)
- Elizabeth Manders
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States.,Department of Therapy Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Sharon Goodill
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Sabine C Koch
- Department of Therapy Sciences, SRH University Heidelberg, Heidelberg, Germany.,Research Institute for Creative Arts Therapies (RIArT), Alanus University of Arts and Social Science, Alfter, Germany
| | - Ellen Giarelli
- Doctoral Nursing Program, Drexel University, Philadelphia, PA, United States
| | - Marcia Polansky
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Kathleen Fisher
- Doctoral Nursing Program, Drexel University, Philadelphia, PA, United States
| | - Thomas Fuchs
- Psychiatrische Universitätsklinik, University of Heidelberg, Heidelberg, Germany
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37
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Lange L, Klimek L, Beyer K, Blümchen K, Novak N, Hamelmann E, Bauer A, Merk H, Rabe U, Jung K, Schlenter W, Ring J, Chaker A, Wehrmann W, Becker S, Mülleneisen N, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Zuberbier T, Spindler T, Vogelberg C. White paper on peanut allergy - part 1: Epidemiology, burden of disease, health economic aspects. ACTA ACUST UNITED AC 2021; 30:261-269. [PMID: 34603938 PMCID: PMC8477625 DOI: 10.1007/s40629-021-00189-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Peanuts are Leguminosae, commonly known as the legume or pea family, and peanut allergy is among the most common food allergies and the most common cause of fatal food reactions and anaphylaxis. The prevalence of peanut allergy increased 3.5-fold over the past two decades reaching 1.4–2% in Europe and the United States. The reasons for this increase in prevalence are likely multifaceted. Sensitization via the skin appears to be associated with the development of peanut allergy and atopic eczema in infancy is associated with a high risk of developing peanut allergy. Until recently, the only possible management strategy for peanut allergy was strict allergen avoidance and emergency treatment including adrenaline auto-injector in cases of accidental exposure and reaction. This paper discusses the various factors that impact the risks of peanut allergy and the burden of self-management on peanut-allergic children and their caregivers.
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Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, GFO Clinics Bonn, Bonn, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Kirsten Beyer
- Department of Pediatrics m.S. Pneumology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blümchen
- Center of Pediatric and Adolescent Medicine, Focus on Allergology, Pneumology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Bethel Children's Center, OWL University Hospital of Bielefeld University, Bielefeld, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Hans Merk
- Department of Dermatology & Allergology, RWTH Aachen, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Kirsten Jung
- Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
| | | | | | - Adam Chaker
- Department of Otolaryngology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Sven Becker
- Department of Otolaryngology, University of Tübingen, Tübingen, Germany
| | | | - Katja Nemat
- Pediatric Pneumology/Allergology Practice, Kinderzentrum Dresden (Kid), Dresden, Germany
| | - Wolfgang Czech
- Practice and clinic for allergology/dermatology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Holger Wrede
- Practice and clinic for allergology/ear, nose and throat specialist, Herford, Germany
| | - Randolf Brehler
- Clinic for Skin Diseases, Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Hospital, Georg-August-University, Göttingen, Germany
| | - Thilo Jakob
- rd Clinic for Dermatology and Allergology University Hospital Giessen, UKGM Justus Liebig University Giessen, Giessen, Germany
| | - Tobias Ankermann
- th Clinic for Pediatric and Adolescent Medicine, Pneumology, Allergology, Neonatology, Intensive Care Medicine, Infectiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian M Schmidt
- th Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, Greifswald University Medical Center, Greifswald, Germany
| | - Michael Gerstlauer
- pediatric pneumologist/pediatric allergologist, II. clinic for children and adolescents, University Hospital Augsburg, Augsburg, Germany
| | - Torsten Zuberbier
- Clinic for Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Spindler
- Department of Pediatrics and Adolescent Medicine, Pediatric Pneumology, Allergology, Sports Medicine, Hochgebirgsklinik Davos, Davos-Wolfgang, Switzerland
| | - Christian Vogelberg
- TU Dresden/UKDD, Pediatric Department, University Hospital Dresden, Dresden, Germany.,Department of Pediatric Pneumology/Allergology, Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Hospital Carl Gustav Carus, Fetscher Street 74, 01307 Dresden, Germany
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38
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Ring J, Beyer K, Biedermann T, Bircher A, Fischer M, Fuchs T, Heller A, Hoffmann F, Huttegger I, Jakob T, Klimek L, Kopp MV, Kugler C, Lange L, Pfaar O, Rietschel E, Rueff F, Schnadt S, Seifert R, Stöcker B, Treudler R, Vogelberg C, Werfel T, Worm M, Sitter H, Brockow K. Messages for patients and relatives from the 2021 update of the guideline on acute therapy and management of anaphylaxis. ACTA ACUST UNITED AC 2021; 30:243-248. [PMID: 34603937 PMCID: PMC8475294 DOI: 10.1007/s40629-021-00185-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Johannes Ring
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Kirsten Beyer
- Department of Pediatrics, Division of Pulmonology, Immunology and Critical Care Medicine, Charité—University Hospital Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Andreas Bircher
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, ALB FILS Hospitals Göppingen, Göppingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, University Hospital Göttingen, Göttingen, Germany
| | - Axel Heller
- Department of Anesthesiology and Operative Intensive Care Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Florian Hoffmann
- Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich, Germany
| | - Isidor Huttegger
- Department of Pediatrics, University Hospital Salzburg, Salzburg, Austria
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Gießen (UKGM), Justus-Liebig-University Gießen, Gießen, Germany
| | - Ludger Klimek
- Center of Rhinology and Allergology, Wiesbaden, Germany
| | - Matthias V. Kopp
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Kugler
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | | | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Ernst Rietschel
- Department of Pediatrics, University Hospital Cologne, Cologne, Germany
| | - Franziska Rueff
- Department of Dermatology and Allergology, Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Sabine Schnadt
- German Allergy and Asthma Association, Mönchengladbach, Germany
| | - Roland Seifert
- Institute of Pharmacology, Hannover Medical School, Hannover, Germany
| | - Britta Stöcker
- Medical practice for pediatrics and youth medicine, Poppelsdorfer Allee, Bonn, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology, and Allergology, Leipzig Interdisciplinary Allergy Center, University Hospital Leipzig, Leipzig, Germany
| | - Christian Vogelberg
- Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Thomas Werfel
