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Krentel H, Keckstein J, Füger T, Hornung D, Theben J, Salehin D, Buchweitz O, Mueller A, Schäfer SD, Sillem M, Schweppe KW, Tchartchian G, Gilman E, De Wilde RL. Accuracy of ultrasound signs on two-dimensional transvaginal ultrasound in prediction of adenomyosis: prospective multicenter study. Ultrasound Obstet Gynecol 2023; 62:739-746. [PMID: 36920431 DOI: 10.1002/uog.26197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Two-dimensional (2D) transvaginal ultrasound (TVS) is an accessible and cost-effective diagnostic tool for the detection of adenomyosis. Different ultrasound features related to adenomyosis have been described, but the predictive value of each ultrasound sign and their combinations requires further investigation. We aimed to analyze the accuracy of 2D-TVS and describe possible combinations of ultrasound signs with a high predictive value in the diagnosis of adenomyosis. METHODS This was a prospective multicenter study of patients scheduled for laparoscopic hysterectomy who had been examined using standardized 2D-TVS at nine expert centers specializing in the diagnosis and treatment of endometriosis. 2D-TVS examination included nine typical adenomyosis ultrasound features, comprising heterogeneous myometrium, myometrial linear striations, myometrial cysts, subendometrial microcysts, asymmetrical myometrial thickening, uterine enlargement, the 'question mark sign', thickening of the junctional zone and hyperechoic myometrial spots, in order to predict or exclude the presence of adenomyosis. Ultrasound examination results were compared with histology after hysterectomy. The diagnostic reliability of the nine ultrasound signs and their combinations, and the influence of concurrent fibroids on the accuracy of the results, were analyzed. RESULTS A total of 202 patients were enrolled into the study. Histopathological examination revealed adenomyosis in 130 patients (64.4%). The accuracy of prediction of adenomyosis by 2D-TVS examination using all signs was 63.4% (positive predictive value, 71.5%; negative predictive value, 48.6%; sensitivity, 71.5%; specificity, 48.6%). Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy (55.7-62.1%) as individual ultrasound signs for the prediction of adenomyosis. The combination of the most accurate ultrasound signs (subendometrial microcysts, myometrial cysts and heterogeneous myometrium) improved the specificity of prediction (86.1%) when compared with that of these three single markers (35.2-81.7%). Uterine enlargement and asymmetry showed both low sensitivity (60.8% and 52.3%, respectively) and specificity (41.7% and 49.3%, respectively) as individual sonographic signs. CONCLUSIONS Heterogeneous myometrium, myometrial cysts, subendometrial microcysts and hyperechoic myometrial spots showed the highest accuracy for the detection of adenomyosis in this study, while uterine enlargement and asymmetry led to high false-positive and false-negative results. A combination of ultrasound features including the most accurate signs increases specificity. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Academic Teaching Hospital, Bethesda Krankenhaus Duisburg, Duisburg, Germany
| | - J Keckstein
- Endometriosis Clinic, Dres. Keckstein, Villach, Austria
| | - T Füger
- MIC Zentrum, München, Germany
| | - D Hornung
- Department of Obstetrics and Gynecology, Vidia Diakonissenkrankenhaus, Karlsruhe, Germany
| | - J Theben
- Department of Obstetrics and Gynecology, St Elisabeth Hospital Köln-Hohenlind, Köln, Germany
| | - D Salehin
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | | | - A Mueller
- Department of Obstetrics and Gynecology, Städtisches Klinikum, Karlsruhe, Germany
| | - S D Schäfer
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim and Saarland University Medical Centre, Homburg, Germany
| | - K W Schweppe
- Stiftung Endometrioseforschung, Westerstede, Germany
| | | | - E Gilman
- Gilman Biometrics, Köln, Germany
| | - R L De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
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Choi W, Nourzadeh H, Chen Y, Ainsley C, Desai V, Kubli A, Vinogradskiy Y, Mooney K, Werner-Wasik M, Mueller A. Novel Deep Learning Segmentation Models for Accurate GTV and OAR Segmentation in MR-Guided Adaptive Radiotherapy for Pancreatic Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e462. [PMID: 37785478 DOI: 10.1016/j.ijrobp.2023.06.1660] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided adaptive radiotherapy (MRgART) improves target coverage and organ-at-risk (OAR) sparing in pancreatic cancer radiation therapy (RT). Inter-fractional changes in patients undergoing RT require time intensive re-delineation of gross tumor volume (GTV) and OARs prior to adaptive optimization. Accurate automatic segmentation has the potential to significantly improve efficiency of the adaptive workflow. We hypothesized that state-of-the-art deep learning (DL) segmentation models could adequately segment GTV and OARs in both planning and daily fractional MR scans. MATERIALS/METHODS The study included 21 patients with pancreatic cancer treated with MRgART (10 Gy x 5 fractions). The planning MR as well as all daily MR images and registrations were collected (6 image sets per patient and a total of 126 image sets). The planning MR and fraction 1-4 image sets were used as the training set (N = 105), while the test set (N = 21) comprised images for fraction 5, to simulate the last step of incremental learning from planning to final fraction. Evaluated contours included the GTV, Small Bowel, Large Bowel, Duodenum, Left and Right Kidney, Liver, Spinal Cord, and Stomach. To mimic clinical conditions, contour accuracy was evaluated within the ring structure surrounding the PTV, inside of which daily adaptive re-contouring is applied (2 cm expansion in the cradio-caudal direction, 3 cm expansion otherwise). We evaluated three DL model architectures: SegResNet, SegResNet 2D, and SwinUNETR to autosegment GTV and OARs. The segmentation models were trained on the training set using 5-fold cross-validation (CV) and quantitatively analyzed by comparing against clinically used contours with DICE scores. Qualitative analysis was performed by a radiation oncologist using a scoring scale: 1 = perfect, 2 = minor discrepancy, 3 = moderate discrepancy, and 4 = rejected. RESULTS Overall, the DL segmentations were in acceptable agreement with clinical contours. The best performing model was the SwinUNETR model with overall training DICE = 0.88±0.06, test DICE = 0.78±0.11, and qualitative score of 1.6±0.8. The agreement between the DL model and clinical segmentation for the GTV was 0.79±0.08, with a qualitative score of 2.2±0.9. The highest and lowest OAR DICE scores were for the Left Kidney (DICE = 0.93) and Small Bowel (DICE = 0.68), respectively. The highest qualitative OAR scores were for the Kidney, Liver, and Spinal Cord (score = 1.0) and the lowest qualitative score was for the Duodenum (score = 2.3) CONCLUSION: We report here the most comprehensive work on DL segmentation for pancreatic cancer MRgART, including quantitative and clinically-pertinent qualitative evaluations of 126 image sets and 3 DL architectures. Our data show good quantitative agreement between DL and clinical contours, and acceptable clinician evaluations for the majority of GTVs and OARs. The current work has great potential to significantly reduce a major bottleneck in the MRgART workflow for pancreatic cancer patients.
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Affiliation(s)
- W Choi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - H Nourzadeh
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - C Ainsley
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - V Desai
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - A Kubli
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Vinogradskiy
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - K Mooney
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - M Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Hughes R, Gandhi V, Snook A, Waldman S, Mueller A. Gamma Secretase Inhibition Sensitizes Pancreatic Adenocarcinoma Tumors to RT In Vivo. Int J Radiat Oncol Biol Phys 2023; 117:S103-S104. [PMID: 37784274 DOI: 10.1016/j.ijrobp.2023.06.060] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Pancreatic adenocarcinoma (PDAC) is an extremely aggressive cancer that lacks curative treatment options. Almost half of patients present with unresectable disease limiting treatment to non-curative options. Patients treated with neoadjuvant radiation therapy (RT) exhibit increases in fibrosis and epithelial-to-mesenchymal transition (EMT). ADAM10, an extracellular sheddase, can stimulate stromal fibrosis, EMT, and radioresistance. ADAM10 also mediates EMT through Notch signaling by cleaving its extracellular domain. Further cleavage by gamma secretase produces the Notch intracellular domain (NICD), which translocates to the nucleus and activates downstream transcriptional targets. Here, we explore whether inhibition of Notch cleavage by gamma secretase radiosensitizes PDAC tumors. MATERIALS/METHODS Bilateral flank subcutaneous PDAC isografts were produced in 40 mice using PK5L1940 KPC cells. Intraperitoneal injections of the gamma secretase inhibitor, DAPT (5 mg/kg), were delivered daily for 7 days, starting 3 days prior to RT. A single dose of 20 Gy was administered to each flank tumor, and volumes were measured twice weekly. Colony formation assays of KPC cells were performed after RT, in the presence or absence of DAPT. Since stromal fibrosis can mediate radio-resistance in the tumor microenvironment (TME), the effect of tumor cells on Notch pathway activation in mouse fibroblasts (3T3 cells) was investigated using a luciferase reporter assay. Thus, 3T3 cells transfected with a Notch pathway luciferase reporter were incubated with PDAC cells for 48 h, followed by measurement of luciferase activity. RESULTS In vivo, the combination of DAPT and RT significantly delayed tumor growth, and some tumors were completely eradicated. Mean tumor size for the combination at 21 days was 21 mm3 (range = 0-53, p = 0.005), while tumor size was 577 mm3 (range = 217-955, p = 0.69) for DAPT alone, 435 mm3 for RT alone (range = 51-932, p = 0.79), and 367 mm3 for untreated vehicle (range = 97-1144). Surprisingly, DAPT did not reduce clonogenic survival in vitro. Both ADAM10 knockout and DAPT decreased NICD cleavage and transcription of the downstream target Hes1 in vivo and in vitro. Co-culture with PDAC cells increased Notch luciferase reporter activity in fibroblasts. This effect was not mimicked by PDAC-conditioned media, suggesting a requirement for intercellular contact. CONCLUSION Notch pathway inhibition sensitizes PDAC tumors to RT in vivo, but not in vitro, suggesting involvement of the TME. Indeed, co-culture with PDAC cells stimulates notch signaling in fibroblasts, suggesting non-cell autonomous mechanisms mediating fibrosis in the TME driving radioresistance. Future studies will determine if ADAM10 inhibition targeting PDAC cells and/or gamma secretase inhibition targeting the TME enhances radiation sensitivity in vivo by blocking fibroblast Notch signaling.
