1
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Hoffmann U. [Management of polypharmacy in older people with multimorbidity]. Inn Med (Heidelb) 2024; 65:9-16. [PMID: 38059997 DOI: 10.1007/s00108-023-01630-x] [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] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
If the individual diagnoses of older people with multimorbidity are treated according to guidelines and by different specialists, confusing medication plans are sometimes the consequence. Therefore, a regular and structured drug evaluation is essential. As the life goals of patients can be very different, especially in older age, certain preliminary considerations should be made when starting, prescribing or discontinuing medication, taking into account the individual situation, including geriatric aspects. Updated so-called positive and negative lists provide assistance as to which medications are suitable or unsuitable for older people. Discontinuing certain medications when the life expectancy is reduced certainly makes sense but undertreatment of symptoms that cause distress to people, such as pain, should definitely be avoided.
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Affiliation(s)
- Ute Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
- Klinik für Alterstraumatologie, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland.
- Zentrum für Ernährungsmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland.
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2
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Tjong M, Zhang S, Gasho J, Silos K, Gay C, McKenzie E, Steers J, Bitterman D, Nikolova A, Nohria A, Hoffmann U, Brantley K, Mak R, Atkins K. External validation of Cardiac disease, Hypertension, and Logarithmic Left anterior descending coronary artery radiation dose (CHyLL) for predicting major adverse cardiac events after lung cancer radiotherapy. Clin Transl Radiat Oncol 2023; 42:100660. [PMID: 37545790 PMCID: PMC10403724 DOI: 10.1016/j.ctro.2023.100660] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background and purpose Major adverse cardiac events(MACE) are prevalent in patients with locally advanced-non-small cell lung cancer(LA-NSCLC) following radiotherapy(RT). The CHyLL model, incorporating coronary heart disease(CHD),Hypertension(HTN),Logarithmic LADV15 was developed and internally-validated to predict MACE among LA-NSCLC patients. We sought to externally validate CHyLL to predict MACE in an independent LA-NSCLC cohort. Patients and methods Patients with LA-NSCLC treated with RT were included. CHyLL score was calculated:5.51CHD + 1.28HTN + 1.48ln(LADV15 + 1)-1.36CHD*ln(LADV15 + 1). CHyLL performance in predicting MACE was assessed and compared to mean heart dose(MHD) using Cox-proportional hazard(PH) analyses and Harrel's concordance(C)-indices. MACE and overall survival(OS) among low-vs high-risk groups(CHyLL < 5 vs ≥ 5) were compared. Results In the external validation cohort(N = 102), the median age was 71 years and 55% were females. Most(n = 74,73%), had clinical Stage III disease and 35(34%) underwent surgery. CHyLL demonstrated good MACE prediction with C-index of 0.73(95% Confidence Interval(CI):0.58-0.89), while MHD did not (C-index = 0.46 (95% CI:0.30-0.62)). Per CHyLL, 32(31%) and 70(69%) patients were considered low-and high-risk for MACE, respectively. CHyLL consistently identified lower MACE rates in the low-vs high-risk group(log-rank p = 0.108):0 vs 8%(12 months),5 vs 16%(24 months),5 vs 16%(36 months),and 5 vs 19%(48 months) post-RT. In the pooled internal and external validation cohort(N = 303), MACE rates in low-vs high-risk groups were statistically significantly different(log-rank p = 0.01):1 vs 6%(12 months),3 vs 12%(24 months),6 vs 19%(36 months),and 6 vs 21%(48 months). Conclusions CHyLL was externally validated and superior to MHD in predicting MACE. CHyLL has the potential to identify high-risk patients who may benefit from cardio-oncology optimization and to estimate personalized LADV15 constraints based on cardiac risk factors and acceptable MACE thresholds.
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Affiliation(s)
- M.C. Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, United States
| | - S.C. Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - J.O. Gasho
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - K.D. Silos
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - C. Gay
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - E.M. McKenzie
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - J. Steers
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - D.S. Bitterman
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, United States
| | - A.P. Nikolova
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - A. Nohria
- Department of Cardiovascular Medicine, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, United States
| | - U. Hoffmann
- Cleerly Health Inc., Denver, CO, United States
| | - K.D. Brantley
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - R.H. Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, United States
| | - K.M. Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Li J, Reinke S, Shen Y, Schollmeyer L, Liu YC, Wang Z, Hardt S, Hipfl C, Hoffmann U, Frischbutter S, Chang HD, Alexander T, Perka C, Radbruch H, Qin Z, Radbruch A, Dong J. A ubiquitous bone marrow reservoir of preexisting SARS-CoV-2-reactive memory CD4+ T lymphocytes in unexposed individuals. Front Immunol 2022; 13:1004656. [PMID: 36268016 PMCID: PMC9576920 DOI: 10.3389/fimmu.2022.1004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Circulating, blood-borne SARS-CoV-2-reactive memory T cells in persons so far unexposed to SARS-CoV-2 or the vaccines have been described in 20-100% of the adult population. They are credited with determining the efficacy of the immune response in COVID-19. Here, we demonstrate the presence of preexisting memory CD4+ T cells reacting to peptides of the spike, membrane, or nucleocapsid proteins of SARS-CoV-2 in the bone marrow of all 17 persons investigated that had previously not been exposed to SARS-CoV-2 or one of the vaccines targeting it, with only 15 of these persons also having such cells detectable circulating in the blood. The preexisting SARS-CoV-2-reactive memory CD4+ T cells of the bone marrow are abundant and polyfunctional, with the phenotype of central memory T cells. They are tissue-resident, at least in those persons who do not have such cells in the blood, and about 30% of them express CD69. Bone marrow resident SARS-CoV-2-reactive memory CD4+ memory T cells are also abundant in vaccinated persons analyzed 10-168 days after 1°-4° vaccination. Apart from securing the bone marrow, preexisting cross-reactive memory CD4+ T cells may play an important role in shaping the systemic immune response to SARS-CoV-2 and the vaccines, and contribute essentially to the rapid establishment of long-lasting immunity provided by memory plasma cells, already upon primary infection.
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Affiliation(s)
- Jinchan Li
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Simon Reinke
- Berlin Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Yu Shen
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Lena Schollmeyer
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Yuk-Chien Liu
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Zixu Wang
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ute Hoffmann
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
- Schwiete-Laboratory for Microbiota and Inflammation, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Stefan Frischbutter
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Hyun-Dong Chang
- Schwiete-Laboratory for Microbiota and Inflammation, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Helena Radbruch
- Institute of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Zhihai Qin
- Medical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Andreas Radbruch
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
| | - Jun Dong
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Institute of the Leibniz Association, Berlin, Germany
- *Correspondence: Jun Dong,
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Karady J, Mayrhofer T, Nagurney JT, Udelson JE, Fleg JL, Peacock WF, Januzzi JL, Koenig W, Ferencik M, Hoffmann U. Agreement between four high-sensitivity cardiac troponin assays and non-invasive testing, clinical and quality of care outcomes based on the 2020 ESC guidelines: results from the ROMICAT II trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quality of care and safety of patients with suspected acute coronary syndrome (ACS) would greatly benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification.
Purpose
To assess the agreement of 4 hs-cTn assays to risk stratify patients with suspected ACS using the ESC2020 Guidelines 0/2-hour algorithm, and to assess their associations with non-invasive diagnostic testing, clinical- and quality of care outcomes.
Methods
We analyzed blood samples obtained at emergency department (ED) presentation and 2 hours later from patients with suspected ACS enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) II trial, using 4 hs-cTn assays (Roche Diagnostics, Elecsys 2010; Abbott Diagnostics, ARCHITECT i2000SR; Siemens Diagnostics, HsVista; Beckman Coulter, ACCESS). We determined the agreement between the assays to assign patients to rule-out, observe, and rule-in management pathways according to the ESC2020 Guidelines. Further, we assessed assay association with non-invasive diagnostic test findings and adjudicated clinical- and quality of care outcomes. Finally, we compared observed conventional troponin management with predicted management per ESC2020 guidelines using hs-cTn assays.
Results
Overall, assignment to ESC2020 Guideline management pathways among 238 patients with suspected ACS (age 52.7±8.0 years; 40.3% [96/238] female) was concordant across all hs-Tn assays in 74% of patients but differed for rule-out rates (89.9% vs 76.5% vs 78.6% vs 86.6%, p<0.001) and observation rates (6.7% vs 20.6% vs 17.7% vs 9.2%, p<0.001), but not for rule-in (3.4% vs 2.9% vs 3.8% vs 4.2%, p=0.623). Among those whose management recommendation was rule-out, 19.1–21.6% had obstructive CAD defined as coronary stenosis ≥50% on coronary CT angiography or inducible myocardial ischemia on perfusion imaging and 3.3–4.2% were diagnosed with ACS as adjudicated by independent panel. Predicted ED discharge rates based on hs-cTn assays were higher than those observed with conventional troponin (80.3% to 90.8% vs. 21.0%, respectively p<0.001). As a result, predicted costs of care were significantly lower based on strategies utilizing hs-cTn assays than with conventional troponin ($2,578±2,896 to $2,894±4,371 vs $3,889±4,833, respectively, p<0.001)
Conclusion
In a quarter of patients presenting to the ED with suspected ACS ESC2020 Guideline-based management may be different, depending on the hs-cTn assay. As compared to conventional troponin, hs-cTn is predicted to significantly increase direct ED discharges and lower costs of care.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Karady
- Massachusetts General Hospital , Boston , United States of America
| | - T Mayrhofer
- Massachusetts General Hospital , Boston , United States of America
| | - J T Nagurney
- Massachusetts General Hospital , Boston , United States of America
| | - J E Udelson
- Tufts Medical Center, Department of Medicine , Boston , United States of America
| | - J L Fleg
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences , Bethesda , United States of America
| | - W F Peacock
- Baylor College of Medicine, Department of Emergency Medicine , Houston , United States of America
| | - J L Januzzi
- Massachusetts General Hospital , Boston , United States of America
| | - W Koenig
- University of Ulm, Institute of Epidemiology and Medical Biometry , Ulm , Germany
| | - M Ferencik
- Oregon Health & Science University, Knight Cardiovascular Institute , Portland , United States of America
| | - U Hoffmann
- Massachusetts General Hospital , Boston , United States of America
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5
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Koenig E, Reetz S, Hoffmann U, Fegert J. ProTransition – evaluation of an online-course for professionals to optimize the health care service for young people with mental illness in transition from adolescence to adulthood. Eur Psychiatry 2022. [PMCID: PMC9567796 DOI: 10.1192/j.eurpsy.2022.1791] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Adolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should give greater consideration to the transition phase. Objectives An online-course addressing health care professionals was developed to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize for the special challenges and needs of young adults with mental illness. Evaluation focuses on the gain of competences, benefit for practical work and user satisfaction. Methods Participants´ estimations and opinions on quality of the online-course, on impact of course participation to their practical work and on their competences regarding transition psychiatry are assessed with an online-survey before starting (t1) and after finishing (t2) the online-course. T1-assessment is already completed with 1924 datasets, t2-assessmend will take place 02/2022. Results Analyses of t1-assessment show a high heterogeneity of participants regarding their work background and setting. Special knowledge about mental illnesses during transition and about transition psychiatry, as well as feeling confident in accompanying transition processes is on a medium level. Results of t2-assessment and comparing analyses are expected in March 2022 and will be presented. Conclusions There was high interest of the target group in participating in the online-course. Evaluation will show if the online-course is a helpful measure in delievering the necessary education of professionals in transition psychiatry. Disclosure No significant relationships.