- Immunodermatology and Experimental Allergology Unit, Department of Dermatology, Allergology, and Venereology, Medical University Hannover, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology, and Allergology, Charité—University Hospital Berlin, Berlin, Germany
| | - Helmut Sitter
- Institute for Surgical Research, Philipps-University Marburg, Marburg, Germany
| | - Knut Brockow
- Department Dermatology and Allergology Biederstein, Technical University Munich, Biedersteiner Straße 29, 80802 Munich, Germany
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39
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Fuchs T. [Digitalized psychiatry : Critical considerations on a new paradigm]. Nervenarzt 2021; 92:1149-1154. [PMID: 34515809 DOI: 10.1007/s00115-021-01188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Digitalization and artificial intelligence hold the prospect of new procedures for psychiatry. Machine learning techniques combined with big data should enable algorithmized diagnostics, prediction and therapy that are superior to clinical observation and interaction in terms of accuracy and efficiency. This development converges with the search for new, statistically and biologically based disorder patterns to replace clinical psychopathological disease entities. This article examines the possibilities and the problems of a digitalized psychiatry.
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Affiliation(s)
- Thomas Fuchs
- Karl-Jaspers-Professor für Philosophie und Psychiatrie, Psychiatrische Universitätsklinik, Voßstr. 4, 69115, Heidelberg, Deutschland.
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40
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Untersmayr E, Förster-Waldl E, Bonelli M, Boztug K, Brunner PM, Eiwegger T, Eller K, Göschl L, Grabmeier-Pfistershammer K, Hötzenecker W, Jordakieva G, Moschen AR, Pfaller B, Pickl W, Reinisch W, Wiedermann U, Klimek L, Bergmann KC, Brehler R, Novak N, Merk HF, Rabe U, Schlenter WW, Ring J, Wehrmann W, Mülleneisen NK, Wrede H, Fuchs T, Jensen-Jarolim E. Immunologisch relevante Aspekte der neuen COVID-19-Impfstoffe. Allergo J 2021; 30:34-47. [PMID: 34393384 PMCID: PMC8349614 DOI: 10.1007/s15007-021-4848-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Eva Untersmayr
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
| | - Elisabeth Förster-Waldl
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Michael Bonelli
- Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Kaan Boztug
- St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Patrick M Brunner
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Eiwegger
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Kathrin Eller
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Lisa Göschl
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Katharina Grabmeier-Pfistershammer
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfram Hötzenecker
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Galateja Jordakieva
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Alexander R Moschen
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Pfaller
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Winfried Pickl
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Walter Reinisch
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Ursula Wiedermann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Ludger Klimek
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Karl-Christian Bergmann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Randolf Brehler
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Natalija Novak
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Hans F Merk
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Uta Rabe
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang W Schlenter
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Johannes Ring
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang Wehrmann
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Norbert K Mülleneisen
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Holger Wrede
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Fuchs
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Erika Jensen-Jarolim
- Medical University of Vienna, Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich.,Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie mit Center for Congenital Immunodeficiencies, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.,St. Anna Kinderspital und Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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41
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Franz D, Raschke M, Giannoudis PV, Leliveld M, Metsemakers WJ, Verhofstad MHJ, Craig JA, Shore J, Smith A, Muehlendyck C, Kerstan M, Fuchs T. Use of antibiotic coated intramedullary nails in open tibia fractures: A European medical resource use and cost-effectiveness analysis. Injury 2021; 52:1951-1958. [PMID: 34001375 DOI: 10.1016/j.injury.2021.04.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 10/07/2020] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE In patients with open tibial fractures, bone and wound infections are associated with an increased hospital length of stay and higher costs. The infection risk increases with the use of implants. Innovations to reduce this risk include antibiotic-coated implants. This study models whether the use of a gentamicin-coated intramedullary tibial nail is cost-effective for trauma centers managing patients with a high risk of infection. EFFICACY Absolute infection risk and relative risk reduction, by fracture grade, for antibiotic-coated nails compared to standard nails for patients with open tibial fractures were estimated based on the results of a meta-analysis, which assessed the additional benefit of locally-administered prophylactic antibiotics in open tibia fractures treated with implants. The observed efficacy of antibiotic-coated nails in reducing infections was applied in an economic model. METHODS The model compared infection rates, inpatient days, theatre usage and costs in high risk patients, with a Gustilo-Anderson (GA) grade III open fracture, for two patient cohorts from a trauma center perspective, with a 1-year time horizon. In one cohort all GAIII patients received a gentamicin-coated nail whilst GAI and GAII patients received a standard nail. All patients in the comparator cohort received a standard nail. Four European trauma centers provided patient-level data (n=193) on inpatient days, procedures and related costs for patients with and without infections. RESULTS Using the gentamicin-coated nail in patients at high risk of infection (GAIII) was associated with 75% lower rate of infection and cost savings (€477 - €3.263) for all included centers; the higher cost of the implant was offset by savings from fewer infections, inpatient days (-26%) and re-operations (-10%). This result was confirmed by extensive sensitivity analyses. CONCLUSIONS Analyses demonstrated that infection rates and total costs for in-hospital treatment could be potentially reduced by 75% and up to 15% respectively, by using a gentamicin-coated nail in patients at high risk of infection. Fewer infections, reduced inpatient days and re-operations may be potentially associated with use of antibiotic-coated implants. Results are sensitive to the underlying infection risk, with greatest efficacy and cost-savings when the coated implant is used in high risk patients.