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Affiliation(s)
- R Hughes
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - V Gandhi
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - A Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - S Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Poiset SJ, Laufer T, Anne PR, Mooney K, Werner-Wasik M, Posey JA, Bashir B, Lin D, Basu-Mallick A, Lavu H, Yeo CJ, Mueller A. Early Outcomes of MR-Guided SBRT for Patients with Recurrent Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e333-e334. [PMID: 37785174 DOI: 10.1016/j.ijrobp.2023.06.2387] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local treatment options for patients with locally recurrent pancreatic adenocarcinoma (L-PAC) are limited, with expected median survival time (MST) of 8-11 months (mo) following recurrence. MRI-guided radiation therapy (MRgRT) provides the ability to dose escalate while sparing normal tissue. The literature for MR-guided Stereotactic Body Radiotherapy (MRgSBRT) for L-PAC is sparse. Here we report on the early outcomes of MRgSBRT in patients with L-PAC. MATERIALS/METHODS Patients with prior resection of pancreatic adenocarcinoma with post-operative chemotherapy as indicated followed by local recurrence of disease at prior surgical site and treated with MRgSBRT at a single tertiary referral center from 5-2021 to 8-2022 for L-PAC were identified from our prospective database. MRgSBRT was delivered to 40-50 Gy in 4-5 fractions with target and OAR delineation per institutional standards. Descriptive analysis of the patient, disease, and treatment characteristics were performed. Endpoints included local control, defined as absence of tumor progression per RECIST criteria, distant failure, overall survival (OS), and acute and chronic toxicities per Common Terminology Criteria for Adverse Events (CTCAE), version 5. RESULTS Eleven patients with L-PAC were identified with median follow-up of 10.7 mo (3.2 - 22.3). Ten of those underwent surgical resection at the treating radiation facility and one patient underwent preoperative radiation for 50.4 Gy in 28 fractions followed by surgical resection at an outside hospital. MRgRT was delivered a median of 18.8 mo (3.5 - 48.0) following resection. There were 5 females and 6 males, with a median age of 72 years (52-83) and median KPS of 80 (60-100). OS rates following initial diagnosis at 12, 18 and 24 mo were 100%, 82%, and 61%, respectively, with an MST of 25.3 mo (12.4-53.1). OS rates following recurrence at 6 and 12 mo were 82% and 52%, respectively, with an MST of 10.7 mo (3.2 - 21.9). One patient experienced local failure at 7.8 mo, and 9 patients experienced distant failure at a median of 3.4 mo (0.3 - 21.9) following MRgSBRT. Five patients experienced distant failure less than 3 mo following radiation. Grade 1 or 2 acute GI toxicity was noted in 45% of patients and chronic GI toxicity, in 18% of patients. No Grade≥3 AEs were noted. CONCLUSION MRgSBRT for recurrent pancreatic adenocarcinoma demonstrates good local control with acceptable acute and chronic toxicity as well as reasonable overall survival. Distant failure remains a substantial problem with a significant number of patients demonstrating metastases immediately following radiation, suggesting the presence of micro-metastatic disease prior to local therapy. Adequate patient selection for MRgSBRT, and proper integration of systemic therapy in this patient population remains a topic of discussion that requires further exploration.
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Affiliation(s)
- S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - T Laufer
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - P R Anne
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - K Mooney
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - M Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - J A Posey
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - B Bashir
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D Lin
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Basu-Mallick
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - H Lavu
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - C J Yeo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Winkelmann I, Botros Y, Kojetinsky C, Sonntag F, Mueller A. [Acute-onset myopia]. Ophthalmologie 2023; 120:426-429. [PMID: 35925335 DOI: 10.1007/s00347-022-01664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 04/29/2023]
Affiliation(s)
- I Winkelmann
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Y Botros
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - C Kojetinsky
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - F Sonntag
- 2. Medizinische Klinik, Nephrologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - A Mueller
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Parikh P, Lee P, Low D, Kim J, Mittauer K, Bassetti M, Glide-Hurst C, Raldow A, Yang Y, Portelance L, Zaki B, Kim H, Mancias J, Ng J, Pfeffer R, Mueller A, Kelly P, Boldrini L, Fuss M, Chuong M. Stereotactic MR-Guided On-Table Adaptive Radiation Therapy (SMART) for Patients with Borderline or Locally Advanced Pancreatic Cancer: Primary Endpoint Outcomes of a Prospective Phase II Multi-Center International Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Quittner A, Georgiopoulos A, Barker D, Muther E, Tillman L, Schechter M, Graziano S, Verkleij M, Mueller A, Lomas P, Hempstead S, Smith B. 324 National implementation of depression and anxiety screening and treatment at U.S. CF centers: What predicts success? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Werkl P, Woltsche N, Mueller A, Guschlbauer L, Horwath-Winter J, Steinwender G, Maertz J. [Acute keratoconjunctivitis in a breeder of highly poisonous exotic corals]. Ophthalmologie 2022; 119:1071-1073. [PMID: 35089413 DOI: 10.1007/s00347-022-01576-9] [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] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 01/26/2023]
Affiliation(s)
- P Werkl
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich. .,Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland.
| | - N Woltsche
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - A Mueller
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - L Guschlbauer
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Horwath-Winter
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - G Steinwender
- Universitätsaugenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - J Maertz
- Klinik für Augenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
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Roffler M, Mueller A, Steeb I. POS0087-PARE IMPROVED SELF-MANAGEMENT IN PATIENTS WITH OSTEOPOROSIS AND INFLAMMATORY ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2576] [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: 11/03/2022]
Abstract
BackgroundSelf-management care services have received a great deal of attention in Switzerland lately. However, there is still a huge gap in service provision, especially with regard to rheumatic diseases. To fill this gap, the Swiss League against Rheumatism has developed a comprehensive self-management programme for patients with inflammatory arthritis (IA) and osteoporosis. In the course of this programme, eleven medical assistants in outpatient rheumatological and general practitioner clinics were trained to help osteoporosis and IA patients to strengthen their self-management capacity. This programme was implemented within the scope of a three-year pilot project (2019 – 2021) and is continuing as a regular project from 2022 onwards.ObjectivesThe ultimate objective was to increase the quality of life and health status of people with osteoporosis and IA by enhancing their capacity for self-management. This included all three components of self-management, i.e. strengthening patients’ knowledge of the disease, motivating them to take action and increasing their ability to manage the disease. Furthermore, the pilot project aimed to close an important gap in the Swiss health care system.MethodsA questionnaire was designed to measure the change in self-management abilities and the health status of patients. The questionnaire was given to patients at three points in time (t1=enrolment of patient, t2=last session of the self-management programme and t3= two months after the last session) and contained several validated scales such as the heiQ, Self-Efficacy for Managing Chronic Disease 6-Item Scale, RADAI-5 and EQ-5D-5L. Descriptive statistics were applied to analyse the data by comparing the mean values of all relevant indicators at three points in time.ResultsIn total 52 patients were enrolled in the pilot project. 48 patients completed the programme and 35 took part in the follow-up questionnaire. Overall, the results show a positive trend in self-management abilities and an improvement in the patients’ current health status. The slight increase in knowledge remained until the follow-up. Significant changes are seen in Skill and Technique Acquisition as well as in Self-Monitoring and Insight of the disease, which are two important components of self-management. Other components such as the knowledge and constructive attitudes and approaches also underwent a small but positive change that lasts up to two months after the last session of the self-management programme. Self-efficacy improved as well, but with a slight decrease during the follow-up. The disease activity also declined slightly over time. The results also indicate a small and steady improvement of the current health status. Using a visual analogue scale as part of the EQ-ED-EL, participants evaluated their current health status as 69 (t=1), 73 (t=2) and 74 (t=3). The quality of life has improved too, but the change doesn’t seem to be relevant. Furthermore, the use of health services indicates a slight decline after taking part in the self-management programme.ConclusionThe comprehensive self-management programme designed by the Swiss League against Rheumatism embedded in outpatient rheumatological and general practitioner clinics proved to be successful. The three components of self-management in particular, i.e. knowledge, motivation to take action and skills to manage the disease improved significantly. The results also show a positive trend in the patients’ current health status, their quality of live and a decline in disease activity. However, based on the study design, it cannot be concluded that there is a correlation between the improved health status/quality of life and the self-management programme. For this purpose, a control group would be necessary to evaluate the programme’s effect on the health status and quality of life of people with rheumatic disease. Nevertheless, this pilot project represents an important foundation on which further services and programmes to strengthen self-management in rheumatology can be developed.Disclosure of InterestsNone declared