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Haehnle S, Fegert J, Hoffmann U. Influence of personal resources on job satisfaction. A study among professionals in the inpatient care of children and adolescents. Eur Psychiatry 2022. [PMCID: PMC9564257 DOI: 10.1192/j.eurpsy.2022.776] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Professionals in the inpatient care of burdened children and adolescents are confronted with high demands in their daily work. The job satisfaction can be affected negatively, if these professionals do not have the necessary resources to carry out their work. Objectives In a study as part of the accompanying research of an online course called “Trauma informed Care”, the connection between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction were investigated on a sample of N = 543 professionals working in the (inpatient) care of children and adolescents. Methods In order to quantify the connections between the personal resources action competence, emotional competence, self-efficacy and self-care and job satisfaction, correlations and a multiple regression were calculated. Results Moderate to strong correlations were identified between personal resources and job satisfaction among the professionals. The regression model revealed self-efficacy to be the most important predictor of job satisfaction. Self-care was also identified as an important predictor. Less importance could be ascribed to emotional competence. Action competence showed no effects in the regression model. Conclusions The results indicate the importance of personal resources for job satisfaction an their targeted promotion in order to increase job satisfaction and thus counteract the tendency of fluctuation and shortage of professionals in the area of child and youth welfare. Disclosure No significant relationships.
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7
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Bittner J, Maier A, Fegert J, Rassenhofer M, Hoffmann U. Basic knowledge in child protection– evaluation of an online-course for webbased transfer of interprofessional basic knowledge in child protection. Eur Psychiatry 2022. [PMCID: PMC9568126 DOI: 10.1192/j.eurpsy.2022.1135] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Insufficient or faulty cooperation between the various child protection professions can have an extremly negative impact on the well-being of the concerned children. Communication problems that were revealed when dealing with cases of child abuse show the importance of adequate cooperation and common language of the involved professions in child protection. Objectives An online-course adressing medical-therapeutic professionals, youth welfare as well as judiciary and police was developed to impart skills and knowledge in child protection to create interdisciplinary understanding and improve cooperation between the involved professions. Methods The acquisition of competencies, the transfer of learning content into everyday work and the quality of the online-course are determined using an online-survey before starting (t1) and after completing (t2) the course. T1-assessment is currently being evaluated with 1034 datasets, t2-assessment will take place 03/2022. Results Intended target groups could be accessed and participated in the online-course, although the ratio of medical-therapeutic participants was greater than of judiciary professionals. Specific results of T1- and T2- assesssment and comparing analyses are expected in March 2022 and will be presented. Conclusions
Based on existing online-courses developed by the Universityhospital Ulm, the suitability of online-education for training professionals in the field of child protection could be proven. If comparable effects can be shown for this online-course, there is an increase in evaluated offers of high quality. These enable comprehensive and low-threshold access to the subject of interdisciplinary communication and cooperation in child protection for involved professionals. Disclosure No significant relationships.
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8
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Christensen MB, Levy AM, Mohammadi NA, Niceta M, Kaiyrzhanov R, Dentici ML, Alam CA, Alesi V, Benoit V, Bhatia KP, Bierhals T, Boßelmann CM, Buratti J, Callewaert B, Ceulemans B, Charles P, De Wachter M, Dehghani M, D'haenens E, Doco-Fenzy M, Geßner M, Gobert C, Guliyeva U, Haack TB, Hammer TB, Heinrich T, Hempel M, Herget T, Hoffmann U, Horvath J, Houlden H, Keren B, Kresge C, Kumps C, Lederer D, Lermine A, Magrinelli F, Maroofian R, Mehrjardi MYV, Moudi M, Müller AJ, Oostra AJ, Pletcher BA, Ros-Pardo D, Samarasekera S, Tartaglia M, Van Schil K, Vogt J, Wassmer E, Winkelmann J, Zaki MS, Zech M, Lerche H, Radio FC, Gomez-Puertas P, Møller RS, Tümer Z. Biallelic variants in ZNF142 lead to a syndromic neurodevelopmental disorder. Clin Genet 2022; 102:98-109. [PMID: 35616059 PMCID: PMC9546172 DOI: 10.1111/cge.14165] [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: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Biallelic variants of the gene encoding for the zinc-finger protein 142 (ZNF142) have recently been associated with intellectual disability (ID), speech impairment, seizures, and movement disorders in nine individuals from five families. In this study, we obtained phenotype and genotype information of 26 further individuals from 16 families. Among the 27 different ZNF142 variants identified in the total of 35 individuals only four were missense. Missense variants may give a milder phenotype by changing the local structure of ZF motifs as suggested by protein modelling; but this correlation should be validated in larger cohorts and pathogenicity of the missense variants should be investigated with functional studies. Clinical features of the 35 individuals suggest that biallelic ZNF142 variants lead to a syndromic neurodevelopmental disorder with mild to moderate ID, varying degrees of delay in language and gross motor development, early onset seizures, hypotonia, behavioral features, movement disorders, and facial dysmorphism. The differences in symptom frequencies observed in the unpublished individuals compared to those of published, and recognition of previously underemphasized facial features are likely to be due to the small sizes of the previous cohorts, which underlines the importance of larger cohorts for the phenotype descriptions of rare genetic disorders. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maria B Christensen
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Amanda M Levy
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nazanin A Mohammadi
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Rauan Kaiyrzhanov
- Department of Neuromuscular Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Maria Lisa Dentici
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.,Medical Genetics Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chadi Al Alam
- Pediatric Neurology department, American center for Psychiatry and Neurology, Abu Dhabi and Al Ain, United Arab Emirates.,Pediatric Neurology department, Haykel Hospital, El Koura, Lebanon
| | - Viola Alesi
- Translational Cytogenomics Research Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tatjana Bierhals
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian M Boßelmann
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Julien Buratti
- Department of Medical Genetics, Pitié-Salpêtrière Hospital, AP- HP, Sorbonne Université, Paris, France
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Perrine Charles
- Department of Medical Genetics, Pitié-Salpêtrière Hospital, AP- HP, Sorbonne Université, Paris, France
| | - Matthias De Wachter
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Mohammadreza Dehghani
- Medical Genetics Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Erika D'haenens
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Martine Doco-Fenzy
- SFR CAP SANTE, HMB2 CHU, Reims, France.,CHU de Nantes, service de génétique médicale, Nantes, France
| | - Michaela Geßner
- KfH-Board of Trustees for Dialysis and Kidney Transplantation (KfH-Kuratorium für Dialyse und Nierentransplantation e.V.), Neu Isenburg, Germany
| | - Cyrielle Gobert
- Neuropediatric department, Centre Hospitalier Neurologique William Lennox, Ottignies, Belgium
| | | | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Trine B Hammer
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark
| | - Tilman Heinrich
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,MVZ Humangenetik und Molekularpathologie GmbH, Rostock, Germany
| | - Maja Hempel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Theresia Herget
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Judit Horvath
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - Henry Houlden
- Department of Neuromuscular Disorders, University College London Institute of Neurology, London, United Kingdom
| | - Boris Keren
- Department of Medical Genetics, Pitié-Salpêtrière Hospital, AP- HP, Sorbonne Université, Paris, France
| | | | - Candy Kumps
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | | | | | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Reza Maroofian
- Department of Neuromuscular Disorders, University College London Institute of Neurology, London, United Kingdom
| | | | - Mahdiyeh Moudi
- Department of Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amelie J Müller
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Anna J Oostra
- Neuropediatric department, Ghent University Hospital, Ghent, Belgium.,Centre for Developmental disorders, Ghent, Belgium
| | | | - David Ros-Pardo
- Molecular Modeling Group, Centro de Biología Molecular Severo Ochoa, CBMSO (CSIC-UAM), Madrid, Spain
| | | | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Kristof Van Schil
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Julie Vogt
- West Midlands Regional Genetics Service, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Evangeline Wassmer
- Birmingham Women and Children's Hospital, Birmingham, United Kingdom.,Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Juliane Winkelmann
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt.,Genetics Department, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Michael Zech
- Institute of Human Genetics, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Paulino Gomez-Puertas
- Molecular Modeling Group, Centro de Biología Molecular Severo Ochoa, CBMSO (CSIC-UAM), Madrid, Spain
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Langer F, Gerlach H, Schimke A, Heinken A, Hoffmann U, Noppeney T, Pittrow D, Klotsche J, Rabe E, Bauersachs R. OC-02: Outcomes of cancer-associated isolated superficial vein thrombosis in daily practice. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Bauersachs R, Gerlach H, Heinken A, Hoffmann U, Langer F, Noppeney T. Management and outcomes of patients with isolated superficial vein thrombosis under real life conditions (INSIGHTS-SVT). J Vasc Surg Venous Lymphat Disord 2021. [DOI: 10.1016/j.jvsv.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Maier A, Fegert JM, Hoffmann U. Health professionals' perspectives on child protection capacities, training and need for action. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.510] [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: 11/14/2022] Open
Abstract
Abstract
Background
Child maltreatment is because of its prevalence and consequences one of the main reasons for global health inequalities and a major public health problem. The medical field offers many opportunities to support affected children. However, there is often very limited awareness concerning child protection beyond a few engaged professionals. The present work aims to survey the state of knowledge and capacities in view of child protection in the medical field and explores health professionals' perspectives on a potential need for action.
Methods
From 06/2016 until 02/2021 3,360 health professionals were interviewed. Using quantitative and qualitative items the questionnaire gathered demographic and professional background information as well as assessments regarding the awareness of child protection, capacities in child protection among health professionals and training offers in medicine.
Results
The analysis indicated that the topic child protection in medicine is not as present as the high prevalence demands it. The majority (94.0%; n = 3,159) of the probands stated that they need more knowledge and capacities regarding child protection in medicine. More than half of the probands assessed the importance of the issue child protection as low among health professionals. The reasons cited included child protection as being an uncomfortable topic, unwillingness among managers, and a lack of training on the topic.
Conclusions
It turned out that there is too little awareness and importance regarding child protection in the medical field. Hence, it is difficult to ensure an adequate care for those affected. Child protection topics should be made mandatory in the training curricula of all health professionals as well as quality standards for prevention and intervention should be implemented in medical institutions.
Key messages
Too little attention is paid to child protection in the medical field. More training in child protection and quality standards must be established in the medical field.