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Affiliation(s)
- D Franz
- Franz und Wenke, Beratung im Gesundheitswesen GbR, Technologiehof Mendelstraße 11, 48149 Münster, Germany.
| | - M Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Germany.
| | - P V Giannoudis
- Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, England.
| | - M Leliveld
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - J A Craig
- York Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - J Shore
- York Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - A Smith
- Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - C Muehlendyck
- J&J, Hummelsbutteler Steindamm 71, 22851 Norderstedt, Germany.
| | - M Kerstan
- J&J, Synthes GmbH, Luzernstrasse 21, 4528 Zuchwil, Switzerland.
| | - T Fuchs
- Vivantes Klinikum im Friedrichshain, Zentrum für Muskuloskelettale Medizin, Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie Standort Landsberger Allee 49, 10249 Berlin, Germany.
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42
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Untersmayr E, Förster-Waldl E, Bonelli M, Boztug K, Brunner PM, Eiwegger T, Eller K, Göschl L, Grabmeier-Pfistershammer K, Hötzenecker W, Jordakieva G, Moschen AR, Pfaller B, Pickl W, Reinisch W, Wiedermann U, Klimek L, Bergmann KC, Brehler R, Pfützner W, Novak N, Merk H, Rabe U, Schlenter W, Ring J, Wehrmann W, Mülleneisen N, Wrede H, Fuchs T, Jensen-Jarolim E. Immunologically relevant aspects of the new COVID-19 vaccines-an ÖGAI (Austrian Society for Allergology and Immunology) and AeDA (German Society for Applied Allergology) position paper. Allergo J Int 2021; 30:155-168. [PMID: 34178577 PMCID: PMC8212077 DOI: 10.1007/s40629-021-00178-2] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The vaccines against the coronavirus disease 2019 (COVID-19) approved in the European Union represent a decisive step in the fight against the pandemic. The application of these available vaccines to patients with pre-existing immunological conditions leads to a multitude of questions regarding efficacy, side effects and the necessary patient information. RESULTS This review article provides insight into mechanisms of action of the currently available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines and summarises the current state of science as well as expert recommendations regarding tolerability of the vaccines. In addition, the potential to develop protective immune responses is determined. A special focus is given on patients under immunosuppression or in treatment with immunomodulatory drugs. Special groups of the population such as children, pregnant women and the elderly are also considered. CONCLUSION Despite the need for a patient-specific risk-benefit assessment, the consensus among experts is that patients with immunological diseases in particular benefit from the induced immune protection after COVID-19 vaccination and do not have an increased risk of side effects.