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Holt D, Carr A, Roberts S, Milgrom S, Kolva E, Kavanagh B, Switzer G, Eitel C, Nelson J, Miller B, Shiao J, Mueller A, Karam S, Dzingle W, Clapp T. 3D Virtual Reality Volumetric Imaging Review in Cancer Patients’ Understanding and Education of their Disease and Treatment. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Piper M, Van Court B, Mueller A, Nguyen D, Gadwa J, Bickett T, Schulick R, Messersmith W, Del Chiaro M, Goodman K, Dent A, Kedl R, Lenz L, Karam S. P-218 STAT3 signaling inhibition in regulatory T cells improves immune response to RT in PDAC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hsu T, D’silva K, Serling-Boyd N, Wang J, Mueller A, Fu X, Prisco L, Martin L, Vanni K, Zaccardelli A, Cook C, Choi H, Zhang Y, Gravallese E, Wallace Z, Sparks J. POS1174 HYPERINFLAMMATION AND CLINICAL OUTCOMES FOR PATIENTS WITH SYSTEMIC RHEUMATIC DISEASES HOSPITALIZED FOR COVID-19: A COMPARATIVE COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.936] [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:COVID-19 can induce a hyperinflammatory state resulting in cytokine storm, which can lead to poor outcomes. Patients with systemic rheumatic diseases may be at increased risk for respiratory failure with COVID-19. Therefore, we investigated the relationship between rheumatic disease, hyperinflammation, and clinical outcomes among hospitalized COVID-19 patients.Objectives:To compare laboratory values, hyperinflammation, and clinical outcomes of hospitalized COVID-19 rheumatic patients and matched comparators.Methods:We performed a comparative cohort study of patients with polymerase chain reaction (PCR)-confirmed COVID-19 requiring hospitalization between 3/1/20-7/7/20 at a large health care system. We compared each systemic rheumatic disease case to up to 5 matched (by age, sex, and date of +SARS-CoV-2 PCR) comparators without systemic rheumatic disease. We extracted laboratory values from their hospitalization to compare peaks/troughs of individual laboratory results by case status and derived the COVID-19-associated hyperinflammation score (cHIS), a composite of 6 laboratory domains (0-6, ≥2 indicating hyperinflammation), as previously developed1. We used multivariable logistic regression to estimate ORs for COVID-19 outcomes by hyperinflammation and case status.Results:We identified 57 hospitalized rheumatic disease cases (mean age 67 years, 67% female) and 232 matched comparators hospitalized with PCR-confirmed COVID-19. Among cases, 26 (46%) had rheumatoid arthritis and 14 (25%) had systemic lupus erythematosus. Most cases (34, 60%) had active rheumatic disease. At baseline, 15 (27%) of cases were treated with biologic DMARDs, and 32 (56%) were using glucocorticoids. We analyzed 39,900 total laboratory results (median 85 per patient). Cases had higher peak neutrophil-to-lymphocyte ratio (9.6 vs 7.8, p=0.02), LDH (421 vs 345 U/L, p=0.04), creatinine (1.2 vs 1.0 mg/dL, p=0.01), and BUN (31 vs 23 mg/dL, p=0.03) than comparators but similar peak CRP (149 vs 116 mg/L, p=0.11, Figure 1). Cases had higher peak median cHIS (3 vs 2, p=0.01). Peak cHIS ≥2 had higher odds of intensive care unit (ICU) admission (OR 3.45, 95%CI 1.98-5.99), mechanical ventilation (OR 66.0, 95%CI 9.0-487.8), and mortality (OR 16.4, 95%CI 4.8-56.4) compared to cHIS <2 (Table 1). Cases had increased risk of ICU admission (OR 2.0, 95%CI 1.1-3.7) and mechanical ventilation (OR 2.7, 95%CI 1.4-5.2) than comparators.Table 1.Associations of peak cHIS and systemic rheumatic disease with COVID-19 hospitalization outcomesIntensive care unit admissionMechanical ventilationDeath%Adjusted OR (95%CI)%Adjusted OR (95%CI)%Adjusted OR (95%CI)Hospitalization outcomes by hyperinflammation on cHIS1cHIS <2 (n=112)21%1.0 (Ref)1%1.0 (Ref)3%1.0 (Ref)cHIS ≥2 (n=177)48%3.5 (2.0-6.0)37%66.2 (9.0-487.8)27%16.4 (4.8-56.4)Hospitalization outcomes by rheumatic disease statusComparators (n=232)30%1.0 (Ref)19%1.0 (Ref)16%1.0 (Ref)Rheumatic cases (n=57)51%1.87 (1.03-3.40)39%2.46 (1.30-4.67)21%1.32 (0.61-2.88)Matching factors: age, sex, and date of +PCR.1Adjusted for age, sex, and case status.2Adjusted for race, smoking, comorbidities, and body mass index.cHIS, COVID-19-associated hyperinflammation score; CI, confidence interval; OR, odds ratio; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.Conclusion:Patients with systemic rheumatic disease hospitalized for COVID-19 had higher risk for hyperinflammation, kidney injury, and mechanical ventilation than non-rheumatic comparators. We validated the cHIS in our cohort, which was strongly associated with poor COVID-19 outcomes. These findings highlight that hospitalized patients with rheumatic diseases may be vulnerable to poor COVID-19 outcomes.References:[1]Webb BJ et al. Clinical criteria for COVID-19-associated hyperinflammatory syndrome. Lancet Rheumatol. 2020 Dec;2(12):e754-e763.Disclosure of Interests:Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Jiaqi Wang: None declared, Alisa Mueller: None declared, Xiaoqing Fu: None declared, Lauren Prisco: None declared, Lily Martin: None declared, Kathleen Vanni: None declared, Alessandra Zaccardelli: None declared, Claire Cook: None declared, Hyon Choi Consultant of: Dr. Choi reports consultancy fees from Takeda, Selecta, GlaxoSmithKline, and Horizon, Grant/research support from: Dr. Choi reports research support from AstraZeneca., Yuqing Zhang: None declared, Ellen Gravallese: None declared, Zachary Wallace Consultant of: Dr. Wallace reports consulting fees from Viela Bio and MedPace., Grant/research support from: Dr. Wallace reports research support from Bristol-Myers Squibb and Principia., Jeffrey Sparks Consultant of: Dr. Sparks reports consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, Optum, and Pfizer., Grant/research support from: Dr. Sparks reports research support from Amgen and Bristol-Myers Squibb.
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van Norden J, Spies CD, Borchers F, Mertens M, Kurth J, Heidgen J, Pohrt A, Mueller A. The effect of peri-operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non-cardiac surgical patients: a randomised, double-blind placebo-controlled trial. Anaesthesia 2021; 76:1342-1351. [PMID: 33960404 DOI: 10.1111/anae.15469] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
Delirium occurs commonly following major non-cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri-operative administration of dexmedetomidine on the incidence of postoperative delirium in non-cardiac and cardiac surgical patients. In this randomised, double-blind placebo-controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non-cardiac surgery, we conclude that the peri-operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.
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Affiliation(s)
- J van Norden
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - C D Spies
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - F Borchers
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Mertens
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - J Kurth
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - J Heidgen
- Department of Anaesthesia and Intensive Care Medicine, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - A Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - A Mueller
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Moser O, Ziko H, Elsayed H, Hochfellner DA, Pöttler T, Mueller A, Eckstein ML, Sourij H, Mader JK. People with type 1 diabetes and impaired awareness of hypoglycaemia have a delayed reaction to performing a glucose scan during hypoglycaemia: a prospective observational study. Diabet Med 2020; 37:2153-2159. [PMID: 32638428 PMCID: PMC7689757 DOI: 10.1111/dme.14362] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
AIMS Considering that people with type 1 diabetes and impaired awareness of hypoglycaemia (IAH) have a delayed perception of hypoglycaemia, the question arises whether they perform scans later in case of hypoglycaemia than people without IAH. We assessed whether time to performing a scan after reaching hypoglycaemia while using a flash glucose monitoring (flash GM) system is different in people with IAH compared with people without IAH. METHODS Ninety-two people with type 1 diabetes [mean (± sd) age 42 ± 14 years, HbA1c 57 ± 9 mmol/mol] using a flash GM system for 3 months were included. Flash GM data were assessed for time until scan after reaching hypoglycaemia level 1 (< 3.9 mmol/l) and level 2 (< 3.0 mmol/l) and compared for type 1 diabetes with vs. without IAH via unpaired t-test/Mann-Whitney U test (P < 0.05). RESULTS Significant differences were found only for the delay between reaching hypoglycaemia and scan between people with and without IAH for Gold score [hypoglycaemia level 1: IAH 78 (51-105) min vs. without IAH 63 (42-89) min, P = 0.03; night-time hypoglycaemia level 2: IAH 140 (107-227) min vs. without IAH 96 (41-155) min, P = 0.004] and Pedersen-Bjergaard score [hypoglycaemia level 1: IAH 76 (52-97) min vs. without IAH 54 (38-71) min, P = 0.011; night-time hypoglycaemia level 1: IAH 132 (79-209) min vs. without IAH 89 (59-143) min, P = 0.011; night-time hypoglycaemia level 2: IAH 134 (66-212) min vs. without IAH 80 (37-131) min, P = 0.002). Data are shown as median (i.q.r.). CONCLUSIONS Time until scan after reaching hypoglycaemia might be an objective assessment tool for IAH, but needs to be investigated comprehensively in future studies.