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Affiliation(s)
- A Maier
- University hospital of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm, Germany
| | - JM Fegert
- University hospital of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm, Germany
| | - U Hoffmann
- University hospital of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm, Germany
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Foldyna B, Uhlig J, Mayrhofer T, Natale L, Vliegenthart R, Lotz J, Salgado R, Francone M, Nikolaou K, Bamberg F, Maintz D, Maurovich-Horvat P, Thiele H, Hoffmann U, Gutberlet M. Rising utilization of coronary CT angiography across Europe over the last decade: insights from a large prospective European registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The recently updated 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes endorse the use of coronary computed tomography angiography (CCTA) for exclusion of obstructive coronary artery disease in patients with a low clinical likelihood (Class I, LOE B). Higher demand for CCTA requires broad availability, inevitably involving smaller healthcare providers, such as non-academic hospitals and private practices. Nevertheless, most published data on CCTA image quality and safety rely on exams performed in high-volume academic centers, and little is known about CCTA in non-academic settings.
Purpose
To investigate the utilization of CCTA across Europe over the last decade, focusing on differences between academic and non-academic centers.
Methods
We included patients with stable chest pain and suspected coronary artery disease (CAD) who received CCTA and were included in the European Society of Cardiovascular Radiology MR/CT registry 01/2010–01/2020. We compared CT equipment, image quality, radiation dose, the incidence of periprocedural adverse events, patient characteristics, and CCTA findings between academic (high volume university hospitals) and non-academic centers (non-academic hospitals and private practices).
Results
Overall, 64,317 patients (41.2% women; age 60±13 years) from 212 sites across 19 European countries were included. Academic centers submitted most cases in 2010—2014 (51.6%), whereas non-academic centers accounted for 71.3% of records in 2015–2020. While non-academic centers used less advanced technology, radiation dose remained low (4.54 [interquartile range (IQR) 2.28–6.76] mSv) with a 30% decline of high-dose scans (>7 mSv) over time. Diagnostic image quality was reported in 97.7% of cases, and the rate of acute scan-related events was low (0.4%) (Figure 1). From 2010–2014 to 2015–2020, CCTA nearly doubled in patients with low to intermediate pretest-probability, women >50, and 40–60 years old men (Figure 2). CAD presence and extent decreased slightly over time (prevalence: 2010–2014: 41.5% vs. 2015–2020: 40.6%), (multi-vessel disease in those with CAD: 2010–2014: 61.9% vs. 2015–2020: 55.9%; all p<0.01).
Conclusion
CCTA expands rapidly to non-academic centers across Europe, increasing availability while maintaining relatively low radiation dose, high diagnostic image quality, and safety. Broad availability of high-quality CCTA is essential for a successfully implementation of the recently updated guidelines for the diagnosis and management of chronic coronary syndromes.
Funding Acknowledgement
Type of funding sources: None. Changes in CCTA utilizationChanges in patient characteristics
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Affiliation(s)
- B Foldyna
- Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, United States of America
| | - J Uhlig
- University Medical Center Goettingen, Department of Diagnostic and Interventional Radiology, Goettingen, Germany
| | - T Mayrhofer
- Stralsund University of Applied Sciences, School of Business Studies, Stralsund, Germany
| | - L Natale
- Catholic University of the Sacred Heart, Radiology, Rome, Italy
| | - R Vliegenthart
- University Medical Center Groningen, Department of Radiology, Groningen, Netherlands (The)
| | - J Lotz
- University Medical Center Goettingen, Department of Diagnostic and Interventional Radiology, Goettingen, Germany
| | - R Salgado
- Antwerp University Hospital, Department of Radiology, Antwerp, Belgium
| | - M Francone
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - K Nikolaou
- University Hospital Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen, Germany
| | - F Bamberg
- University of Freiburg, Department of Diagnostic and Interventional Radiology, Freiburg, Germany
| | - D Maintz
- University of Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - P Maurovich-Horvat
- Semmelweis University, MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Budapest, Hungary
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - U Hoffmann
- Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, United States of America
| | - M Gutberlet
- Heart Center at University of Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig, Germany
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Nanna MG, Wang TY, Chiswell K, Sun JL, Vemulapalli S, Hoffmann U, Patel MR, Udelson JE, Fordyce CB, Douglas PS. Estimating the real-world performance of the PROMISE minimal-risk tool. Am Heart J 2021; 239:100-109. [PMID: 34077743 DOI: 10.1016/j.ahj.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.
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König E, Hoffmann U, Plener P, Fegert J. Innovative professional training approaches on the german national clinical guideline for NSSI in adolescents. Eur Psychiatry 2021. [PMCID: PMC9528394 DOI: 10.1192/j.eurpsy.2021.614] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionGerman mental health care providers report to encounter many cases of NSSI in their professional context, but only around 50% know about the treatment guidelines for NSSI of children and adolescents. Many consider professional training about NSSI as necessary for themselves. In response to this need, within the project Star Train different strategies of dissemination of the content of the guidelines were developed.ObjectivesThis study aims at comparing the effectiveness of different strategies of dissemination: printed material, e-learning and blended-learning.Methods
Participants were randomly assigned to one of three different learning formats: printed material, e-learning, and blended-learning. Via online-survey participants provide pre- and post-training self-assessments of their knowledge of NSSI, practical skills, self-efficacy in handling cases of NSSI and attitudes towards NSSI and those affected. Additionally a multiple-choice-test of NSSI is assessed. For data-analyses between-group and within-group comparisons were conducted using a mixed design ANOVA. To ensure quality of learning formats, user-satisfaction was surveyed.ResultsData of the pretest-posttest comparison group design show that knowledge, practical skills, and self-efficacy in handling cases of NSSI raise for all participants and that attitudes towards NSSI and those affected are improved. There is no difference between the learning formats, thus all participants profit equally from their education. User satisfaction is high.ConclusionsResults of this study suggest that the developed different training strategies can contribute equally to a better understanding and enhance skills of professionals regarding NSSI. The choice of training method could be driven by considering which goals want to be achieved and cost-value ratio.
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Pfeil J, Simonetti M, Lauer U, von Thülen B, Durek P, Poulsen C, Pawlowska J, Kröger M, Krähmer R, Leenders F, Hoffmann U, Hamann A. Prevention of EAE by tolerogenic vaccination with PEGylated antigenic peptides. Ther Adv Chronic Dis 2021; 12:20406223211037830. [PMID: 34408824 PMCID: PMC8366199 DOI: 10.1177/20406223211037830] [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: 11/13/2020] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Therapeutic treatment options for chronic autoimmune disorders such as multiple sclerosis (MS) rely largely on the use of non-specific immunosuppressive drugs, which are not able to cure the disease. Presently, approaches to induce antigen-specific tolerance as a therapeutic approach; for example, by peptide-based tolerogenic 'inverse' vaccines have regained great interest. We have previously shown that coupling of peptides to carriers can enhance their capacity to induce regulatory T cells in vivo. METHOD In this present study, we investigated whether the tolerogenic potential of immunodominant myelin T-cell epitopes can be improved by conjugation to the synthetic carrier polyethylene glycol (PEG) in an experimental autoimmune encephalomyelitis (EAE) mouse model for chronic MS (MOG C57BL/6). RESULTS Preventive administration of the PEGylated antigenic peptide could strongly suppress the development of EAE, accompanied by reduced immune cell infiltration in the central nervous system (CNS). Depletion of regulatory T cells (Tregs) abrogated the protective effect indicating that Tregs play a crucial role in induction of antigen-specific tolerance in EAE. Treatment during the acute phase of disease was safe and did not induce immune activation. However, treatment at the peak of disease did not affect the disease course, suggesting that either induction of Tregs does not occur in the highly inflamed situation, or that the immune system is refractory to regulation in this condition. CONCLUSION PEGylation of antigenic peptides is an effective and feasible strategy to improve tolerogenic (Treg-inducing) peptide-based vaccines, but application for immunotherapy of overt disease might require modifications or combination therapies that simultaneously suppress effector mechanisms.
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Affiliation(s)
- Jennifer Pfeil
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | - Mario Simonetti
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Uta Lauer
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | | | - Pawel Durek
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | - Christina Poulsen
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | - Justyna Pawlowska
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | - Matthias Kröger
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | | | | | - Ute Hoffmann
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz-Institute, Berlin, Germany
| | - Alf Hamann
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, Berlin 10117, Germany
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Radbruch A, McGrath MA, Siracusa F, Hoffmann U, Sercan-Alp Ö, Hutloff A, Tokoyoda K, Chang HD, Dong J. Homeostasis and Durability of T-Cell Memory-The Resting and the Restless T-Cell Memory. Cold Spring Harb Perspect Biol 2021; 13:cshperspect.a038083. [PMID: 33903153 DOI: 10.1101/cshperspect.a038083] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The molecular basis of the persistence of experienced T lymphocytes, also known as "memory T lymphocytes," is still enigmatic. We are beginning to understand their considerable heterogeneity and topographic compartmentalization into memory T cells circulating through the body and those residing in a particular tissue. In some tissues, like murine spleen, subpopulations of memory T cells proliferating in the absence of antigen (homeostatic proliferation) have been described. Other populations are maintained resting in terms of transcription, mobility, and proliferation in dedicated survival niches organized by stromal cells. The survival of these memory T cells is conditional on being in such a niche, where they can persist for a lifetime. Circulating memory T lymphocytes of distinct immune responses slowly decline in numbers over time. The rules governing their entry into and exit from blood, as well as their lifestyle outside of the blood and their relation to resident memory T cells are poorly understood. Homeostasis of circulating, proliferating, and resting memory T cells is obviously controlled by different rheostats: tissue-exit and tissue-entry signals for circulating and proliferation-inducing signals for proliferating memory T cells. For tissue-resident, resting memory T cells, it is the availability of their survival niche. Apparently, this mechanism (i.e., the link between memory T cell and stromal cell) is so robust that it provides efficient T-cell memory over a lifetime in tissues such as the bone marrow.
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Affiliation(s)
- Andreas Radbruch
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
| | - Mairi Anne McGrath
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
| | - Francesco Siracusa
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany.,Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ute Hoffmann
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
| | - Özen Sercan-Alp
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany.,Sanofi R&D Immunology and Inflammation Therapeutic Area, Type 1/17 Inflammation and Arthritis Cluster, Industriepark Hoechst, Frankfurt am Main, 65929 Frankfurt, Germany
| | - Andreas Hutloff
- Chronic Immune Reactions, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
| | - Koji Tokoyoda
- Osteoimmunology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
| | - Hyun-Dong Chang
- Schwiete-Laboratory for Microbiota and Inflammation, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany.,Chair of Cytometry, Institute of Biotechnology, Technische Universität Berlin, 10623 Berlin, Germany
| | - Jun Dong
- Cell Biology, Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, 10117 Berlin, Germany
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Thondapu V, Ranganath P, Zhang E, Takigami A, Kohanski M, McGowan J, Harris G, Tower-Rader A, Meyersohn N, Lu M, Hoffmann U, Hedgire S, Ghoshhajra B. Integration Of Fractional Flow Reserve Derived From Coronary Ct Angiography (FFRCT) Into Clinical Practice: Initial Experience From A Tertiary Care Center. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Abstract
Both exsiccosis and hydropic decompensation occur more frequently in the older persons and are associated with complications, increased morbidity and mortality. This paper presents the age-associated causes and consequences of both conditions, as well as a practical approach to preventive measures, diagnostics, and therapy.