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Affiliation(s)
- Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Elisabeth Förster-Waldl
- Department of Neonatology, Paediatric Intensive Care Medicine and Neuropaediatrics with Centre for Congenital Immunodeficiencies, University Clinics of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Bonelli
- Clinical Department of Rheumatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children’s Hospital and University Clinic for Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- St. Anna Kinderkrebsforschung GmbH, Vienna, Austria
- CeMM Research Centre for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Patrick M. Brunner
- University Clinics of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Clinical Department of Pediatrics, University Hospital St. Pölten, St. Pölten, Austria
| | - Kathrin Eller
- Clinical Department of Nephrology, Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lisa Göschl
- Clinical Department of Rheumatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Wolfram Hötzenecker
- University Clinics of Dermatology and Venereology, Kepler University Hospital, Comprehensive Allergy Centre, Linz, Austria
| | - Galateja Jordakieva
- University Clinics of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander R. Moschen
- University Clinics of Internal Medicine, Department of Gastroenterology and Hepatology, Kepler University Hospital, Linz, Austria
| | - Birgit Pfaller
- Department of Internal Medicine 1, Karl Landsteiner University of Health Sciences, University Hospital, St. Pölten, Austria
| | - Winfried Pickl
- Institute of Immunology, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Walter Reinisch
- Clinical Division of Gastroenterology and Hepatology, University Clinics of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Karl-Christian Bergmann
- Department of Dermatology, Venereology and Allergy, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Randolf Brehler
- Department of Skin Diseases—General Dermatology and Venereology—Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, University Hospital Münster, Münster, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg (UKGM), Philipps University Marburg, Marburg, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen University, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | | | | | | | | | | | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
- Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University of Vienna, University of Vienna, Vienna, Austria
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43
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Chiriac U, Frey OR, Roehr AC, Koeberer A, Gronau P, Fuchs T, Roberts JA, Brinkmann A. Personalized ß-lactam dosing in patients with coronavirus disease 2019 (COVID-19) and pneumonia: A retrospective analysis on pharmacokinetics and pharmacokinetic target attainment. Medicine (Baltimore) 2021; 100:e26253. [PMID: 34087915 PMCID: PMC8183774 DOI: 10.1097/md.0000000000026253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/05/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Pathophysiological changes are important risk factors for critically ill patients with pneumonia manifesting sub-therapeutic antibiotic exposures during empirical treatment. The effect of coronavirus disease 2019 (COVID-19) on antibiotic dosing requirements is uncertain. We aimed to determine the effect of COVID-19 on ß-lactam pharmacokinetics (PK) and PK target attainment in critically ill patients with a personalized dosing strategy.Retrospective, single-center analysis of COVID-19 ± critically ill patients with pneumonia (community-acquired pneumonia or hospital-acquired pneumonia) who received continuous infusion of a ß-lactam antibiotic with dosing personalized through dosing software and therapeutic drug monitoring. A therapeutic exposure was defined as serum concentration between (css) 4 to 8 times the EUCAST non-species related breakpoint).Data from 58 patients with pneumonia was analyzed. Nineteen patients were tested COVID-19-positive before the start of the antibiotic therapy for community-acquired pneumonia or hospital-acquired pneumonia. Therapeutic exposure was achieved in 71% of COVID-19 patients (68% considering all patients). All patients demonstrated css above the non-species-related breakpoint. Twenty percent exceeded css above the target range (24% of all patients). The median ß-lactam clearance was 49% compared to ß-lactam clearance in a standard patient without a significant difference regarding antibiotic, time of sampling or present COVID-19 infection. Median daily doses were 50% lower compared to standard bolus dosing.COVID-19 did not significantly affect ß-lactam pharmacokinetics in critically ill patients. Personalized ß-lactam dosing strategies were safe in critically ill patients and lead to high PK target attainment with less resources.
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Affiliation(s)
- Ute Chiriac
- Department of Pharmacy, University Hospital of Heidelberg
| | - Otto R. Frey
- Department of Pharmacy, Heidenheim General Hospital
| | | | - Andreas Koeberer
- Department of Anesthesiology and Intensive Care Medicine, Heidenheim General Hospital
| | - Patrick Gronau
- Department of Anesthesiology and Intensive Care Medicine, Heidenheim General Hospital
| | - Thomas Fuchs
- Department of Anesthesiology and Intensive Care Medicine, Heidenheim General, Heidenheim, Germany
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France
| | - Alexander Brinkmann
- Department of Anesthesiology and Intensive Care Medicine, Heidenheim General Hospital
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Maris I, Dölle‐Bierke S, Renaudin J, Lange L, Koehli A, Spindler T, Hourihane J, Scherer K, Nemat K, Kemen C, Neustädter I, Vogelberg C, Reese T, Yildiz I, Szepfalusi Z, Ott H, Straube H, Papadopoulos NG, Hämmerling S, Staden U, Polz M, Mustakov T, Cichocka‐Jarosz E, Cocco R, Fiocchi AG, Fernandez‐Rivas M, Worm M, Grünhagen J, Wittenberg M, Beyer K, Henschel A, Küper S, Möser A, Fuchs T, Ruëff F, Wedi B, Hansen G, Buck T, Büsselberg J, Drägerdt R, Pfeffer L, Dickel H, Körner‐Rettberg C, Merk H, Lehmann S, Bauer A, Nordwig A, Zeil S, Hannapp C, Wagner N, Rietschel E, Hunzelmann N, Huseynow I, Treudler R, Aurich S, Prenzel F, Klimek L, Pfaar O, Reider N, Aberer W, Varga E, Bogatu B, Schmid‐Grendelmeier P, Guggenheim R, Riffelmann F, Kreft B, Kinaciyan K, Hartl L, Ebner C, Horak F, Brehler R, Witte J, Buss M, Hompes S, Bieber T, Gernert S, Bücheler M, Rabe U, Brosi W, Nestoris S, Hawranek T, Lang R, Bruns R, Pföhler C, Eng P, Schweitzer‐Krantz S, Meller S, Rebmann H, Fischer J, Stichtenoth G, Thies S, Gerstlauer M, Utz P, Neustädter I, Klinge J, Volkmuth S, Plank‐Habibi S, Schilling B, Kleinheinz A, Brückner A, Schäkel K, Manolaraki I, Kowalski M, Solarewicz‐Madajek K, Tscheiller S, Seidenberg J, Cardona V, Garcia B, Bilo M, Cabañes Higuero N, Vega Castro A, Poziomkowska‐Gęsicka I, Büsing S, Virchow C, Christoff G, Jappe U, Müller S, Knöpfel F, Correard A, Rogala B, Montoro A, Brandes A, Muraro A, Zimmermann N, Hernandez D, Minale P, Niederwimmer J, Zahel B, Dahdah L, Arasi S, Reissig A, Eitelberger F, Asero R, Hermann F, Zeidler S, Pistauer S, Geißler M, Ensina L, Plaza Martin A, Meister J, Stieglitz S, Hamelmann E. Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry. Allergy 2021; 76:1517-1527. [PMID: 33274436 DOI: 10.1111/all.14683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. METHODS Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. RESULTS 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). CONCLUSIONS The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.