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Affiliation(s)
- O. Moser
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - H. Ziko
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - H. Elsayed
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - D. A. Hochfellner
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - T. Pöttler
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - A. Mueller
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
- Exercise PhysiologyTraining & Training Therapy Research GroupInstitute of Sports ScienceUniversity of GrazGrazAustria
| | - M. L. Eckstein
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - H. Sourij
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
- Zayed Center for Health Sciences (ZCHS)United Arab Emirates UniversityAl AinUnited Arab Emirates
| | - J. K. Mader
- Division of Endocrinology and DiabetologyDepartment of Internal MedicineMedical University of GrazGrazAustria
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Bozzini G, Filippi B, Alriyalat S, Calori A, Besana U, Mueller A, Pushkar D, Otero J, Pastore A, Sighinolfi M, Micali S, Buizza C, Rocco B. Disposable versus reusable ureteroscopes: A prospective multicenter randomized comparison. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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16
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Regidor PA, Mueller A, Matilla S, Díez C. Elution from intact and broken vaginal contraceptive rings: an in vitro study. Eur Rev Med Pharmacol Sci 2020; 24:5668-5675. [PMID: 32495902 DOI: 10.26355/eurrev_202005_21358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The in vitro elution of the active substances etonogestrel (ETO) and ethinylestradiol (EE) of Ornibel® (a vaginal delivery system) was determined after a deliberate breakage of the vaginal contraceptive ring and compared to the standard elution and hormone release of intact rings under the same experimental conditions. MATERIALS AND METHODS Ornibel® intact and broken vaginal rings were placed in a dissolution buffer and subject to a repetitive sampling of ETO and EE following a standardized in vitro elution (IVE) procedure for 21 days. The hormone dissolution profile was determined by HPLC using a fully validated analytical method. In a second study, rings were broken after day seven, and their elution profiles were compared to that of intact rings. For all utilized batches, the stability conditions established were 24 months at 5°C. Furthermore, no special storage conditions are needed. RESULTS The instantaneous elution on day 1 of ETO and EE for intact rings were 119±8 µg/day and 15±1 µg/day, respectively (mean ± SD), which was non-significantly different to the immediate release of ETO and EE for broken rings (118±4 µg/day and 14±1 µg/day). The average elution profile for days 2-20 were 132±5 µg/day and 18±1 µg/day (ETO/EE, intact rings) and 132±4 µg/day and 19±1 µg/day (ETO/EE, broken rings) respectively. On day 21, the elution of ETO and EE was numerically similar 111±5 (±4) µg/day and 18±1 µg/day) for both intact and broken rings. The IVE results from intact rings and vaginal rings deliberately cut on day seven similarly did not differ in their release of ETO and EE. CONCLUSIONS Our study concludes that the hormonal release of ETO and EE from Ornibel® are similar for intact and broken vaginal rings under standardized in vitro conditions.
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Mueller A, Roffler M. PARE0032 STRENGTHENING SELF-MANAGEMENT TO IMPROVE THE QUALITY OF LIFE AND HEALTH STATUS OF PATIENTS WITH INFLAMMATORY ARTHRITIS AND OSTEOPOROSIS IN SWITZERLAND. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5220] [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: 11/03/2022]
Abstract
Background:Previous UK studies suggest that people with arthritis taking part in self-management programmes feel more confident in their ability to manage and control their symptoms. These patients may also visit the doctor less frequently and have shown improved physical and clinical outcomes (1, 2). Based on this evidence, self-management has become an essential component of care for patients with arthritis, or generally with chronic diseases. However, there is still a huge gap regarding such self-management services and support programmes in rheumatology in Switzerland.In the Swiss National Strategy “Musculoskeletal Diseases” 2017–2022, strengthening patients’ empowerment is one of the main strategic pillars. Considering that approximately 500,000 people are suffering in Switzerland from inflammatory arthritis (IA) and osteoporosis (OP) alone, there is huge potential to strengthen patients’ self-management capacity and thus improve their quality of life (3).Therefore, the SLR has developed a self-management programme for IA and OP patients. In this programme medical assistants in outpatient rheumatology clinics are trained to consult patients in self-management. This programme is part of a two-year pilot project (2019–2020) that is supported by a consortium of important stakeholders in rheumatology in Switzerland.Objectives:The ultimate objective is to increase the quality of life and the health status of people with IA and OP in Switzerland by enhancing their capacity for self-management. Furthermore, this pilot project aims at closing an important gap in the Swiss healthcare system by creating an innovative model that can potentially be replicated for other chronic diseases.Methods:To measure the quality of life, the health status as well as the change in behaviour in patients, the study design includes both qualitative and quantitative methods. Patients enrolled in the programme are asked to answer a questionnaire at three points in time; at enrolment, after the last session and two months after completing the programme. It is expected that at least 45 patients will be enrolled. For a qualitative assessment, in-depth interviews will be conducted with rheumatologists and their medical assistants as well as some of the programme participants.The training material for the medical assistants was developed by the SLR and will be evaluated by the programme participants. All patients will also evaluate the quality of the consulting provided by the medical assistant, answering a questionnaire after the last session.Results:Within the first year of implementation, ten outpatient clinics, with twenty-four rheumatologists and twelve medical assistants, were enrolled in the pilot project. Four medical assistants were trained in 2019 and eight are in the process of receiving training in spring 2020. Only after the completion of training will patients be enrolled in the self-management programme. Therefore, outcome-related results cannot be expected until the beginning of 2021.Conclusion:This pilot project provides an innovative approach to closing an important gap in the Swiss healthcare system and to providing a missing component of care for patients with IA and OP. However, it has been challenging to enrol enough clinics in the pilot project. The way the programme is embedded in the current healthcare system, it demands a cultural change within outpatient clinics, allowing medical assistants to step into a new role as consultant.References:[1]Barlow JH, Turner, Wright (2000). ‘A randomised controlled study of the arthritis self-management programme in the UK’. Health Ed Res 15(6): 665–80.[2]De Silva, D. (2011). Evidence: Helping people help themselves. A review of the evidence considering whether it is worthwhile to support self-management. The Health Foundation. London.[3]Swiss League against Rheumatism (2017). Swiss National Strategy ‘Musculoskeletal Diseases’ 2017–2022. Zurich: 10–13.Disclosure of Interests:None declared
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Kuehlwein JM, Borsche M, Korir PJ, Risch F, Mueller A, Hübner MP, Hildner K, Hoerauf A, Dunay IR, Schumak B. Protection of Batf3-deficient mice from experimental cerebral malaria correlates with impaired cytotoxic T-cell responses and immune regulation. Immunology 2020; 159:193-204. [PMID: 31631339 PMCID: PMC6954726 DOI: 10.1111/imm.13137] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022] Open
Abstract
Excessive inflammatory immune responses during infections with Plasmodium parasites are responsible for severe complications such as cerebral malaria (CM) that can be studied experimentally in mice. Dendritic cells (DCs) activate cytotoxic CD8+ T-cells and initiate immune responses against the parasites. Batf3-/- mice lack a DC subset, which efficiently induces strong CD8 T-cell responses by cross-presentation of exogenous antigens. Here we show that Batf3-/- mice infected with Plasmodium berghei ANKA (PbA) were protected from experimental CM (ECM), characterized by a stable blood-brain barrier (BBB) and significantly less infiltrated peripheral immune cells in the brain. Importantly, the absence of ECM in Batf3-/- mice correlated with attenuated responses of cytotoxic T-cells, as their parasite-specific lytic activity as well as the production of interferon gamma and granzyme B were significantly decreased. Remarkably, spleens of ECM-protected Batf3-/- mice had elevated levels of regulatory immune cells and interleukin 10. Thus, protection from ECM in PbA-infected Batf3-/- mice was associated with the absence of strong CD8+ T-cell activity and induction of immunoregulatory mediators and cells.
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MESH Headings
- Animals
- Basic-Leucine Zipper Transcription Factors/deficiency
- Basic-Leucine Zipper Transcription Factors/genetics
- Blood-Brain Barrier/immunology
- Blood-Brain Barrier/parasitology
- Brain/immunology
- Brain/metabolism
- Brain/parasitology
- Cells, Cultured
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Dendritic Cells/parasitology
- Disease Models, Animal
- Female
- Granzymes/immunology
- Granzymes/metabolism
- Host-Parasite Interactions
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Interleukin-10/immunology
- Interleukin-10/metabolism
- Malaria, Cerebral/immunology
- Malaria, Cerebral/metabolism
- Malaria, Cerebral/parasitology
- Malaria, Cerebral/prevention & control
- Mice, Inbred C57BL
- Mice, Knockout
- Plasmodium berghei/immunology
- Plasmodium berghei/pathogenicity
- Repressor Proteins/deficiency
- Repressor Proteins/genetics
- Spleen/immunology
- Spleen/metabolism
- Spleen/parasitology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
- T-Lymphocytes, Cytotoxic/parasitology
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Affiliation(s)
- Janina M. Kuehlwein
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Max Borsche
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Patricia J. Korir
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Frederic Risch
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Ann‐Kristin Mueller
- Parasitology UnitCentre for Infectious DiseasesHeidelberg University HospitalHeidelbergGermany
- DZIF German Center for Infection ResearchPartner Site HeidelbergHeidelbergGermany
| | - Marc P. Hübner
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
| | - Kai Hildner
- Medical Department 1University Hospital ErlangenErlangenGermany
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
- DZIF German Center for Infection ResearchPartner Site Bonn‐CologneBonnGermany
| | - Ildiko Rita Dunay
- Institute of Inflammation and NeurodegenerationUniversity of MagdeburgMagdeburgGermany
| | - Beatrix Schumak
- Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany
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Wahler S, Mueller A, Birkemeyer R. P5489Old ladies paradox: trends in the inpatient care of coronary heart disease 2005–2016 in Germany. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0442] [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
Objectives
Coronary heart disease (CHD) and subsequent illnesses are the most common cause of death in industrialized countries and they continue to lead the cause of death statistics.
In Germany, 2015 from all registered deaths 7.1% (n=65,686) are due to chronic CHD and 5.3% (n=49,210) due to acute myocardial infarction (AMI), but the proportion has fallen: Compared to 2003, when 10.9% (n=92,637) of the deceased of CHD and 7.5% of AMI (n=64,229).
It is established that there are sex-differences in prevalence and in the age of the persons concerned. E.g. 2015 AMI infarction is cause of death in 57% (n=27,835) men and 43% (n=21,375) women from 49% men (n=36,049) and 51% women (n=37,127) in 2003.
Aim of the study was, whether these differences in prevalence and diagnostic and interventional measurements in the hospital sector have shifted in recent years with the various entities of the acute coronary disease.
Methods
G-DRG Report-Browser 2005–2016 of the German DRG-Institute (InEK) and Federal Statistical Office data were used.
Analysis was carried out with Microsoft Excel and Access (version 2016).
Results
Inpatient cases of main diagnosis AMI increased from 2005 from 206,104 cases to 219,156 cases in 2016 (+6.3%).