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König E, Reetz S, Hoffmann U, Fegert J. Protransition – an online-course for professionals to optimize the health care service for young people with mental illness in transition from adolescence to adulthood. Eur Psychiatry 2021. [PMCID: PMC9475927 DOI: 10.1192/j.eurpsy.2021.1236] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Adolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should be given greater consideration to the transition phase. Objectives The aim of the project ProTransition is the development of an online course for health care professionals to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize them for the special challenges and needs of young adults with mental illness. Methods The online-course is being developed at the Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm and is expected to start in May 2021. It comprises e.g. special psychopathology of emerging adulthood, clinical interventions for adolescents with mental illness or legal aspects. An innovative and multi-didactical approach with specialized texts, case-studies, online-chats and interviews with experts and young people is applied. Additionally, user satisfaction with the online course will be evaluated. Results On the basis of the gained experiences, ideas for new transition-psychiatric treatment models will be derived. The accompanying research will point out the status quo and the course-related increasing knowledge of health care professionals regarding transition psychiatry. First results are expected in November 2021. Conclusions As transition psychiatry is facing great difficulties and challenges, professionals should be adequately educated. E-Learning offers a flexible and low-level approach to reach a broad target group.
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20
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Hoffmann U. [Treatment of geriatric patients with end-stage renal failure : Dialysis or conservative procedure?]. Z Gerontol Geriatr 2021; 54:223-228. [PMID: 33496833 DOI: 10.1007/s00391-021-01840-8] [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: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
Compared to younger patients, an acceptable state of health in older patients with various comorbidities is rarely achieved by the initiation of dialysis. Despite dialysis treatment, further functional and cognitive impairments often rapidly occur in geriatric patients. Thus, newer studies are concerned with the quality of life of this patient group after initiation of dialysis as well as with palliative treatment strategies as alternatives. A structured clarification for the patients on all possibilities with mediation of all necessary information is a prerequisite for a shared decision-making. To assess life expectancy after dialysis initiation, various scores have been developed but the sensitivity could not fulfil the expectations. In the case of renal replacement, chronic intermittent hemodialysis is the treatment form most frequently performed in geriatric patients. The main concern of conservative palliative treatment is the quality of life and the management of uremic symptoms, which have to be addressed by a multidisciplinary team.
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Affiliation(s)
- Ute Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie/Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
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21
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Großmann S, Hoffmann U, Girlich C. [Confusion, tachypnea, and tachycardia in a 71-year-old man with type 2 diabetes mellitus]. Internist (Berl) 2021; 62:672-678. [PMID: 33411015 PMCID: PMC7788531 DOI: 10.1007/s00108-020-00930-w] [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] [Accepted: 12/08/2020] [Indexed: 11/14/2022]
Abstract
Bei Patienten mit Diabetes mellitus Typ 2 muss im Falle einer unklaren Bewusstseinsstörung und/oder Bauchschmerzen eine Natrium/Glukose-Kotransporter-2(SGLT-2)-Inhibitor-induzierte diabetische Ketoazidose in die Differenzialdiagnose einbezogen werden. Dabei können die Blutzuckerspiegel trotz ausgeprägter Azidose nur moderat erhöht sein. Bei Nachweis ist eine umgehende intensivmedizinische Therapie unerlässlich.
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Affiliation(s)
- S Großmann
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Deutschland.
| | - U Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - C Girlich
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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22
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Zeleznik R, Weiss J, Taron J, Guthier C, Hancox C, Bitterman D, Kim D, Kann B, Punglia R, Bredfeldt J, Foldyna B, Lu M, Hoffmann U, Mak R, Aerts H. Deep Learning Based Heart Segmentation Algorithm to Improve Radiation Treatment Planning. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atkins K, Bitterman D, Chaunzwa T, Lamba N, Williams C, Kozono D, Baldini E, Nohria A, Hoffmann U, Aerts H, Mak R. Statin Use and Major Adverse Cardiac Events among High Cardiac Risk Patients with Lung Cancer Receiving Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Atkins K, Bitterman D, Chaunzwa T, Lamba N, Williams C, Kozono D, Baldini E, Nohria A, Hoffmann U, Aerts H, Mak R. Isolated Low Left Coronary Artery Dose Exposure– Reduces the Risk of Major Adverse Cardiac Events in Lung Cancer Radiotherapy: Should Mean Heart Dose Be Retired? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pfeil J, Simonetti M, Lauer U, Volkmer R, von Thülen B, Durek P, Krähmer R, Leenders F, Hamann A, Hoffmann U. Tolerogenic Immunomodulation by PEGylated Antigenic Peptides. Front Immunol 2020; 11:529035. [PMID: 33162973 PMCID: PMC7581722 DOI: 10.3389/fimmu.2020.529035] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/22/2020] [Indexed: 01/29/2023] Open
Abstract
Current treatments for autoimmune disorders rely on non-specific immunomodulatory and global immunosuppressive drugs, which show a variable degree of efficiency and are often accompanied by side effects. In contrast, strategies aiming at inducing antigen-specific tolerance promise an exclusive specificity of the immunomodulation. However, although successful in experimental models, peptide-based tolerogenic "inverse" vaccines have largely failed to show efficacy in clinical trials. Recent studies showed that repetitive T cell epitopes, coupling of peptides to autologous cells, or peptides coupled to nanoparticles can improve the tolerogenic efficacy of peptides, suggesting that size and biophysical properties of antigen constructs affect the induction of tolerance. As these materials bear hurdles with respect to preparation or regulatory aspects, we wondered whether conjugation of peptides to the well-established and clinically proven synthetic material polyethylene glycol (PEG) might also work. We here coupled the T cell epitope OVA323-339 to polyethylene glycols of different size and structure and tested the impact of these nano-sized constructs on regulatory (Treg) and effector T cells in the DO11.10 adoptive transfer mouse model. Systemic vaccination with PEGylated peptides resulted in highly increased frequencies of Foxp3+ Tregs and reduced frequencies of antigen-specific T cells producing pro-inflammatory TNF compared to vaccination with the native peptide. PEGylation was found to extend the bioavailability of the model peptide. Both tolerogenicity and bioavailability were dependent on PEG size and structure. In conclusion, PEGylation of antigenic peptides is an effective and feasible strategy to improve Treg-inducing, peptide-based vaccines with potential use for the treatment of autoimmune diseases, allergies, and transplant rejection.
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Affiliation(s)
- Jennifer Pfeil
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz Institute (DRFZ), Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Mario Simonetti
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Uta Lauer
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz Institute (DRFZ), Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Rudolf Volkmer
- Institute for Medical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | | | - Pawel Durek
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz Institute (DRFZ), Berlin, Germany
| | | | | | - Alf Hamann
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz Institute (DRFZ), Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Ute Hoffmann
- Experimental Rheumatology, Deutsches Rheuma-Forschungszentrum, a Leibniz Institute (DRFZ), Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
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Voss L, Yilmaz K, Burkard L, Vidmar J, Stock V, Hoffmann U, Pötz O, Hammer HS, Peiser M, Braeuning A, Löschner K, Böhmert L, Sieg H. Impact of iron oxide nanoparticles on xenobiotic metabolism in HepaRG cells. Arch Toxicol 2020; 94:4023-4035. [PMID: 32914219 DOI: 10.1007/s00204-020-02904-1] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
Iron oxide nanoparticles are used in various industrial fields, as a tool in biomedicine as well as in food colorants, and can therefore reach human metabolism via oral uptake or injection. However, their effects on the human body, especially the liver as one of the first target organs is still under elucidation. Here, we studied the influence of different representative iron oxide materials on xenobiotic metabolism of HepaRG cells. These included four iron oxide nanoparticles, one commercially available yellow food pigment (E172), and non-particulate ionic control FeSO4. The nanoparticles had different chemical and crystalline structures and differed in size and shape and were used at a concentration of 50 µg Fe/mL. We found that various CYP enzymes were downregulated by some but not all iron oxide nanoparticles, with the Fe3O4-particle, both γ-Fe2O3-particles, and FeSO4 exhibiting the strongest effects, the yellow food pigment E172 showing a minor effect and an α-Fe2O3 nanoparticle leading to almost no inhibition of phase I machinery. The downregulation was seen at the mRNA, protein expression, and activity levels. Thereby, no dependency on the size or chemical structure was found. This underlines the difficulty of the grouping of nanomaterials regarding their physiological impact, suggesting that every iron oxide nanoparticle species needs to be evaluated in a case-by-case approach.
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Affiliation(s)
- Linn Voss
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Kiymet Yilmaz
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Lea Burkard
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Janja Vidmar
- National Food Institute, Technical University of Denmark, Kemitorvet, Building 201, 2800 Kgs, Lyngby, Denmark
| | - Valerie Stock
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Ute Hoffmann
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and University of Tübingen, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - Oliver Pötz
- SIGNATOPE GmbH, Markwiesenstraße 55, 72770, Reutlingen, Germany
| | | | - Matthias Peiser
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Albert Braeuning
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany
| | - Katrin Löschner
- National Food Institute, Technical University of Denmark, Kemitorvet, Building 201, 2800 Kgs, Lyngby, Denmark
| | - Linda Böhmert
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany.
| | - Holger Sieg
- German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Straße 8-10, 10589, Berlin, Germany.