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Affiliation(s)
- Ioana Maris
- Bon Secours Hospital Cork/Paediatrics and Child HealthUniversity College Cork Cork Ireland
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Lars Lange
- Department of Paediatrics St. Marien‐Hospital Bonn Germany
| | - Alice Koehli
- Division of Allergology University Children’s Hospital Zurich Zürich Switzerland
| | - Thomas Spindler
- Department of Paediatrics Medical Campus Hochgebirgsklinik Davos Davos Switzerland
| | - Jonathan Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Children’s Health Ireland Dublin Ireland
| | | | - Katja Nemat
- Practice for paediatric pneumology and allergology Kinderzentrum Dresden‐Friedrichstadt Dresden Germany
| | - C. Kemen
- Department of Paediatrics Children’s Hospital WILHELMSTIFT Hamburg Germany
| | - Irena Neustädter
- Department of Paediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | - Christian Vogelberg
- Department of Paediatrics Universitätsklinikum Carl Gustav CarusTechnical University Dresden Germany
| | - Thomas Reese
- Department of Paediatrics Mathias‐Spital Rheine Rheine Germany
| | - Ismail Yildiz
- Department of Paediatrics Friedrich‐Ebert‐Krankenhaus Neumuenster Germany
| | - Zsolt Szepfalusi
- Division of Paediatric Pulmonology, Allergology and Endocrinology Department of Paediatrics and Adolescent Medicine Competence Center Paediatrics Medical University of Vienna Vienna Austria
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology Epidermolysis bullosa‐Centre HannoverChildren’s Hospital AUF DER BULT Hanover Germany
| | - Helen Straube
- Division of Allergology Darmstädter Kinderkliniken Prinzessin Margaret Darmstadt Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection Immunity& Respiratory Medicine University of Manchester Manchester UK
| | - Susanne Hämmerling
- Division of Paediatric Pulmonology and Allergology University Children`s Hospital Heidelberg Heidelberg Germany
| | - Ute Staden
- Paediatric Pneumology & Allergology Medical practice Klettke/Staden Berlin Germany
| | - Michael Polz
- Department of Paediatrics GPR Klinikum Rüsselsheim Germany
| | - Tihomir Mustakov
- Chair of Allergy University Hospital Alexandrovska Sofia Bulgaria
| | - Ewa Cichocka‐Jarosz
- Department of Paediatrics Jagiellonian University Medical College Krakow Poland
| | - Renata Cocco
- Division of Allergy Clinical Immunology and Rheumatology Department of Paediatrics Federal University of São Paulo São Paulo Brazil
| | | | | | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Forkel S, Beutner C, Schröder SS, Bader O, Gupta S, Fuchs T, Schön MP, Geier J, Buhl T. Sensitization against Fungi in Patients with Airway Allergies over 20 Years in Germany. Int Arch Allergy Immunol 2021; 182:515-523. [PMID: 33780961 DOI: 10.1159/000512230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fungal spores are ubiquitous allergens. Severe forms of asthma are particularly highly associated with fungal sensitization. National and international asthma guidelines recommend the implementation of allergen immunotherapy if indicated. Thus, detection and treatment of relevant allergies are key components of primary care of these patients. OBJECTIVES The aims of the study were (i) to investigate trends in the prevalence of sensitization to twelve fungi in central Germany over the last 20 years and (ii) to dissect specific sensitization patterns among the 3 most important fungi: Aspergillus, Alternaria, and Cladosporium. METHODS This single-center study evaluated skin prick test (SPT) results of 3,358 patients with suspected airway allergies over a period of 20 years (1998-2017). RESULTS While 19.2% of all study patients had positive test results to at least 1 of the 3 fungi (Alternaria, Aspergillus, or Cladosporium) in the first study decade, this rate increased to 22.5% in the second decade. Slight increases in sensitization rates to almost all fungi were observed over the 20-year period. In the last decade, polysensitization to Alternaria, Aspergillus, and Cladosporium increased significantly. Sensitization to fungi is age-dependent and peaks in the age-group of 21-40 years during the second decade. CONCLUSION Fungi are relevant allergens for perennial and seasonal allergy symptoms. We currently recommend including Aspergillus, Alternaria, and Cladosporium in the standard series of SPTs for airway allergies.