Share of male increased from 62.5% to 66.6%.
The NSTEMI share increased from 39.7% in 2005 to 66.2% in 2016; a total 145.202 cases (+77.2% to 2005). The increase was smaller in older women: 60–70y: +33.7%; 70–80y: +44.5%; 80–90y: +61.9%The NSTEMI increase in men was slightly higher than in women; proportion of men 2005: 64.2%, 2016; 65.1%. The STEMIs number shrank from 104,082 in 2005 to 70,521 (−34.0%) in 2016. The relative reduction was very high in older women:
60–70y: −45.2%; 70–80y: −55.3%; 80–90y: −54.1%. Share of men 2005: 60.1%, 2015; 70.0%.
In 2008: 220,595 diagnostic-only coronarographies were conducted from a total of 690,745 coronarography measurements.
These numbers increased to 485.496 (+120.1%) and 869.002 (+25.8%) in 2016.
Share of the male decreased from 73.0% in 2008 to 65.6% in 2015.
The increase for all coronarographies was highest in older women: 50–60y: +60.7% 60–70y: +39.4%; 70–80y: +72.5%; 80–90y: +168,4%
The total number of percutaneous transluminal vascular interventions (PCI) increased from 2008 with 488,542 to 661,693 in 2016 (+35.4%). The relative increase in PCI was high in older women:
60–70y: +18.6%; 70–80y: +42.7%; 80–90y: +126.1%; >90y: +314.1%
Conclusions
The number of cases of ACS is declining since 2005. There is a significant shift from STEMI to NSTEMI events over the observation period.
In all forms of the ACS, the proportion of men in is increasing.
The rate of coronary diagnostic and coronary intervention in men is disproportionately high in relation to disease rate. Paradoxically the share of examinations older women without further action increases strongly, despite their share in the disease was small and is still decreasing.
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Affiliation(s)
| | - A Mueller
- St. Bernward GmbH, Cardiac Diagnostics, Hamburg, Germany
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Starobova H, Mueller A, Allavena R, Lohman RJ, Sweet MJ, Vetter I. Minocycline Prevents the Development of Mechanical Allodynia in Mouse Models of Vincristine-Induced Peripheral Neuropathy. Front Neurosci 2019; 13:653. [PMID: 31316337 PMCID: PMC6610325 DOI: 10.3389/fnins.2019.00653] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022] Open
Abstract
Vincristine is an antineoplastic substance that is part of many chemotherapy regimens, used especially for the treatment of a variety of pediatric cancers including leukemias and brain tumors. Unfortunately, many vincristine-treated patients develop peripheral neuropathy, a side effect characterized by sensory, motoric, and autonomic symptoms. The sensory symptoms include pain, in particular hypersensitivity to light touch, as well as loss of sensory discrimination to detect vibration and touch. The symptoms of vincristine-induced neuropathy are only poorly controlled by currently available analgesics and therefore often necessitate dose reductions or even cessation of treatment. The aim of this study was to identify new therapeutic targets for the treatment of vincristine-induced peripheral neuropathy (VIPN) by combining behavioral experiments, histology, and pharmacology after vincristine treatment. Local intraplantar injection of vincristine into the hind paw caused dose- and time-dependent mechanical hypersensitivity that developed into mechanical hyposensitivity at high doses, and lead to a pronounced, dose-dependent infiltration of immune cells at the site of injection. Importantly, administration of minocycline effectively prevented the development of mechanical hypersensitivity and infiltration of immune cells in mouse models of vincristine induce peripheral neuropathy (VIPN) based on intraperitoneal or intraplantar administration of vincristine. Similarly, Toll-like receptor 4 knockout mice showed diminished vincristine-induced mechanical hypersensitivity and immune cell infiltration, while treatment with the anti-inflammatory meloxicam had no effect. These results provide evidence for the involvement of Toll-like receptor 4 in the development of VIPN and suggest that minocycline and/or direct Toll-like receptor 4 antagonists may be an effective preventative treatment for patients receiving vincristine.
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Affiliation(s)
- H Starobova
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, Saint Lucia, QLD, Australia
| | - A Mueller
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, Saint Lucia, QLD, Australia
| | - R Allavena
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - R J Lohman
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - M J Sweet
- Centre for Inflammation and Disease Research, Institute for Molecular Bioscience, The University of Queensland, Saint Lucia, QLD, Australia
| | - I Vetter
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, Saint Lucia, QLD, Australia.,School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
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21
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med 2019; 36:606-611. [PMID: 30677187 DOI: 10.1111/dme.13909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system using reference blood glucose levels during moderate-intensity exercise while on either full or reduced basal insulin dose in people with Type 1 diabetes. METHODS Ten participants with Type 1 diabetes [four women, mean ± sd age 31.4 ± 9.0 years, BMI 25.5±3.8 kg/m2 , HbA1c 55±7 mmol/mol (7.2±0.6%)] exercised on a cycle ergometer for 55 min at a moderate intensity for 5 consecutive days at the clinical research facility, while receiving either their usual or a 75% basal insulin dose. After a 4-week washout period, participants performed the second exercise period having switched to the alternative basal insulin dose. During exercise, reference capillary blood glucose values were analysed using the fully enzymatic-amperometric method and compared with the interstitial glucose values obtained. Intermittently viewed continuous glucose monitoring accuracy was analysed according to median (interquartile range) absolute relative difference, and Clarke error grid and Bland-Altman analysis for overall glucose levels during exercise, stratified by glycaemic range and basal insulin dosing scheme (P<0.05). RESULTS A total of 845 glucose values were available during exercise to evaluate intermittently viewed continuous glucose monitoring sensor performance. The median (interquartile range) absolute relative difference between the reference values and those obtained by the sensor across the glycaemic range overall was 22 (13.9-29.7)%, and was 36.3 (24.2-45.2)% during hypoglycaemia, 22.8 (14.6-30.6)% during euglycaemia and 15.4 (9-21)% during hyperglycaemia. Usual basal insulin dose was associated with a worse sensor performance during exercise compared with the reduced (75%) basal insulin dose [median (interquartile range) absolute relative difference: 23.7 (17.2-30.7)% vs 20.5 (12-28.1)%; P<0.001). CONCLUSIONS The intermittently viewed continuous glucose monitoring sensor showed diminished accuracy during exercise. Absolute glucose readings derived from the sensor should be used cautiously and need confirmation by additional finger-prick blood glucose measurements.
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Affiliation(s)
- O Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - M L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - A Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - F Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - G Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - C Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - H Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Holler
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - H Simi
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - R M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - P Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - H Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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22
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Nurjadi D, Fleck R, Lindner A, Schäfer J, Gertler M, Mueller A, Lagler H, Van Genderen PJJ, Caumes E, Boutin S, Kuenzli E, Gascon J, Kantele A, Grobusch MP, Heeg K, Zanger P. Import of community-associated, methicillin-resistant Staphylococcus aureus to Europe through skin and soft-tissue infection in intercontinental travellers, 2011-2016. Clin Microbiol Infect 2018; 25:739-746. [PMID: 30315958 DOI: 10.1016/j.cmi.2018.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Recently, following import by travel and migration, epidemic community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused nosocomial outbreaks in Europe, sometimes with a fatal outcome. We describe clinico-epidemiological characteristics of CA-MRSA detected by the European Network for the Surveillance of imported S. aureus (www.staphtrav.eu) from May 2011 to November 2016. METHODS Sentinel surveillance at 13 travel clinics enrolling patients with travel-associated skin and soft-tissue infection (SSTI) and analysing lesion and nose swabs at one central laboratory. RESULTS A total of 564 independent case-patients with SSTI were enrolled and had 374 (67%) S. aureus-positive lesions, of which 14% (51/374) were MRSA. The majority of CA-MRSA isolates from SSTI were Panton-Valentine leucocidin (PVL) -positive (43/51, 84%). The risk of methicillin-resistance in imported S. aureus varied by travel region (p <0.001) and was highest in Latin America (16/57, 28%, 95% CI 17.0-41.5) and lowest in Sub-Saharan Africa (4/121, 3%, 95% CI 0.9-8.3). Major epidemic clones (USA300 / USA300 Latin-American Variant, Bengal Bay, South Pacific) accounted for more than one-third (19/51, 37%) of CA-MRSA imports. CA-MRSA SSTI in returnees was complicated (31/51 multiple lesions, 61%; 22/50 recurrences, 44%), led to health-care contact (22/51 surgical drainage, 43%; 7/50 hospitalization, 14%), was transmissible (13/47 reported similar SSTI in non-travelling contacts, 28%), and associated with S. aureus nasal colonization (28 of 51 CA-MRSA cases, 55%; 24 of 28 colonized with identical spa-type in nose and lesion, 85%). CONCLUSIONS Travel-associated CA-MRSA SSTI is a transmissible condition that leads to medical consultations and colonization of the infected host.
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Affiliation(s)
- D Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany
| | - R Fleck
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - A Lindner
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Schäfer
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - M Gertler
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Mueller
- Klinikum Würzburg Mitte gGmbH, Missioklinik, Tropenmedizin, Würzburg, Germany
| | - H Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria; Department of Tropical Medicine, University Medical Centre Hamburg Eppendorf & Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - P J J Van Genderen
- Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands
| | - E Caumes
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - S Boutin
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany
| | - E Kuenzli
- Swiss Tropical and Public Health Institute, Department Medicine, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - J Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Kantele
- Inflammation Centre, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - M P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - K Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany
| | - P Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Clinics, Heidelberg, Germany; Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Clinics, Heidelberg, Germany.