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Ferencik M, Mayrhofer T, Lu M, Bittner D, Emami H, Puchner S, Meyersohn N, Ivanov A, Adami E, Foldyna B, Voora D, Ginsburg G, Januzzi J, Douglas P, Hoffmann U. Relationship Of Myocardial Necrosis, Inflammation And Coronary Atherosclerosis To Cardiovascular Outcomes In Patients With Stable Chest Pain: Results From The Promise Trial. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Goiffon R, Depetris J, Thondapu V, Takigami A, Hoffmann U, Hedgire S, Ghoshhajra B. Diagnostic Performance Of Coronary Ct Angiography Compared To Invasive Coronary Angiography In A Large Academic Practice. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Takigami A, Thondapu V, Goiffon R, Depetris J, Gupta S, Knyazev V, Lu M, Meyersohn N, Hoffmann U, Hedgire S, Ghoshhajra B. Use And Exceptions Of CAD-RADS Classification In Coronary CT Reporting At A Large Quaternary Hospital. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eslami P, Hartman E, Karady J, Thondapu V, Albaghdadi M, Jin Z, Cefalo N, Marsden A, Coksun A, Lu M, Stone P, Wentzel J, Hoffmann U. Endothelial Shear Stress Calculation In Human Coronary Arteries: Comparison Between 3d Reconstructions Based On Invasive And Noninvasive Imaging. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wirths M, Hudowenz O, Hoffmann U, Müller-Ladner U, Lange U, Klemm P. THU0350 LOGOPEDIC TESTING IN SSC PATIENTS REVEALS HIGH FREQUENCY OF OROPHARYNGEAL DYSFUNCTION: A MONOCENTRIC EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3467] [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: 11/04/2022]
Abstract
Background:Up to 98% of patients with systemic sclerosis (SSc) show involvement of the gastrointestinal system (GI) [1]. While meteorism, heartburn and GI dysmotility are very common and accessible to pharmacologic treatment on an evidence based level [1–3], checking for oropharyngeal dysfunction is usually not part of the standard diagnostic algorithm. However, in a survey of the German Network for Systemic Sclerosis (DNSS) patients reported coughing and/or a sore voice in up to 78% [1]. As impairment in speaking or swallowing for example does not only substantially reduce quality of life, it can also be very stigmatizing. In addition, the usual prokinetic therapy of GI-involvement, e.g. metoclopramide, does not appear to improve these symptoms. As the first step to approach this problem is the qualitative and quantitative description, we evaluated the oropharyngeal function in our cohort of SSc patients by detailed logopedic assessment.Objectives:To evaluate the frequency and type of oropharyngeal dysfunction, e.g. swallowing or speaking, in patients with SSc and to elucidate the correlating and associated factors, e.g. disease duration or modified Rodnan Skin Score.Methods:After obtaining written consent, oropharyngeal function using a standardized assessment protocol was evaluated in patients with SSc fulfilling the ACR/EULAR criteria by a speech therapist. Furthermore, we investigated whether oropharyngeal dysfunction is associated with patients’ characteristics. In addition, all patients received instruction for a training program to treat their individual oropharyngeal dysfunction.Results:37 patients with d/lSSc were assessed for eligibility. 34 patients met the inclusion criteria (3 patients did not speak German) and written consent was obtained.Oropharyngeal dysfunction (impairment of speaking, swallowing, breathing or oropharyngeal muscle function) was found in 29 of 34 (85%) of both l/dSSc patients. Neither the subtype of SSc, disease duration nor mRSS were significantly correlated with oropharyngeal dysfunction in general. Only GI involvement in general was associated with oropharyngeal dysfunction.After logopedic therapy, 28 of the 34 (82%) patients with oropharyngeal dysfunction reported a benefit after 3 days of training and were motivated to continue logopedic training at home.Oropharyngeal dysfunctionPresent(n=29)absent(n=5)p-values (x2-test)dcSSc800,027lcSSc2240,027disease duration (mean)12,7 y12 y0,462mRSS<4920,322mRSS>42030,322Raynauds syndrom2950,673digital ulcers1920,812lung fibrosis1120,596eosophageal dilatation1520,566eosophageal dysmotility1900,015GI-involvement2310,007Conclusion:Logopedic assessment revealed a high incidence of oropharyngeal dysfunction in our cohort of SSc patients. Oropharyngeal dysfunction was not associated with disease duration, skin- or lung-involvement or dcSSc/lcSSc differentiation. A logopedic training program seems to be of benefit for this currently not pharmacologically treatable problem.References:[1]Schmeiser T, Saar P, Jin D, Noethe M, Müller A, Soydan N, et al. Profile of gastrointestinal involvement in patients with systemic sclerosis. Rheumatol Int 2012;32:2471–8.doi:10.1007/s00296-011-1988-6.[2]Boeckxstaens GE, Bartelsman JFWM, Lauwers L, Tytgat GNJ. Treatment of GI dysmotility in scleroderma with the new enterokinetic agent prucalopride. Am J Gastroenterol 2002;97:194–7.doi:10.1016/S0002-9270(01)03958-2.[3]Mercado U, Arroyo de Anda R, Avendaño L, Araiza-Casillas R, Avendaño-Reyes M. Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities. Clin Exp Rheumatol 2005;23:685–8.Disclosure of Interests:Miriam Wirths: None declared, Ole Hudowenz: None declared, Ulrike Hoffmann: None declared, Ulf Müller-Ladner Speakers bureau: Biogen, Uwe Lange: None declared, Philipp Klemm Consultant of: Lilly, Medac
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Lauster D, Klenk S, Ludwig K, Nojoumi S, Behren S, Adam L, Stadtmüller M, Saenger S, Zimmler S, Hönzke K, Yao L, Hoffmann U, Bardua M, Hamann A, Witzenrath M, Sander LE, Wolff T, Hocke AC, Hippenstiel S, De Carlo S, Neudecker J, Osterrieder K, Budisa N, Netz RR, Böttcher C, Liese S, Herrmann A, Hackenberger CPR. Phage capsid nanoparticles with defined ligand arrangement block influenza virus entry. Nat Nanotechnol 2020; 15:373-379. [PMID: 32231271 DOI: 10.1038/s41565-020-0660-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/25/2020] [Indexed: 05/21/2023]
Abstract
Multivalent interactions at biological interfaces occur frequently in nature and mediate recognition and interactions in essential physiological processes such as cell-to-cell adhesion. Multivalency is also a key principle that allows tight binding between pathogens and host cells during the initial stages of infection. One promising approach to prevent infection is the design of synthetic or semisynthetic multivalent binders that interfere with pathogen adhesion1-4. Here, we present a multivalent binder that is based on a spatially defined arrangement of ligands for the viral spike protein haemagglutinin of the influenza A virus. Complementary experimental and theoretical approaches demonstrate that bacteriophage capsids, which carry host cell haemagglutinin ligands in an arrangement matching the geometry of binding sites of the spike protein, can bind to viruses in a defined multivalent mode. These capsids cover the entire virus envelope, thus preventing its binding to the host cell as visualized by cryo-electron tomography. As a consequence, virus infection can be inhibited in vitro, ex vivo and in vivo. Such highly functionalized capsids present an alternative to strategies that target virus entry by spike-inhibiting antibodies5 and peptides6 or that address late steps of the viral replication cycle7.
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Affiliation(s)
- Daniel Lauster
- Institut für Chemie und Biochemie, Organische Chemie, Freie Universität Berlin, Berlin, Germany
- Institut für Biologie, Molekulare Biophysik, IRI Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simon Klenk
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Berlin, Germany
- Institut für Chemie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kai Ludwig
- Forschungszentrum für Elektronenmikroskopie und Gerätezentrum BioSupraMol, Institut für Chemie und Biochemie, Freie Universität Berlin, Berlin, Germany
| | - Saba Nojoumi
- Institut für Chemie, Biokatalyse, Technische Universität Berlin, Berlin, Germany
- Department of Chemistry, University of Manitoba, Winnipeg, Canada
| | - Sandra Behren
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Berlin, Germany
- Institut für Chemie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lutz Adam
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Berlin, Germany
- Institut für Chemie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marlena Stadtmüller
- Robert Koch Institut, FG 17 Influenzaviren und weitere Viren des Respirationstraktes, Berlin, Germany
| | - Sandra Saenger
- Robert Koch Institut, FG 17 Influenzaviren und weitere Viren des Respirationstraktes, Berlin, Germany
| | - Stephanie Zimmler
- Robert Koch Institut, FG 17 Influenzaviren und weitere Viren des Respirationstraktes, Berlin, Germany
| | - Katja Hönzke
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | - Ling Yao
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | - Ute Hoffmann
- Experimentelle Rheumatologie, Deutsches Rheuma-Forschungszentrum Berlin, ein Leibniz-Institut, Berlin, Germany
| | - Markus Bardua
- Experimentelle Rheumatologie, Deutsches Rheuma-Forschungszentrum Berlin, ein Leibniz-Institut, Berlin, Germany
| | - Alf Hamann
- Experimentelle Rheumatologie, Deutsches Rheuma-Forschungszentrum Berlin, ein Leibniz-Institut, Berlin, Germany
| | - Martin Witzenrath
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | - Leif E Sander
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | - Thorsten Wolff
- Robert Koch Institut, FG 17 Influenzaviren und weitere Viren des Respirationstraktes, Berlin, Germany
| | - Andreas C Hocke
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | - Stefan Hippenstiel
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Germany
| | | | - Jens Neudecker
- Chirurgische Klinik, Campus Mitte/Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Partner von Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Germany
| | - Klaus Osterrieder
- Institut für Virologie, Robert von Ostertag-Haus, Zentrum für Infektionsmedizin, Freie Universität Berlin, Berlin, Germany
| | - Nediljko Budisa
- Institut für Chemie, Biokatalyse, Technische Universität Berlin, Berlin, Germany
- Department of Chemistry, University of Manitoba, Winnipeg, Canada
| | - Roland R Netz
- Fachbereich Physik, Theoretische Biophysik und Physik weicher Materie, Freie Universität Berlin, Berlin, Germany
| | - Christoph Böttcher
- Forschungszentrum für Elektronenmikroskopie und Gerätezentrum BioSupraMol, Institut für Chemie und Biochemie, Freie Universität Berlin, Berlin, Germany
| | - Susanne Liese
- Fachbereich Physik, Theoretische Biophysik und Physik weicher Materie, Freie Universität Berlin, Berlin, Germany.
- Department of Mathematics, University of Oslo (UiO), Oslo, Norway.
| | - Andreas Herrmann
- Institut für Biologie, Molekulare Biophysik, IRI Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Christian P R Hackenberger
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Berlin, Germany.
- Institut für Chemie, Humboldt-Universität zu Berlin, Berlin, Germany.
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Burns M, Schulz AR, Kunkel D, Hönig M, Warth S, Bengsch B, Burns T, Reinhardt J, Grützkau A, Yaspo ML, Sodenkamp J, Hoffmann U, Mei HE. Mass Cytometry-A Tool for the Curious: Networking in Berlin. Cytometry A 2020; 97:764-767. [PMID: 32298052 DOI: 10.1002/cyto.a.24015] [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: 03/06/2020] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Désirée Kunkel
- Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Manfred Hönig
- Universität Ulm, Medizinische Fakultät, Ulm, Germany
| | - Sarah Warth
- Universität Ulm, Medizinische Fakultät, Ulm, Germany
| | - Bertram Bengsch
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, University Medical Center Freiburg, Faculty of Medicine, and Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Tyler Burns
- DRFZ Berlin, a Leibniz Institute, Berlin, Germany
| | - Julia Reinhardt
- Technische Universität Dresden, Center for Regenerative Therapies Dresden, Dresden, Germany
| | | | | | - Jan Sodenkamp
- TranslaTUM, Technische Universität München, Munich, Germany
| | - Ute Hoffmann
- DRFZ Berlin, a Leibniz Institute, Berlin, Germany
| | - Henrik E Mei
- DRFZ Berlin, a Leibniz Institute, Berlin, Germany
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Hasseli R, Pfeiffer S, Kappesser J, Hermann C, Richter-Bastian K, Sattler T, Tschernatsch M, Hoffmann U, Müller-Ladner U, Lange U. Modellprojekt zur interdisziplinären universitären Lehre – Studierende der Medizin und der Psychologie lernen erstmals gemeinsam. Z Rheumatol 2020; 79:200-202. [DOI: 10.1007/s00393-020-00749-8] [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: 10/25/2022]
Abstract
ZusammenfassungEine interdisziplinäre Zusammenarbeit ist in der medizinischen Versorgung chronisch erkrankter Patienten mit komplexen Erkrankungen erforderlich. Vor allem im Bereich der internistischen Rheumatologie ist eine interdisziplinäre Arbeit unerlässlich, um die komplexen somatischen und psychosozialen Aspekte einer chronischen Erkrankung zu berücksichtigen. Dennoch werden die Aspekte der interprofessionellen Arbeit im Studium der Medizin und Psychologie unzureichend thematisiert. Aus diesem Grund wurde ein Modellprojekt zur interdisziplinären universitären Lehre konzipiert, welches beide Fächer miteinander vereint. Die Veranstaltung wurde im Wintersemester 2019/20 erstmalig durchgeführt und stieß bei den Teilnehmer*innen auf positive Resonanz. Das Hauptziel der Veranstaltung ist die Implementierung interprofessioneller Arbeit in die Ausbildung des medizinischen Personals. Zusätzlich konnte das Fach der internistischen Rheumatologie den Studierenden nähergebracht werden.