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Affiliation(s)
- Susann Forkel
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Caroline Beutner
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Silke S Schröder
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Oliver Bader
- Department of Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany
| | - Sidhi Gupta
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Geier
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany.,Information Network of Department of Dermatology (IVDK), University Medical Center Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
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Kreipe K, Forkel S, Heinemann KE, Amschler K, Fuchs T, Geier J, Buhl T. Contact sensitizations to disinfectants containing alcohols or quaternary ammonium compounds are rarely of clinical relevance. Contact Dermatitis 2021; 85:211-214. [PMID: 33763911 DOI: 10.1111/cod.13844] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of disinfectants is part of the everyday life of people, especially in the medical profession. During the coronavirus disease 2019 (COVID-19) pandemic, the use of disinfectants continues to increase and is of fundamental importance in infection control. OBJECTIVES To determine the frequency of sensitization and the value of patch testing to didecyldimethylammonium chloride (DDAC) and the alcohols ethanol, 1-propanol, and isopropanol. METHODS Clinical patch test data of 145 patients with suspected contact allergy to disinfectants were retrospective analysed. RESULTS Among the 145 patients patch tested with the different alcohols, only one nurse was detected with a possible allergy to 1-propanol. Additional patch testing in 84 patients with DDAC 0.05% resulted in five patients with weakly positive reactions only, without clinical relevance. Patch testing with DDAC 0.03% showed no positive reactions at all on day 3 readings. CONCLUSIONS DDAC and alcohols are rarely responsible for allergic contact dermatitis. The accused products of the patients should be checked for other allergens and further additives with skin-irritating properties. Individual susceptibility and mishandling of the disinfectants should be considered.
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Affiliation(s)
- Katharina Kreipe
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Katharina Amschler
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Geier
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany.,Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
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Loman L, Uter W, Armario‐Hita JC, Ayala F, Balato A, Ballmer‐Weber BK, Bauer A, Bircher AJ, Buhl T, Czarnecka‐Operacz M, Dickel H, Fuchs T, Giménez Arnau A, John SM, Kränke B, Kręcisz B, Mahler V, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Scherer Hofmeier K, Schliemann S, Simon D, Spiewak R, Spring P, Valiukevičienė S, Wagner N, Weisshaar E, Pesonen M, Schuttelaar MLA. European Surveillance System on Contact Allergies (ESSCA): Characteristics of patients patch tested and diagnosed with irritant contact dermatitis. Contact Dermatitis 2021; 85:186-197. [PMID: 33729576 PMCID: PMC8360089 DOI: 10.1111/cod.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. OBJECTIVES To describe the characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. METHODS Data collected by the ESSCA in consecutively patch-tested patients from January 2009 to December 2018 were analyzed. RESULTS Of the 68 072 patients, 8702 were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry cooks, and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. CONCLUSIONS The hands were mainly involved in OICD also in the subgroup of patients with contact dermatitis, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult-to-treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered.
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Affiliation(s)
- Laura Loman
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyFriedrich‐Alexander‐University Erlangen/NürnbergErlangenGermany
| | - José C. Armario‐Hita
- Department of DermatologyUniversity Hospital of Puerto Real, University of CádizCádizSpain
| | - Fabio Ayala
- Department of DermatologyUniversity of Naples Federico IINaplesItaly
| | - Anna Balato
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Barbara K. Ballmer‐Weber
- Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
- Department of DermatologyUniversity Hospital Zürich and Clinic of Dermatology and Allergology, Kantonsspital St GallenZürichSwitzerland
| | - Andrea Bauer
- Department of DermatologyUniversity Hospital Carl Gustav Carus, Technical University of DresdenDresdenGermany
| | - Andreas J. Bircher
- Department of DermatologyAllergy Unit, University Hospital BaselBaselSwitzerland
| | - Timo Buhl
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Ana Giménez Arnau
- Department of DermatologyHospital del Mar, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Swen M. John
- Department of Dermatology and Environmental MedicineInstitute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Lower Saxony Institute for Occupational Dermatology (NIB)OsnabrückGermany
| | - Birger Kränke
- Department of Dermatology and VenereologyMedical University of GrazGrazAustria
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceInstitute of Medical Science, Jan Kochanowski UniversityKielcePoland
- Department of DermatologyNofer Institute of Occupational MedicineŁódźPoland
| | - Vera Mahler
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
- Division of AllergologyPaul‐Ehrlich‐InstitutLangenGermany
| | - Thomas Rustemeyer
- Department of Dermatology‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | | | | | - Sibylle Schliemann
- Department of Dermatology and AllergologyUniversity Hospital JenaJenaGermany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of PharmacyJagiellonian University Medical CollegeKrakowPoland
| | - Philip Spring
- Dermatologie et vénéréologie FMH, Center Médical d'EpalingesEpalingesSwitzerland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health SciencesKaunasLithuania
| | - Nicola Wagner
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Elke Weisshaar