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23
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Aeschbacher S, Kuhle J, Benkert P, Rodondi N, Mueller A, Ammann P, Auricchio A, Shah D, Sticherling C, Ehret G, Roten L, Kuhne M, Osswald S, Conen D, Bonati L. P2908Serum light-chain neurofilament, a brain lesion marker, correlates with CHA2DS2-VASc score among patients with atrial fibrillation: a cross-sectional study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Affiliation(s)
- S Aeschbacher
- University Hospital Basel, Cardiology division, Department of Medicine, Basel, Switzerland
| | - J Kuhle
- University Hospital Basel, Neurology Division and Stroke Center, Department of Clinical Research, Basel, Switzerland
| | - P Benkert
- University Hospital Basel, Clinical Trial Unit, Department of Clinical Research, Basel, Switzerland
| | - N Rodondi
- University of Bern, BIHAM and Ambulatory Care Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - A Mueller
- Triemli Hospital, Department of Cardiology, Zurich, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Department of Cardiology, St. Gallen, Switzerland
| | - A Auricchio
- Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - D Shah
- Geneva University Hospitals, Department of Cardiology, Geneva, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology division, Department of Medicine, Basel, Switzerland
| | - G Ehret
- Geneva University Hospitals, Department of Cardiology, Geneva, Switzerland
| | - L Roten
- Bern University Hospital, Service of Cardiology, Inselspital, Bern, Switzerland
| | - M Kuhne
- University Hospital Basel, Cardiology division, Department of Medicine, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology division, Department of Medicine, Basel, Switzerland
| | - D Conen
- Population Health Research Institute, Hamilton, Canada
| | - L Bonati
- University Hospital Basel, Neurology Division and Stroke Center, Department of Clinical Research, Basel, Switzerland
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24
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Blum S, Kuehne M, Rodondi N, Mueller A, Ammann P, Moschovitis G, Kobza R, Schlaepfer J, Meyre P, Bonati LH, Ehret G, Sticherling C, Schwenkglenks M, Osswald S, Conen D. 1358Prevalence of silent vascular brain lesions among patients with atrial fibrillation and no known history of stroke. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Affiliation(s)
- S Blum
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - N Rodondi
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - A Mueller
- Triemli Hospital, Department of Cardiology, Zurich, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Department of Cardiology, St. Gallen, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Department of Cardiology, Lugano, Switzerland
| | - R Kobza
- Kantonsspital Lucerne, Department of Cardiology, Lucerne, Switzerland
| | - J Schlaepfer
- University Hospital Centre Vaudois (CHUV), Service of Cardiology, Lausanne, Switzerland
| | - P Meyre
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - L H Bonati
- University Hospital Basel, Neurology Division and Stroke Centre, Department of Clinical Research, Basel, Switzerland
| | - G Ehret
- Geneva University Hospitals, Cardiology Service, Department of Medicine Specialities, Geneva, Switzerland
| | - C Sticherling
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - M Schwenkglenks
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - S Osswald
- University Hospital Basel, Division of Cardiology, Department of Medicine, Basel, Switzerland
| | - D Conen
- McMaster University, Population Health Research Institute, Hamilton, Canada
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25
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Mueller A, Maggiorini M, Radovanovic D, Erne P. 2999Twenty-year trends in the characteristic, management and outcome of patients with STEMI and out-of-hospital reanimation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.2999] [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: 11/13/2022] Open
Affiliation(s)
- A Mueller
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention, Medical Intensive Care, University Zurich, Zurich, Switzerland
| | - M Maggiorini
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention, Medical Intensive Care, University Zurich, Zurich, Switzerland
| | - D Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention, Medical Intensive Care, University Zurich, Zurich, Switzerland
| | - P Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention, Medical Intensive Care, University Zurich, Zurich, Switzerland
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26
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Reichlin T, Baldinger S, Seiler J, Pruvot E, Bisch L, Ammann P, Berte B, Haegeli L, Mueller A, Namdar M, Burri H, Auricchio A, Knecht S, Kuehne M, Sticherling C. 2114Impact of contact force sensing technology on catheter ablation success of idiopathic premature ventricular contractions originating from the outflow tracts. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2114] [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: 11/14/2022] Open
Affiliation(s)
- T Reichlin
- University Hospital Basel, Basel, Switzerland
| | | | - J Seiler
- Bern University Hospital, Bern, Switzerland
| | - E Pruvot
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Bisch
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - B Berte
- Kantonsspital Lucerne, Lucerne, Switzerland
| | - L Haegeli
- University Hospital Zurich, Zurich, Switzerland
| | - A Mueller
- Triemli Hospital, Zurich, Switzerland
| | - M Namdar
- Geneva University Hospitals, Geneva, Switzerland
| | - H Burri
- Geneva University Hospitals, Geneva, Switzerland
| | | | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
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27
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Ros T, Frewen P, Théberge J, Michela A, Kluetsch R, Mueller A, Candrian G, Jetly R, Vuilleumier P, Lanius RA. Neurofeedback Tunes Scale-Free Dynamics in Spontaneous Brain Activity. Cereb Cortex 2018; 27:4911-4922. [PMID: 27620975 DOI: 10.1093/cercor/bhw285] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/19/2016] [Indexed: 11/13/2022] Open
Abstract
Brain oscillations exhibit long-range temporal correlations (LRTCs), which reflect the regularity of their fluctuations: low values representing more random (decorrelated) while high values more persistent (correlated) dynamics. LRTCs constitute supporting evidence that the brain operates near criticality, a state where neuronal activities are balanced between order and randomness. Here, healthy adults used closed-loop brain training (neurofeedback, NFB) to reduce the amplitude of alpha oscillations, producing a significant increase in spontaneous LRTCs post-training. This effect was reproduced in patients with post-traumatic stress disorder, where abnormally random dynamics were reversed by NFB, correlating with significant improvements in hyperarousal. Notably, regions manifesting abnormally low LRTCs (i.e., excessive randomness) normalized toward healthy population levels, consistent with theoretical predictions about self-organized criticality. Hence, when exposed to appropriate training, spontaneous cortical activity reveals a residual capacity for "self-tuning" its own temporal complexity, despite manifesting the abnormal dynamics seen in individuals with psychiatric disorder. Lastly, we observed an inverse-U relationship between strength of LRTC and oscillation amplitude, suggesting a breakdown of long-range dependence at high/low synchronization extremes, in line with recent computational models. Together, our findings offer a broader mechanistic framework for motivating research and clinical applications of NFB, encompassing disorders with perturbed LRTCs.
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Affiliation(s)
- T Ros
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - P Frewen
- Department of Psychiatry, Western University, London N6A 5A5, Ontario, Canada
| | - J Théberge
- Department of Medical Imaging, Lawson Health Research Institute, London N6C 2R5, Ontario, Canada
| | - A Michela
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - R Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Mannheim-Heidelberg University, 68159 Mannheim, Germany
| | - A Mueller
- Brain and Trauma Foundation, CH-7000 Chur, Switzerland
| | - G Candrian
- Brain and Trauma Foundation, CH-7000 Chur, Switzerland
| | - R Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa K1A 0K6, Canada
| | - P Vuilleumier
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - R A Lanius
- Department of Psychiatry, Western University, London N6A 5A5, Ontario, Canada
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28
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Steger A, Hapfelmeier A, Sinnecker D, Dommasch M, Mueller A, Barthel P, Schmidt G. 211Machine learning in risk prediction of post-MI patients. Europace 2018. [DOI: 10.1093/europace/euy015.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Steger
- Technical University of Munich, Cardiology, Munich, Germany
| | - A Hapfelmeier
- Technical University of Munich, Institut für Medizinische Informatik, Statistik und Epidemiologie, Munich, Germany
| | - D Sinnecker
- Technical University of Munich, Cardiology, Munich, Germany
| | - M Dommasch
- Technical University of Munich, Cardiology, Munich, Germany
| | - A Mueller
- Technical University of Munich, Cardiology, Munich, Germany
| | - P Barthel
- Technical University of Munich, Cardiology, Munich, Germany
| | - G Schmidt
- Technical University of Munich, Cardiology, Munich, Germany
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29
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Beck E, Doherty D, Bleecker ER, Moroni-Zentgraf P, Engel M, Mueller A, Kerstjens HAM. Tiotropium Respimat®: efficacy in elderly asthma patients. Pneumologie 2018. [DOI: 10.1055/s-0037-1619203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Beck
- IFG Institut für Gesundheitsförderung, Rüdersdorf
| | | | - ER Bleecker
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - M Engel
- Boehringer Ingelheim, Ingelheim
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30
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Kadala A, Sotelo-Hitschfeld P, Ahmad Z, Tripal P, Schmid B, Mueller A, Bernal L, Winter Z, Brauchi S, Lohbauer U, Messlinger K, Lennerz JK, Zimmermann K. Fluorescent Labeling and 2-Photon Imaging of Mouse Tooth Pulp Nociceptors. J Dent Res 2017; 97:460-466. [PMID: 29130364 DOI: 10.1177/0022034517740577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/15/2022] Open
Abstract
Retrograde fluorescent labeling of dental primary afferent neurons (DPANs) has been described in rats through crystalline fluorescent DiI, while in the mouse, this technique was achieved with only Fluoro-Gold, a neurotoxic fluorescent dye with membrane penetration characteristics superior to the carbocyanine dyes. We reevaluated this technique in the rat with the aim to transfer it to the mouse because comprehensive physiologic studies require access to the mouse as a model organism. Using conventional immunohistochemistry, we assessed in rats and mice the speed of axonal dye transport from the application site to the trigeminal ganglion, the numbers of stained DPANs, and the fluorescence intensity via 1) conventional crystalline DiI and 2) a novel DiI formulation with improved penetration properties and staining efficiency. A 3-dimensional reconstruction of an entire trigeminal ganglion with 2-photon laser scanning fluorescence microscopy permitted visualization of DPANs in all 3 divisions of the trigeminal nerve. We quantified DPANs in mice expressing the farnesylated enhanced green fluorescent protein (EGFPf) from the transient receptor potential cation channel subfamily M member 8 (TRPM8EGFPf/+) locus in the 3 branches. We also evaluated the viability of the labeled DPANs in dissociated trigeminal ganglion cultures using calcium microfluorometry, and we assessed the sensitivity to capsaicin, an agonist of the TRPV1 receptor. Reproducible DiI labeling of DPANs in the mouse is an important tool 1) to investigate the molecular and functional specialization of DPANs within the trigeminal nociceptive system and 2) to recognize exclusive molecular characteristics that differentiate nociception in the trigeminal system from that in the somatic system. A versatile tool to enhance our understanding of the molecular composition and characteristics of DPANs will be essential for the development of mechanism-based therapeutic approaches for dentine hypersensitivity and inflammatory tooth pain.