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Beller A, Kruglov A, Durek P, von Goetze V, Werner K, Heinz GA, Ninnemann J, Lehmann K, Maier R, Hoffmann U, Riedel R, Heiking K, Zimmermann J, Siegmund B, Mashreghi MF, Radbruch A, Chang HD. Specific microbiota enhances intestinal IgA levels by inducing TGF-β in T follicular helper cells of Peyer's patches in mice. Eur J Immunol 2020; 50:783-794. [PMID: 32065660 DOI: 10.1002/eji.201948474] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/15/2019] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
In humans and mice, mucosal immune responses are dominated by IgA antibodies and the cytokine TGF-β, suppressing unwanted immune reactions but also targeting Ig class switching to IgA. It had been suggested that eosinophils promote the generation and maintenance of mucosal IgA-expressing plasma cells. Here, we demonstrate that not eosinophils, but specific bacteria determine mucosal IgA production. Co-housing of eosinophil-deficient mice with mice having high intestinal IgA levels, as well as the intentional microbiota transfer induces TGF-β expression in intestinal T follicular helper cells, thereby promoting IgA class switching in Peyer's patches, enhancing IgA+ plasma cell numbers in the small intestinal lamina propria and levels of mucosal IgA. We show that bacteria highly enriched for the genus Anaeroplasma are sufficient to induce these changes and enhance IgA levels when adoptively transferred. Thus, specific members of the intestinal microbiota and not the microbiota as such regulate gut homeostasis, by promoting the expression of immune-regulatory TGF-β and of mucosal IgA.
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Affiliation(s)
- Alexander Beller
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Andrey Kruglov
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany.,Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia.,Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, 119991, Russia
| | - Pawel Durek
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Victoria von Goetze
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Katharina Werner
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Gitta Anne Heinz
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Justus Ninnemann
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Katrin Lehmann
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - René Maier
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Ute Hoffmann
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - René Riedel
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany.,Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Kevin Heiking
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Jakob Zimmermann
- Maurice Müller Laboratories, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Britta Siegmund
- Medical Department I (Gastroenterology, Infectiology, and Rheumatology), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mir-Farzin Mashreghi
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Andreas Radbruch
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
| | - Hyun-Dong Chang
- Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute (DRFZ), Berlin, Germany
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Wagner A, Shiban Y, Lange N, Joerger AK, Hoffmann U, Meyer B, Shiban E. The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas. J Neurosurg 2019; 131:1840-1847. [DOI: 10.3171/2018.8.jns181343] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/09/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVEMeningiomas are the most common intracranial neoplasm. Evidence concerning surgical management and outcome is abundant, while the implications for the quality of life (QOL) of a patient confronted with the diagnosis and undergoing surgery are unclear. The authors conducted a prospective study to evaluate QOL in relation to psychological comorbidities comorbidities.METHODSA prospective study of patients undergoing elective surgery for the removal of an intracranial meningioma was performed. The authors evaluated depression (Allgemeine Depressionsskala K score) and anxiety (Post-Traumatic Stress Scale–10 [PTSS-10]; State Trait Anxiety Inventory–State Anxiety and –Trait Anxiety [STAI-S and STAI-T]; and Anxiety Sensitivity Index–3 [ASI-3]) scores before surgery and at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative QOL as measured by the 36-Item Short Form Health Survey and EQ-5L questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined.RESULTSA total of 78 patients undergoing resection of a meningioma between January 2013 and September 2017 participated in the preoperative psychological screening and 71 patients fully completed postoperative follow-up examination after 1 year of follow-up. At presentation, 48 patients (67.7%) had abnormal anxiety scores, which decreased to 29.6% (p = 0.003). On follow-up at 12 months, mean EQ-5L visual analog scale scores were significantly lower in patients with pathological scores on the PTSS-10 (0.84 vs 0.69; p = 0.004), STAI-S (0.86 vs 0.68; p = 0.001), and STAI-T (0.85 vs 0.71; p = 0.011). Neurological status (modified Rankin Scale) improved slightly and showed some correlation with psychological comorbidities QOL scores (p = 0.167). There was a nonsignificant increase of EQ-5L scores over the period of follow-up (p = 0.174) in the repeated-measures analysis. In the regression analysis, impaired QOL and physical disability on follow-up correlated with elevated preoperative anxiety and depression levels.CONCLUSIONSThe QOL and physical disability of patients undergoing resection of an intracranial meningioma highly depend on preoperative anxiety and depression levels. Stress and anxiety scores generally decrease after the resection, which leads us to conclude that there is a tremendous emotional burden caused by an upcoming surgery, necessitating close psychooncological support in order to uphold functional outcome and health-related QOL in the postoperative course.
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Affiliation(s)
- Arthur Wagner
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Youssef Shiban
- 2Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany
| | - Nicole Lange
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | | | - Ute Hoffmann
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Bernhard Meyer
- 1Department of Neurosurgery, Technische Universität München, Munich; and
| | - Ehab Shiban
- 1Department of Neurosurgery, Technische Universität München, Munich; and
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Abstract
Abstract
Background
Child abuse is a major problem across Europe. The consequences are often serious and long-lasting disorders which, in addition to the individual burden, are extremely costly for the national health system. It is important to prevent or recognize child abuse at an early stage and to provide adequate help to those affected. Health professionals are privileged first contact persons for the victims. However, the WHO assumes that about 90% of cases of child abuse in medical institutions remain unknown. It is therefore important to train health professionals in this field. For this reason, in Germany an E-Learning course on child protection in medicine is currently being developed and evaluated. This article is intended to present the results of the accompanying evaluation of the E-Learning course.
Methods
The accompanying evaluation collected and analyzed the graduates’ opinion on the course, its contents and the topic of child protection in medicine in general. Knowledge and competence levels were surveyed before and after the course and evaluated with a t-test for related samples.
Results
The evaluation of the course showed a high relevance of the topic of child protection in medicine and the rather low attention paid to the topic in the medical field. The course was, however, assessed very positively and the majority of graduates were already able to apply what they had learnt in their daily work. The pre-post design showed a significant increase in knowledge and skills as a result of the course.
Conclusions
It turned out that the E-Learning course on child protection in medicine closes an existing gap in the continuing medical education system. The evaluation also shows a success of the program and thus a reduction of uncertainties in child protection procedures among health professionals. A corresponding E-Learning offer for other European countries should be considered in order to address the comprehensive problem of child abuse across the whole of Europe.
Key messages
Too little attention is paid to child protection in the medical field. E-Learning can effectively train health professionals in child protection, has a wide reach and is flexible in use.
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Affiliation(s)
- A Maier
- Department of Child and Adolescent Psychiatry, Psychotherapy, Universityhospital of Ulm, Ulm, Germany
| | - U Hoffmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, Universityhospital of Ulm, Ulm, Germany
| | - J M Fegert
- Department of Child and Adolescent Psychiatry, Psychotherapy, Universityhospital of Ulm, Ulm, Germany
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McGarrah RW, Ferencik M, Giamberardino SN, Coles A, Hoffmann U, Ginsburg GS, Kraus WE, Douglas PS, Shah SH. 170Lipoprotein subclasses associated with high-risk coronary atherosclerotic plaque: insights from the PROMISE clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Greater than half of major adverse cardiovascular events (MACE) occur in individuals with non-obstructive coronary artery disease (CAD) and may be related to the presence of high-risk coronary atherosclerotic plaque (HRP). HRP can be detected by coronary computed tomographic angiography (CTA) and is associated with increased MACE risk. Biomarkers associated with HRP may therefore aid in risk stratification in individuals with chest pain and provide insight into the biology of HRP.
Purpose
To determine whether nuclear magnetic resonance (NMR)-measured lipoprotein particles are associated with HRP independent of risk factors.
Methods
This study included 1755 stable symptomatic outpatients enrolled in the PROMISE trial who had coronary CTA performed. Thirty-seven lipoprotein particle parameters were measured in plasma using NMR. Principal components analysis was used to reduce the number of correlated lipoproteins into a smaller number of uncorrelated factors. HRP cases (N=277) were defined as presence of HRP features (positive remodeling, low CT attenuation or napkin-ring sign) with or without obstructive CAD; controls had no HRP and no obstructive CAD (N=1478). Multivariable logistic regression models adjusting for age, sex, diabetes, hypertension, BMI, smoking status and statin use were used to test for association of lipoprotein factors with HRP case/control status; lipoproteins loaded within significant factors (p<0.05) were tested individually. Finally, because event rates in PROMISE were too low, we used a separate study (CATHGEN, a study of individuals undergoing coronary angiography; N=8707) to test for association of lipoproteins with MACE using multivariable Cox proportional hazard models.
Results
HRP cases were less likely to be female than controls (36.8% vs. 56.6%) and were more likely to have diabetes (23.5% vs 19.6%), but were of similar age (60.1 vs 60.4 years [SD±8]) and with similar statin use (45.2% vs 44.4%). In multivariable models, two lipoprotein factors were associated with HRP: an HDL factor (OR 1.29 [95% CI, 1.10–1.52], p=0.002) and a triglyceride (TG) factor (OR 1.19 [1.03–1.36], p=0.01). Within these two factors, H6P (a large HDL subclass; OR 0.67 [0.54–0.82], p<0.001), HDL size (OR 0.78 [0.66–0.92], p=0.003) and small TG-rich lipoproteins (OR 1.22 [1.07–1.39], p=0.002) were associated with HRP. H6P (HR 1.1 [1.07–1.13], p<0.0001) and HDL size (HR 1.28 [1.24–1.32], p<0.0001) were also associated with time to death or MI in CATHGEN, but in the opposite direction.
Conclusions
In a cohort of low-risk patients from the PROMISE trial, large HDL and small TG particles were associated with CTA-defined HRP independent of risk factors. Large HDL particles were also associated with incident MACE in a separate high-risk cohort. The discordant direction of association of HDL subclasses with HRP and MACE is likely due to underlying HDL biology and requires further study.