- Department of Dermatology, Occupational DermatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Maria Pesonen
- Division Occupational MedicineFinnish Institute of Occupational HealthHelsinkiFinland
| | - Marie L. A. Schuttelaar
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Klimek L, Novak N, Hamelmann E, Werfel T, Wagenmann M, Taube C, Bauer A, Merk H, Rabe U, Jung K, Schlenter W, Ring J, Chaker A, Wehrmann W, Becker S, Mülleneisen N, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Vogelberg C, Zuberbier T, Hartmann K, Worm M. Severe allergic reactions after COVID-19 vaccination with the Pfizer/BioNTech vaccine in Great Britain and USA: Position statement of the German Allergy Societies: Medical Association of German Allergologists (AeDA), German Society for Allergology and Clinical Immunology (DGAKI) and Society for Pediatric Allergology and Environmental Medicine (GPA). ACTA ACUST UNITED AC 2021; 30:51-55. [PMID: 33643776 PMCID: PMC7903024 DOI: 10.1007/s40629-020-00160-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Two employees of the National Health Service (NHS) in England developed severe allergic reactions following administration of BNT162b2 vaccine against COVID-19 (coronavirus disease 2019). The British SmPC for the BNT162b2 vaccine already includes reference to a contraindication for use in individuals who have had an allergic reaction to the vaccine or any of its components. As a precautionary measure, the Medicines and Healthcare products Regulatory Agency (MHRA) has issued interim guidance to the NHS not to vaccinate in principle in "patients with severe allergies". Allergic reactions to vaccines are very rare, but vaccine components are known to cause allergic reactions. BNT162b2 is a vaccine based on an mRNA embedded in lipid nanoparticles and blended with other substances to enable its transport into the cells. In the pivotal phase III clinical trial, the BNT162b2 vaccine was generally well tolerated, but this large clinical trial, used to support vaccine approval by the MHRA and US Food and Drug Administration, excluded individuals with a "history of a severe adverse reaction related to the vaccine and/or a severe allergic reaction (e.g., anaphylaxis) to a component of the study medication". Vaccines are recognized as one of the most effective public health interventions. This repeated administration of a foreign protein (antigen) necessitates a careful allergological history before each application and diagnostic clarification and a risk-benefit assessment before each injection. Severe allergic reactions to vaccines are rare but can be life-threatening, and it is prudent to raise awareness of this hazard among vaccination teams and to take adequate precautions while more experience is gained with this new vaccine.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Children's Center Bethel, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Werfel
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Martin Wagenmann
- Department of Ear, Nose and Throat Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Taube
- Clinic for Pneumology, University Medicine Essen-Ruhrlandklinik, West German Lung Center, Essen, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University Allergy Center, University Clinic Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter Hospital in Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Kirsten Jung
- Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
| | | | | | - Adam Chaker
- Ear, Nose and Throat Clinic, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Sven Becker
- Ear, Nose and Throat Clinic, University of Tübingen, Tübingen, Germany
| | | | - Katja Nemat
- Practice for Pediatric Pneumology/Allergology at the Children's Center Dresden (Kid), Dresden, Germany
| | - Wolfgang Czech
- Practice and Clinic for Allergology/Dermatology Schwarzwald-Baar Clinic, Villingen-Schwenningen, Germany
| | - Holger Wrede
- Ear, Nose and Throat Specialist, Herford, Germany
| | - Randolf Brehler
- Department of Skin Diseases, Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital Gießen, UKGM Justus Liebig University Gießen, Gießen, Germany
| | - Tobias Ankermann
- Clinic for Pediatric and Adolescent Medicine, Pneumology, Allergology, Neonatology, Intensive Care Medicine, Infectiology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Sebastian M Schmidt
- Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Michael Gerstlauer
- Pediatric Pneumology/Pediatric Allergology, 2nd Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg, Germany
| | - Christian Vogelberg
- Department of Pediatric Pneumology/Allergology, Clinic and Polyclinic for Pediatric and Adolescent Medicine, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Thomas Zuberbier
- Clinic for Dermatology, Venereology and Allergology, Charité-University Medicine Berlin, Berlin, Germany
| | - Karin Hartmann
- Clinic for Dermatology and Allergology, University Hospital Basel, Basel, Switzerland
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Hanna MG, Raciti P, Godrich R, Casson A, Viret J, Lee D, Lee M, Bozkurt A, Sue J, Dogdas B, Rothrock B, Grady L, Kanan C, Fuchs T. Abstract PD6-03: Clinical-grade detection of breast cancer in biopsies and excisions using machine learning. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd6-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathologists reviewing breast tissue slides must identify the presence of many salient features within each slide, including invasive and in situ breast cancer as well as various forms of atypia. In breast pathology particularly, the large volume of slides poses significant challenges for workload management and pathologist productivity (Johnson et al. 2019). The shift to a digital workflow in pathology, augmented by machine learning algorithms, has the potential to increase the efficiency, and productivity of pathologists by identifying cancer and pre-cancerous lesions in digitized slides. While there has been extensive work using machine learning algorithms to detect breast cancer metastasis in lymph nodes (Liu et al. 2018; Steiner et al. 2018), almost no research has been done on using such systems to detect breast cancer in biopsies and excisions.