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Affiliation(s)
- A Kadala
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - P Sotelo-Hitschfeld
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- 2 Instituto de Fisiología, Facultad de Medicina, Escuela de Graduados, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Z Ahmad
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - P Tripal
- 3 Optical Imaging Centre Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - B Schmid
- 3 Optical Imaging Centre Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - A Mueller
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - L Bernal
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Z Winter
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Brauchi
- 2 Instituto de Fisiología, Facultad de Medicina, Escuela de Graduados, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - U Lohbauer
- 4 Klinik für Zahnerhaltung und Parodontologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - K Messlinger
- 5 Institut für Physiologie und Pathophysiologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - J K Lennerz
- 6 Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - K Zimmermann
- 1 Klinik für Anästhesiologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Bloch R, Mueller A, Llach A, O'Neill A, Jones T, Sakellariou P, Stadller G, Wright W, Jones P. Xenografts of human myogenic cells into mice form pure human muscle: a new model for FSHD. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kiguti LRA, Borges CS, Mueller A, Silva KP, Polo CM, Rosa JL, Silva PV, Missassi G, Valencise L, Kempinas WG, Pupo AS. Gender-specific impairment of in vitro sinoatrial node chronotropic responses and of myocardial ischemia tolerance in rats exposed prenatally to betamethasone. Toxicol Appl Pharmacol 2017; 334:66-74. [PMID: 28887130 DOI: 10.1016/j.taap.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/01/2017] [Accepted: 09/04/2017] [Indexed: 01/28/2023]
Abstract
Excessive fetal glucocorticoid exposure has been linked to increased susceptibility to hypertension and cardiac diseases in the adult life, a process called fetal programming. The cardiac contribution to the hypertensive phenotype of glucocorticoid-programmed progeny is less known, therefore, we investigated in vitro cardiac functional parameters from rats exposed in utero to betamethasone. Pregnant Wistar rats received vehicle (VEH) or betamethasone (BET, 0.1mg/kg, i.m.) at gestational days 12, 13, 18 and 19. Male and female offspring were killed at post-natal day 30 and the right atrium (RA) was isolated to in vitro evaluation of drug-induced chronotropic responses. Additionally, whole hearts were retrograde-perfused in a Langendorff apparatus and infarct size in response to in vitro ischemia/reperfusion (I/R) protocol was evaluated. Male and female progeny from BET-exposed pregnant rats had reduced birth weight, a hallmark of fetal programming. Male BET-progeny had increased basal RA rate, impaired chronotropic responses to noradrenaline and adenosine, and increased myocardial damage to I/R. Though a 12-fold reduction in the negative chronotropic responses to adenosine, the effects of non-metabolisable adenosine receptor agonists 5'-(N-ethylcarboxamido)adenosine or 2-Chloro-adenosine were not different between VEH- and BET-exposed male rats. BET-exposed female offspring presented no cardiac dysfunction. Prenatal BET exposure engenders male-specific impairment of sinoatrial node function and on myocardial ischemia tolerance resulting, at least in part, from an increased adenosine metabolism in the heart. In light of the importance of adenosine in the cardiac physiology our results suggest a link between reduced adenosinergic signaling and the cardiac dysfunctions observed in glucocorticoid-induced fetal programming.
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Affiliation(s)
- L R A Kiguti
- Department of Pharmacology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil.
| | - C S Borges
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - A Mueller
- Department of Pharmacology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil; Instituto de Ciências da Saúde, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - K P Silva
- Department of Pharmacology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - C M Polo
- Department of Physiology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - J L Rosa
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - P V Silva
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - G Missassi
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - L Valencise
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - W G Kempinas
- Department of Morphology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
| | - A S Pupo
- Department of Pharmacology, São Paulo State University (UNESP), Institute of Biosciences, Campus of Botucatu, Distrito de Rubião Junior s/n°, 18618-689 Botucatu, SP, Brazil
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Meyre P, Eggimann L, Beer J, Bonati L, Di Valentino M, Kuehne M, Monsch A, Moschovitis G, Aubert C, Shah D, Sticherling C, Stippich C, Wuerfel J, Mueller A, Osswald S. P4626Cognitive function correlates with CHA2DS2-VASc score in patients with atrial fibrillation: The Swiss atrial fibrillation cohort study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P. Meyre
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L. Eggimann
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J.H. Beer
- University Hospital Zurich, Medicine, Zurich, Switzerland
| | - L.H. Bonati
- University Hospital Basel, Neurology Division and Stroke Center, Basel, Switzerland
| | - M. Di Valentino
- Hospital of San Giovanni, Cardiology, Bellinzona, Switzerland
| | - M. Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A. Monsch
- University of Basel, Memory Clinic, Felix Platter Hospital Basel, Basel, Switzerland
| | - G. Moschovitis
- Lugano Regional Hospital, Cardiology, Lugano, Switzerland
| | - C. Aubert
- Bern University Hospital, General Internal Medicine, Bern, Switzerland
| | - D. Shah
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - C. Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C. Stippich
- University Hospital Basel, Neurology, Basel, Switzerland
| | - J. Wuerfel
- University Hospital Basel, Medical Image Analysis Center (MIAC AG), Basel, Switzerland
| | - A. Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - S. Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
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Dommasch M, Sinnecker D, Steger A, Barthel P, Mueller A, Ubrich R, Laugwitz KL, Schmidt G. P1622Assessment of expiration-triggered sinus arrhythmia from high-resolution ECG recordings for risk prediction in patients after acute myocardial infarction. Europace 2017. [DOI: 10.1093/ehjci/eux158.248] [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: 11/13/2022] Open
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Steger A, Mueller A, Toifl M, Sinnecker D, Dommasch M, Barthel P, Pramstaller PP, Schmidt G. P1612Bivariate PRSA: a novel tool for detection of functional respiration-triggered SA-blocks. Europace 2017. [DOI: 10.1093/ehjci/eux158.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Plumbaum K, Volk GF, Boeger D, Buentzel J, Esser D, Steinbrecher A, Hoffmann K, Jecker P, Mueller A, Radtke G, Witte OW, Guntinas-Lichius O. Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population-based healthcare research study. Clin Otolaryngol 2017; 42:1267-1274. [PMID: 28296237 DOI: 10.1111/coa.12862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. DESIGN Population-based study. SETTING All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. MAIN OUTCOME MEASURES Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. RESULTS A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. CONCLUSIONS Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.
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Affiliation(s)
- K Plumbaum
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - G F Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - D Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - J Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - D Esser
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - A Steinbrecher
- Department of Neurology, HELIOS-Klinikum, Erfurt, Germany
| | - K Hoffmann
- Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany
| | - P Jecker
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - A Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - G Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - O W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Anzueto A, Calverley PMA, Wise RA, Mueller A, Metzdorf N, Dusser D. Assessing COPD profiles and outcomes by dyspnoea severity. Pneumologie 2017. [DOI: 10.1055/s-0037-1598544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Anzueto
- Pulmonary/Critical Care, University of Texas Health Science Center, and South Texas Veterans Health Care System
| | - PMA Calverley
- Clinical Science Center, Institute of Ageing and Chronic Disease, University of Liverpool
| | - RA Wise
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine
| | - A Mueller
- Biostatistics and Data Sciences Europe, Boehringer Ingelheim Pharma GmbH & Co. KG
| | - N Metzdorf
- Respiratory Medicine, Boehringer Ingelheim Pharma GmbH & Co. KG
| | - D Dusser
- Department of Pneumology, Hôpital Cochin, Université Paris Descartes
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Williams D, Mueller A, Browder W. Preclinical and clinical evaluation of carbohydrate immunopharmaceuticals in the prevention of sepsis and septic sequelae. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199500200309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sepsis and sepsis syndrome are significant causes of morbidity and mortality in critically ill patients. Despite technological and therapeutic advances in critical care, sepsis continues to be a pivotal factor in 20-50 % of deaths in surgical intensive care units. It is clear that alternative approaches to the prevention and/or treatment of sepsis must be found. Preclinical data indicate that macrophage activation with (1→3)-β-D-glucans will ameliorate sequelae associated with Gram-negative septicemia. Recent clinical data indicate that macrophage activation with (1→3)-β-D-glucans will significantly reduce septic morbidity and mortality in trauma and/or high-risk surgical patients. This work reviews the preclinical and clinical evaluation of (1→3)-β-D-glucans in the prevention of sepsis and septic sequelae.
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Affiliation(s)
- D.L. Williams
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - A. Mueller
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - W. Browder
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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Hoeke H, Roeder S, Mueller A, Bertsche T, Borte M, Rolle-Kampczyk U, von Bergen M, Wissenbach DK. Biomonitoring of prenatal analgesic intake and correlation with infantile anti-aeroallergens IgE. Allergy 2016; 71:901-6. [PMID: 27012463 DOI: 10.1111/all.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/28/2022]
Abstract
An association between prenatal acetaminophen or ibuprofen intake and an increased risk of asthma and increased IgE level in children is discussed in various epidemiological studies. Although the molecular mechanistic link is still unknown, the question whether or not acetaminophen and/or ibuprofen are safe pain medications during pregnancy arose. In this study, we associate maternal acetaminophen and ibuprofen intake during pregnancy and breastfeeding to infantile asthma phenotypes and elevated IgE level. Therefore, we analysed questionnaires from a local mother-child cohort and monitored drug intake by LC-MS biomonitoring in urine. No association was found between drug intake and any analysed health outcome using questionnaire data. For the information obtained from biomonitoring, no association was found for ibuprofen and acetaminophen intakes during breastfeeding. However, an association between prenatal acetaminophen intake and increased infantile IgEs related to aeroallergens was statistically detected, but not for asthma phenotypes.