Acknowledgement/Funding
The PROMISE trial was funded by the National Heart, Lung, and Blood Institute (grants R01HL098237, R01HL098236, R01HL98305, and R01HL098235)
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Affiliation(s)
- R W McGarrah
- Duke University Medical Center, Durham, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
| | | | - A Coles
- Duke Clinical Research Institute, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - W E Kraus
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke Clinical Research Institute, Durham, United States of America
| | - S H Shah
- Duke University Medical Center, Durham, United States of America
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Karady J, Mayrhofer T, Ferencik M, Udelson JE, Fleg JL, Peacock WF, Januzzi Jr JL, Nagurney JT, Koenig WF, Hoffmann U. 3303Classification of patients with acute chest pain by analytical benchmarks and subsequent management recommendations - A comparison of three highly-sensitivity troponin assays in the ROMICAT trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Concordance of different highly-sensitive troponin (hsTn) assays in stratifying acute chest pain (ACP) patients according to analytical benchmarks and subsequent emergency department (ED) management recommendations are unknown.
Methods
We included patients enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer-Assisted Tomography) I and II trials (n=624; 39.1% female; 52.8±10.0 years), who presented to the ED and were referred to further non-invasive diagnostic testing. In ROMICAT I, blood was obtained at 4 hours, and in ROMICAT II at ED presentation, and at 2 and 4 hours and was tested with three state-of-the-art hsTn assays (Roche Diagnostics, Elecsys 2010; Abbott ARCHITECT i2000SR; Siemens Diagnostics, HsVista). In a per sample analysis, we compared the concordance of assays for analytic benchmarks (below the level of detection (LOD)/LOD to 99th percentile/99th percentile to myocardial infarction (<LOD], ><LOD], >MI)/above MI). In a per patient analysis of serial hsTn testing in ROMICAT II, we determined concordance of management recommendations (rule out/observe/rule in) based on 2015ESC guidelines, results of coronary CT angiography and stress myocardial perfusion, and adjudicated endpoints of ACS.
Results
Overall, only 34.4% (353/1027) of samples were classified into the same benchmark category by all assays (table 1). In a per patient analysis, all assays agreed on the same of management recommendation in 25.3% (49/242) patients after the 1st hsTn, mostly driven by differences in discharge (6.6%, 21.1%, and 61.2%; respectively; all p<0.001). The concordance of management recommendations improved significantly to 67.4% (163/242; p<0.001) after the 2nd hsTn measurement but the final agreement for “observe” and “rule in” remained limited (13/90 and 5/18). Among patients in whom discharge was recommended, at least 18.8% (range: 18.8–21.0% across assays) had a positive imaging/stress test and at least 2.9% (range: 2.9–3.4%) had ACS.
Table 1. Classification of measurements from three hsTn assays in 1027 samples of patients with ACP according to analytical benchmarks <LOD LOD – 99th %tile* 99th %tile* – AMI** AMI**< Roche Elecsys, n (%) 578 (56.3) 328 (31.9) 95 (9.3) 26 (2.5) Abbott ARCHITECT, n (%) 176 (17.1) 788 (76.7) 14 (1.7) 49 (4.8) Siemens Vista, n (%) 96 (9.4) 861 (83.9) 33 (3.2) 37 (3.6) *Assay specific 99th percentiles; **as per ESC 2015 guidelines.
Conclusion
Differences in hsTn assay concordance for analytical benchmarks and subsequent ED management recommendations in patients with ACP are substantial raising concerns about the lack of uniform management.
Acknowledgement/Funding
Fulbright Visiting Student Researcher Grant
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Affiliation(s)
- J Karady
- Massachusetts General Hospital, Cardiac MR PET CT Program, Boston, United States of America
| | - T Mayrhofer
- Massachusetts General Hospital, Cardiac MR PET CT Program, Boston, United States of America
| | - M Ferencik
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, United States of America
| | - J E Udelson
- Tufts Medical Center, Department of Medicine, Boston, United States of America
| | - J L Fleg
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, United States of America
| | - W F Peacock
- Baylor College of Medicine, Department of Emergency Medicine, Houston, United States of America
| | - J L Januzzi Jr
- Massachusetts General Hospital, Division of Cardiology, Boston, United States of America
| | - J T Nagurney
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, United States of America
| | - W F Koenig
- Technical University of Munich, Deutsches Herzzentrum München, Munich, Germany
| | - U Hoffmann
- Massachusetts General Hospital, Cardiac MR PET CT Program, Boston, United States of America
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Kolossvary M, Karady J, Kikuchi Y, Ivanov A, Schlett CL, Lu MT, Foldyna B, Merkely B, Aerts HJ, Maurovich-Horvat P, Hoffmann U. P6166Radiomics-based machine learning versus histogram analysis and visual assessment to identify advanced atherosclerotic lesions on coronary computed tomography angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Currently used coronary CT angiography (CTA) plaque classification and histogram-based methods have limited accuracy to identify advanced atherosclerotic lesions. Radiomics-based machine learning (ML) could provide a more robust tool to identify high-risk plaques.
Purpose
Our objective was to compare the diagnostic performance of radiomics-based ML against histogram-based methods and visual assessment of ex-vivo coronary CTA cross-sections to identify advanced atherosclerotic lesions as defined by histology.
Methods
Overall, 21 coronaries of seven hearts were imaged ex vivo with coronary CTA. From 95 coronary plaques 611 histological cross-sections were obtained and classified based-on the modified American Heart Association scheme. Histology cross-sections were considered advanced atherosclerotic lesions if early, late fibroatheroma or thin-cap atheroma was present. Corresponding coronary CTA cross-section were co-registered and classified into homogenous, heterogeneous, napkin-ring sign plaques based on plaque attenuation pattern. Area of low attenuation (<30HU) and average CT number was quantified. In total, 1919 radiomic parameters describing the spatial complexity and heterogeneity of the lesions were calculated in each coronary CTA cross-section. Eight different radiomics-based ML models were trained on randomly selected cross-sections (training set: 75% of the cross-sections) to identify advanced atherosclerotic lesions. Plaque attenuation pattern, histogram-based methods and the best ML model were compared on the remaining 25% of the data (test-set) using area under the receiver operating characteristic curves (AUC) to identify advanced atherosclerotic lesions using histology as a reference.
Results
After excluding sections with heavy calcium (n=32) and no visible atherosclerotic plaque on CTA (n=134), we analyzed 445 cross-sections. Based on visual assessment, 46.5% of the cross-sections were homogeneous (207/445), 44.9% heterogeneous (200/445) and 8.6% were with napkin-ring sign (38/445). Radiomics-based ML model incorporating 13 parameters significantly outperformed visual assessment, area of low attenuation and average CT number to identify advanced lesions (AUC: 0.73 vs. 0.65 vs. 0.55 vs. 0.53; respectively; p<0.05 for all).
Conclusions
Radiomics-based ML analysis may be able to improve the discriminatory power of CTA to identify high-risk atherosclerotic lesions.
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Affiliation(s)
- M Kolossvary
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - J Karady
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
| | - Y Kikuchi
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
| | - A Ivanov
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
| | - C L Schlett
- University of Freiburg, Department for Diagnostic and Interventional Radiology, Freiburg, Germany
| | - M T Lu
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
| | - B Foldyna
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
| | - B Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - H J Aerts
- Brigham and Womens Hospital, Department of Radiation Oncology, Boston, United States of America
| | | | - U Hoffmann
- Massachusetts General Hospital, Department of Radiology, Boston, United States of America
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Banerji D, Alvi RM, Ivanov A, Sootodeh R, Olalere D, Will E, Aluru JS, Bogdan S, Osborne MT, Lu MT, Hoffmann U. 5196Coronary artery calcification predicts MACE and all-cause mortality in individuals undergoing non-cardiac computed tomography for non-cardiovascular indications. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Coronary artery calcification (CAC) measured on ECG-gated cardiac CT is a strong predictor of cardiovascular (CV) risk in asymptomatic individuals in a primary prevention setting. However, the prognostic value of CAC in an unselected population referred for non-gated non-cardiac chest CT (NCCT) is unknown.
Purpose
To determine whether CAC predicts major adverse cardiovascular events (MACE) and all-cause mortality in patients referred for NCCT for non-CV indications.
Methods
A random sample of 741 individuals, without prior known history of coronary artery disease (CAD) who underwent NCCT for non-CV indications at a tertiary care hospital in 2008 were included in this study. NCCT was assessed qualitatively for the presence and extent of CAC by two experienced physicians. Data abstraction was performed by electronic medical record (EMR) review. Our primary endpoint of MACE, defined as CV mortality, MI, PCI, CABG, heart failure and stroke as well as secondary endpoint of all-cause mortality, over a median follow up of 8 (IQR 4–10) years, was adjudicated per independent review.
Results
Among 741 individuals (mean age 61.1±15.5 years, 60% female, 91% Caucasian), 57% were hypertensive, 30% had hyperlipidemia, 14% were diabetic and the mean ASCVD score was 12.2±11.6. CAC was present in 425/741 (57.4%) individuals. Among those with CAC, it was mild in 172/425 (40%), moderate in 143/425 (34%) and severe in 110/425 (26%) individuals. Overall, MACE occurred in 115/741 (15.5%) patients. Compared to those without MACE, CAC was more prevalent (83% vs. 53%, p<0.001) and extensive (at least moderate: 67% vs. 28%, p<0.001) in those with MACE. Over a median follow up of 8 (IQR 3–10) years, the presence of any CAC was associated with a 4-fold higher risk of MACE (HR 4.22, 95% CI (1.4–8.9), p<0.001), after adjustment for age and gender. On stratification, severe CAC had a near 9-fold increased risk of MACE (HR 8.8, 95% CI (5.1–15.2), p<0.001), followed by moderate CAC with a near 6-fold increased risk of MACE (HR 5.7, 95% CI (2.8–9.8), p<0.001), and a near doubling of MACE risk with mild CAC (HR 1.99, 95% CI (1.1–4.3), p=0.034). Similar results were observed with all-cause mortality (Figure 1).
Conclusions
CAC is an independent predictor of MACE and all-cause mortality in an unselected patient population referred for NCCT for non-CV indications, which may provide an opportunity to improve population health without the need for additional imaging.
Acknowledgement/Funding
Dr. Banerji and Dr. Alvi were supported by NIH/NHLBI 5T32HL076136.