Methods: We created and assessed Paige Breast Alpha, a machine learning system for the detection of breast cancer in hematoxylin and eosin (H&E) stained whole slide images (WSIs) of glass slides. The system is a binary classifier, intended to draw a pathologist’s attention to concerning features. Concerning features (the positive category) consisted of invasive breast cancer, in situ breast cancer, and various forms of atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, etc. ). The deep learning system is based on the method proposed in Campanella et al. (2019). It learns directly from diagnosis using multiple instance learning, without the need for pixel-wise annotations. Paige Breast Alpha was trained on 17354 images from 3378 patients, and was assessed on 7921 images from 2443 patients. All slides were scanned on a Leica Aperio AT2.
Results: For detecting invasive or in situ cancer at the part level, the system achieved an overall sensitivity of 97.3% and a specificity of 98.0% in biopsies and 96.1% sensitivity and 91.5% specificity in excisions. Each part had between 1—10 slides.
Conclusions: We hypothesized that a machine learning system trained to detect predefined types of breast cancer and pre-cancerous lesions could be applied to a range of breast biopsy and resection WSIs to detect for the presence of these lesions. Herein we showed that the presence of these predefined features can be detected with high accuracy. Future studies are being initiated to assess the potential benefits of such a system when used by a pathologist. Additional systems are under development that would have the capability of subtyping the lesion present, in addition to acting as an overall binary classifier.
Citation Format: Matthew G Hanna, Patricia Raciti, Ran Godrich, Adam Casson, Julian Viret, Donghun Lee, Matthew Lee, Alican Bozkurt, Jillian Sue, Belma Dogdas, Brandon Rothrock, Leo Grady, Christopher Kanan, Thomas Fuchs. Clinical-grade detection of breast cancer in biopsies and excisions using machine learning [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD6-03.
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Worm M, Ring J, Klimek L, Jakob T, Lange L, Treudler R, Beyer K, Werfel T, Biedermann T, Bircher A, Fischer M, Fuchs T, Heller AR, Hoffmann F, Huttegger I, Kopp MV, Kugler C, Lommatzsch M, Pfaar O, Rietschel E, Ruëff F, Schnadt S, Seifert R, Stöcker B, Vogelberg C, Sitter H, Gieler U, Brockow K. Management des Anaphylaxie-Risikos bei Covid-19-Impfung. HNO Nachrichten 2021; 51:18-21. [PMID: 33619418 PMCID: PMC7890774 DOI: 10.1007/s00060-021-7480-3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Margitta Worm
- Charité – Universitätsmedizin Berlin, Allergologie und Immunologie, Klinik für Dermatologie und Allergologie, Charitéplatz 1, 10117 Berlin, Germany
| | - Johannes Ring
- Technische Universität München, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein,, München, Germany
| | - Ludger Klimek
- Charité – Universitätsmedizin Berlin, Allergologie und Immunologie, Klinik für Dermatologie und Allergologie, Charitéplatz 1, 10117 Berlin, Germany
| | - Thilo Jakob
- Universitäts-Hautklinik Gießen, Gießen, Schweiz
| | | | - Regina Treudler
- Klinik für Dermatologie und Allergologie, Universitätsmedizin Leipzig, Leipzig, Germany
| | - Kirsten Beyer
- Technische Universität München, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein,, Berlin, Germany
| | - Thomas Werfel
- Medizinische Hochschule Hannover, Klinik und Poliklinik für Dermatologie und Allergologie, Hannover, Germany
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein,, Technische Universität München, München, Germany
| | - Andreas Bircher
- Allergologische Poliklinik, Klinik für Dermatologie,, Universitätsspital Basel, Basel, Schweiz
| | - Matthias Fischer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ALB FILS Kliniken Göppingen, Göppingen, Germany
| | - Thomas Fuchs
- Hautklinik Universitätsmedizin Göttingen, Göttingen, Germany
| | - Axel R. Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Hauner‘schen Kinderspital, Ludwig-Maximilians-Universität München, München, Germany
| | - Isidor Huttegger
- Klinik für Pädiatrie, Universitätsklinikum Salzburg, Salzburg, Österreich
| | - Matthias Volkmar Kopp
- Sektion für Pädiatrische Pneumologie und Allergologie, Universitätsklinikum Lübeck, Lübeck, Germany
| | - Claudia Kugler
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Österreich
| | - Marek Lommatzsch
- Klinik für Pneumologie, Universitätsklinikum Rostock, Rostock, Germany
| | - Oliver Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Sektion Rhinologie und Allergologie,, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Ernst Rietschel
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Sabine Schnadt
- Deutscher Allergie- und Asthmabund e. V. (DAAB), Mönchengladbach, Germany
| | - Roland Seifert
- Institut für Pharmakologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Britta Stöcker
- Praxis für Kinderheilkunde und Jugendmedizin, Bonn, Germany
| | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Helmut Sitter
- Institut für chirurgische Forschung, Philipps-Universität Marburg, Marburg, Germany
| | - Uwe Gieler
- Klinik für Psychosomatik, Vitos-Klinik Giessen-Marburg und Univ. Hautklinik Gießen, Gießen, Germany
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein,, Technische Universität München, München, Germany
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