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Affiliation(s)
- D Banerji
- Massachusetts General Hospital, Boston, United States of America
| | - R M Alvi
- Massachusetts General Hospital, Boston, United States of America
| | - A Ivanov
- Massachusetts General Hospital, Boston, United States of America
| | - R Sootodeh
- Massachusetts General Hospital, Boston, United States of America
| | - D Olalere
- Massachusetts General Hospital, Boston, United States of America
| | - E Will
- Massachusetts General Hospital, Boston, United States of America
| | - J S Aluru
- Massachusetts General Hospital, Boston, United States of America
| | - S Bogdan
- Massachusetts General Hospital, Boston, United States of America
| | - M T Osborne
- Massachusetts General Hospital, Boston, United States of America
| | - M T Lu
- Massachusetts General Hospital, Boston, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
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Hoffmann U, Drey M, Thrun JM, Obermeier E, Weingart C, Hafner K, Sieber C. The role of wrist monitors to measure blood pressure in older adults. Aging Clin Exp Res 2019; 31:1227-1231. [PMID: 30406917 DOI: 10.1007/s40520-018-1065-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/02/2018] [Accepted: 10/24/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Arterial hypertension is a common condition in older adults with increasing data about blood pressure (BP) targets and antihypertensive treatment in this population. Recent studies have opened new discussions about the different usual and unusual methods of blood pressure monitoring. However, there are no evidence-based recommendations whether BP should be measured at upper arms or at wrist, which seems to be more comfortable in older and frail people. AIMS The purpose of this study was to test the quality of wrist BP monitors as diagnostic method in older adults. METHODS BP measurements at both upper arms and at both wrists were compared under standardized conditions in 605 patients ≥ 75 years. Differences in wrist and upper arm BP were, furthermore, correlated with various diagnoses and parameters including ankle-brachial-index (ABI). RESULTS In patients of 75-80 years, there were no differences in BP measurements at upper arms compared to wrists whereas in patients > 80 years, BP measurements at wrists were significantly lower than at upper arms. In both age groups BP measured at wrist was significantly lower in patients with ABI < 0.9. CONCLUSIONS BP wrist monitors could be considered as a serious alternative in adults of 75-80 years or in older persons with normal ABI values.
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Affiliation(s)
- Ute Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Michael Drey
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Jan-Marc Thrun
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Elsa Obermeier
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Christian Weingart
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Katharina Hafner
- Abteilung für elektronische Datenverarbeitung (EDV), Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Cornel Sieber
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany
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Atkins K, Chaunzwa T, Lamba N, Bitterman D, Rawal B, Williams C, Kozono D, Baldini E, Nohria A, Hoffmann U, Aerts H, Mak R. Left Coronary Artery Dose Exposure Predicts Major Adverse Cardiac Events in Coronary Heart Disease Negative Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koschate J, Drescher U, Werner A, Thieschäfer L, Hoffmann U. Cardiovascular regulation: associations between exercise and head-up tilt. Can J Physiol Pharmacol 2019; 97:738-745. [PMID: 30917299 DOI: 10.1139/cjpp-2018-0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It was hypothesized that faster cardiorespiratory kinetics during exercise are associated with higher orthostatic tolerance. Cardiorespiratory kinetics of 14 healthy male subjects (30 ± 4 years, 179 ± 8 cm, 79 ± 8 kg) were tested on a cycle ergometer during exercise with changing work rates of 30 and 80 W. Pulmonary oxygen uptake ( ) was measured breath-by-breath and heart rate (HR), mean arterial blood pressure (MAP), and total peripheral resistance (TPR) were measured beat-to-beat. Muscular oxygen uptake ( ) was estimated from HR and . Kinetic parameters were determined by time-series analysis, using cross-correlation functions (CCFmax(x)) between the parameter and the work rate. Cardiovascular regulations of MAP, HR, and TPR during orthostatic stress were measured beat-to-beat on a tilt seat. Changes between the minima and maxima during the 6° head-down tilt and the 90° head-up tilt positions were calculated for each parameter (Δtilt-up). correlated significantly with ΔTPRtilt-up (r = 0.790, p ≤ 0.001). CCFmax(HR) was significantly correlated with ΔHRtilt-up (r = -0.705, p = 0.002) and the amplitude in HR from 30 to 80 W (rSP = -0.574, p = 0.016). The observed correlations between cardiorespiratory regulation in response to exercise and orthostatic stress during rest might allow for a more differential analysis of the underlying mechanisms of orthostatic intolerance in, for example, patient groups.
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Affiliation(s)
- J Koschate
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - U Drescher
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - A Werner
- b German Air Force - Centre of Aerospace Medicine, Branch I 1, Aviation Physiology Diagnostics and Research, Steinborner Str. 43, 01936 Königsbrück, Germany.,c Center for Space Medicine and Extreme Environments, Institute of Physiology, Charitéplatz 1, CharitéCrossOver, Charité University Medicine, 10117 Berlin, Germany
| | - L Thieschäfer
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - U Hoffmann
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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Pencina KM, Travison TG, Bhasin S, Li Z, Nigam N, Manning WJ, Vasan RS, Hoffmann U, O'Donnell CJ, Basaria S. Endogenous circulating testosterone and sex hormone-binding globulin levels and measures of myocardial structure and function: the Framingham Heart Study. Andrology 2019; 7:307-314. [PMID: 30761772 DOI: 10.1111/andr.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/23/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. OBJECTIVES To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. METHODS A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean = 59.6 years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). RESULTS Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p = 0.009), left ventricular mass index (p = 0.006), cardiac output (p = 0.001), and main pulmonary artery diameter (p = 0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p = 0.002), left ventricular mass index (p = 0.004), cardiac output (p = 0.003), left ventricular ejection fraction (p = 0.039), and main pulmonary artery diameter (p = 0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. CONCLUSIONS Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.
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Affiliation(s)
- K M Pencina
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T G Travison
- Program on Aging, Hebrew Senior Life, Roslindale, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Z Li
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Nigam
- St. Mary's Medical Center, San Francisco, CA, USA
| | - W J Manning
- Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R S Vasan
- Framingham Heart Study, Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - U Hoffmann
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | | | - S Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hoffmann U, Thrun JM. [2018 ESC/ESH Guidelines for the Management of Arterial Hypertension: What's New with Regard to Our Older People?]. Dtsch Med Wochenschr 2018; 143:1745-1748. [PMID: 30508852 DOI: 10.1055/a-0622-9131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the "2018 ESC/ESH Guidelines for the management of arterial hypertension" there are new blood pressure (BP) recommendations with regard to older patients based on randomized controlled trials and well-conducted meta-analyses performed during the last years.It is recommended to base the diagnosis of hypertension on repeated office BP measurements under standardized conditions and in older people in out-of-office BP measurement with ABPM and/or HBPM if logistically and economically feasible. Furthermore lying and standing BP measurements should also be considered in subsequent visits in older people to exclude orthostatic hypotension.Older people should measure their BP in upper arms by validated devices with a well readable display.In the new guidelines more attention is directed on frailty, concomitant treatments and independence influencing the likely tolerability of BP-lowering medications. In fit older patients, it is now recommended that systolic BP should be targeted to a BP range of 130 - 139 mmHg, if tolerated.Lifestyle changes are also recommended in elder patients. Preferred combination therapies are a RAS blocker with a CCB or thiazid diuretic, preferably in a "single pill". When combination therapy is used, this should be initiated at the lowest available doses in elder people.
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Affiliation(s)
- Ute Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder Regensburg
| | - Jan-Marc Thrun
- Klinik für Allgemeine Innere Medizin und Geriatrie, Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder Regensburg
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Abstract
Zusammenfassung
Gegenstand und Ziel: Kindesmisshandlung stellt eine individuelle und gesellschaftliche Belastung dar. Gesundheitsfachkräfte sind hierbei wichtige Akteure, haben aber häufig unzureichende Kompetenzen. Deshalb fördert das Bundesministerium für Gesundheit die Entwicklung eines Online-Kurses zu Kinderschutz in der Medizin. Diese Arbeit stellt erste Ergebnisse der Kursevaluation für die ärztlichen Teilnehmenden vor. Material und Methoden: Vor und nach Bearbeitung des Kurses wurde Bedarf, Qualität und Kompetenzvermittlung des Online-Kurses mittels Fragebögen evaluiert. An der Befragung beteiligten sich 178 ärztliche Absolventen. Ergebnisse: 74,2% der Befragten empfanden die Inhalte des Kurses als genau angemessen. Wissen und Handlungskompetenz nahmen durch Bearbeitung des Kurses signifikant zu (Cohen’s d = 1,28 und 1,06). Der häufigste Grund für den Abbruch des Kurses waren mangelnde zeitliche Ressourcen (68,4%). Schlussfolgerungen: Der Online-Kurs stellt eine gute Möglichkeit dar, notwendige Kenntnisse zu Kinderschutz in der Medizin zu erwerben oder diese auszubauen. Klinische Relevanz: Es müssen Möglichkeiten geschaffen werden, um die Verbreitung der Kursinhalte noch weiter voranzutreiben.
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48
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Rusnak J, Behnes M, Saleh A, Fastner C, Sattler K, Barth C, Wenke A, Sartorius B, Mashayekhi K, Hoffmann U, Yuecel G, Lang S, Borggrefe M, Akin I. Interventional left atrial appendage closure may affect metabolism of essential amino acids and bioenergetic efficacy. Int J Cardiol 2018; 268:125-131. [DOI: 10.1016/j.ijcard.2018.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
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Lex C, Reuter M, Schuster A, Grabenhenrich L, Bauer CP, Hoffmann U, Forster J, Zepp F, Wahn U, Keil T, Lau S, Schramm D. Lung function trajectories using different reference equations in a birth cohort study up to the age of 20 years. Eur Respir J 2018; 52:13993003.00364-2018. [PMID: 30002104 DOI: 10.1183/13993003.00364-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/11/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine with Paediatric Respiratory Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany.,Dept of Paediatrics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Antje Schuster
- Dept of Paediatrics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Linus Grabenhenrich
- Dept for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
| | - Carl-Peter Bauer
- Dept of Pediatrics, Technical University of Munich, Munich, Germany
| | - Ute Hoffmann
- Dept of Pediatrics, Technical University of Munich, Munich, Germany
| | | | - Fred Zepp
- Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Freiburg, Germany
| | - Ulrich Wahn
- Dept of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lau
- Dept of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Schramm
- Dept of Paediatrics, Heinrich-Heine-University, Duesseldorf, Germany
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50
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Meyersohn NM, Mayrhofer T, Ivanov A, Bittner DO, Staziaki PV, Szilveszter B, Hallett T, Lu ML, Puchner SB, Simon TG, Corey KE, Ginsburg GS, Douglas PS, Hoffmann U, Ferencik M. P6209Association of hepatic steatosis with adverse cardiovascular events: insights from the PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N M Meyersohn
- Massachusetts General Hospital, Boston, United States of America
| | - T Mayrhofer
- Massachusetts General Hospital, Boston, United States of America
| | - A Ivanov
- Massachusetts General Hospital, Boston, United States of America
| | - D O Bittner
- Massachusetts General Hospital, Boston, United States of America
| | - P V Staziaki
- Massachusetts General Hospital, Boston, United States of America
| | - B Szilveszter
- Massachusetts General Hospital, Boston, United States of America
| | - T Hallett
- Massachusetts General Hospital, Boston, United States of America
| | - M L Lu
- Massachusetts General Hospital, Boston, United States of America
| | - S B Puchner
- Massachusetts General Hospital, Boston, United States of America
| | - T G Simon
- Massachusetts General Hospital, Boston, United States of America
| | - K E Corey
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke University Medical Center, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
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