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Affiliation(s)
- H. Hoeke
- Department of Pharmaceutical and Medicinal Chemistry; Institute of Pharmacy; University of Leipzig; Leipzig Germany
- Department of Molecular Systems Biology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
| | - S. Roeder
- Department of Environmental Immunology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
| | - A. Mueller
- Department of Molecular Systems Biology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
| | - T. Bertsche
- Department of Clinical Pharmacy; Institute of Pharmacy; University of Leipzig; Leipzig Germany
- Drug Safety Center; University Hospital Leipzig and University of Leipzig; Leipzig Germany
| | - M. Borte
- Children's Hospital; Municipal Hospital St. Georg Leipzig; Affiliated to the University of Leipzig; Leipzig Germany
| | - U. Rolle-Kampczyk
- Department of Molecular Systems Biology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
| | - M. von Bergen
- Department of Molecular Systems Biology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
- Department of Biotechnology; Chemistry and Environmental Engineering Aalborg University; Aalborg Denmark
- Institute of Biochemistry; Faculty of Biosciences; Pharmacy and Psychology; University of Leipzig; Leipzig Germany
| | - D. K. Wissenbach
- Department of Molecular Systems Biology; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
- Institute of Forensic Medicine; University Hospital Jena; Jena Germany
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Kerstein A, Erschig A, Holl-Ulrich K, Marschner G, Pitann S, Mueller A, Riemekasten G, Lamprecht P. SAT0336 Damage-Associated Molecular Patterns IL-33 and High-Mobility Group Box 1 Amplify Inflammatory Processes in Granulomatosis with Polyangiitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4807] [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: 11/04/2022]
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41
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Klein A, Reinhard H, Mueller A, Horneff G. AB0857 Spontaneous Regression of Ebv-Associated Lymphoproliferative Disorder in A Juvenile Idiopathic Arthritis Patient after Discontinuation of Methotrexate and Etanercept. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2119] [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: 11/04/2022]
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42
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Dorneanu JF, Mueller A, Rambaud P, Weide ETAVD, Hirschberg A. Tonal and Silent Wake Modes of a Square Rod at Incidence. ACTA ACUST UNITED AC 2016. [DOI: 10.3813/aaa.918959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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43
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Maatouk I, Mueller A, Schmook R, Angerer P, Herbst K, Cranz A, Voss E, Salize H, Gantner M, Herzog W, Gündel H. Healthy aging at work – Development of a preventive group intervention to promote quality of life of nursing staff aged 45 years and older. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.mhp.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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44
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Dusser D, Calverley P, Tetzlaff K, Mueller A, Metzdorf N, Disse B, Dahl R. Impact des antécédents d’exacerbations et de l’utilisation des CSI sur le devenir des patients BPCO de l’étude TIOSPIR™. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Bozzini G, Albersen M, Romero Otero J, Margreiter M, Garcia Cruz E, Mueller A, Gratzke C, Serefoglu EC, Martinez Salamanca JI, Verze P. Feasibility and safety of conservative surgery for the treatment of spermatic cord leiomyosarcoma. Int J Surg 2015; 24:81-4. [PMID: 26578108 DOI: 10.1016/j.ijsu.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/20/2015] [Accepted: 11/08/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma. METHODS Patients undergoing inguinoscrotal exploration in 10 different Urological Centers with diagnosis of leiomyosarcoma were enrolled. Preoperative evaluation included physical examination, Scrotal US, Abdominal CT and Scrotal MRI in selected cases. Patients underwent organ sparing surgery or orchiectomy in case of intraoperative FSE was positive for a local infiltration. Data collected were: age, presence of infiltration, length of the lesion, number of lesions, definitive histological outcome, pre and postoperative testosterone level. Follow up was performed with abdomen CT scan and scrotal US. RESULTS From January 2007 to December 2013, 23 patients (mean age: 64.7 yrs) were diagnosed with spermatic cord leiomyosarcoma. Each patients underwent scrotal US. 10 patients underwent radical orchiectomy and 13 patients underwent conservative surgery. Mean follow up was 36.5 months. 5 patients (21.7%) developed a recurrent disease, 18 patients (78.3%) had a negative follow up (mean time: 40.8 months). Statistical analysis reveals that there is a significant correlation between number of lesions, length of the lesions and recurrent disease. CONCLUSIONS Spermatic cord leiomyosarcoma is a rare disease. Conservative surgical treatment of spermatic cord leiomyosarcoma is a feasible therapeutic option for small, single and not infiltrating lesion.
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Affiliation(s)
- G Bozzini
- Humanitas Mater Domini, Dept. of Urology, Castellanza-Varese, Italy.
| | - M Albersen
- University Hospitals Leuven, Dept. of Urology, Leuven, Belgium
| | - J Romero Otero
- Hospital Universitario 12 De Octubre, Dept. of Urology, Madrid, Spain
| | - M Margreiter
- Vienna General Hospital, Dept. of Urology, Vienna, Austria
| | - E Garcia Cruz
- Hospital Clínic De Barcelona, Dept. of Urology, Barcelona, Spain
| | - A Mueller
- University Hospital Zurich, Dept. of Urology, Zurich, Switzerland
| | - C Gratzke
- Ludwig-Maximilians-University (LMU), Dept. of Urology, Munich, Germany
| | - E C Serefoglu
- Bagcilar Training & Research Hospital, Dept. of Urology, Istanbul, Turkey
| | | | - P Verze
- University of Naples Federico II, Dept. of Urology, Naples, Italy
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Mueller A, Stoetter L, Kalluvya S, Stich A, Majinge C, Weissbrich B, Kasang C. Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania. BMC Infect Dis 2015; 15:386. [PMID: 26399765 PMCID: PMC4581415 DOI: 10.1186/s12879-015-1129-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 01/27/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background Sub-Saharan Africa has a high prevalence of hepatitis B virus (HBV) infections. Health care workers (HCWs) are at high risk of contracting HBV infection through their occupation. Vaccination of HCWs against HBV is standard practice in many countries, but is often not implemented in resource-poor settings. We aimed with this cross-sectional study to determine HBV prevalence, HCW vaccination status, and the risk factors for HCWs contracting HBV infection in Tanzania. Methods We enrolled 600 HCWs from a tertiary Tanzanian hospital. Their demographics, medical histories, HBV vaccination details and risk factors for contracting blood-borne infections were collected using a standardized questionnaire. Serum samples were tested for HBV and hepatitis C virus (HCV) markers by ELISA techniques, PCR and an anti-HBs rapid test. HCWs were divided in two subgroups: those at risk of contracting HBV (rHCW 79.2 %) via exposure to potentially infectious materials, and those considered not at risk of contracting HBV (nrHCW, 20.8 %). Results The overall prevalence of chronic HBV infection (HBsAg+, anti-HBc+, anti-HBs-) was 7.0 % (42/598). Chronic HBV infection was found in 7.4 % of rHCW versus 5.6 % of nrHCW (p-value = 0.484). HCWs susceptible to HBV (HBsAg-, anti-HBc-, anti-HBs-) comprised 31.3 %. HBV immunity achieved either by healed HBV infection (HBsAg-, anti-HBc+, anti-HBs+) or by vaccination (HBsAg-, anti-HBc-, anti-HBs+) comprised 36.5 % and 20.2 %, respectively. 4.8 % of participants had indeterminate results (HBsAg-, anti-HBc+, anti-HBc-IgM-, anti-HBs-). Only 77.1 % of HCWs who received a full vaccination course had an anti-HBs titer >10 ml/U. An anti-HBs point-of-care test was 80.7 % sensitive and 96.9 % specific. There was a significantly higher risk for contracting HBV (anti-HBc+) among those HCW at occupational risk (rHCW) of older age (odds ratios (OR) in rHCW 3.297, p < 0.0001 vs. nrHCW 1.385, p = 0.606) and among those HCW being employed more than 11 years (OR 2.51, p < 0.0001***). HCV prevalence was low (HCV antibodies 1.2 % and HCV-RNA 0.3 %). Conclusions Chronic HBV infection is common among Tanzanian HCWs. One third of HCWs were susceptible to HBV infection, highlighting the need for vaccination. Due to high prevalence of naturally acquired immunity against HBV pre-testing might be a useful tool to identify susceptible individuals.
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Affiliation(s)
- A Mueller
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - L Stoetter
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - S Kalluvya
- Bugando Medical Centre, P.O. Box 1370, Mwanza, United Republic of Tanzania. .,CUHAS, P.O. Box 1370, Mwanza, United Republic of Tanzania.
| | - A Stich
- Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97074, Wuerzburg, Germany.
| | - C Majinge
- Bugando Medical Centre, P.O. Box 1370, Mwanza, United Republic of Tanzania.
| | - B Weissbrich
- Institute of Virology and Immunobiology, University of Wuerzburg, Versbacher Strasse 7, 97078, Wuerzburg, Germany.
| | - C Kasang
- Medical Mission Institute, Salvatorstrasse 7, 97067, Wuerzburg, Germany.
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Nurjadi D, Schäfer J, Friedrich-Jänicke B, Mueller A, Neumayr A, Calvo-Cano A, Goorhuis A, Molhoek N, Lagler H, Kantele A, Van Genderen PJJ, Gascon J, Grobusch MP, Caumes E, Hatz C, Fleck R, Mockenhaupt FP, Zanger P. Predominance of dfrG as determinant of trimethoprim resistance in imported Staphylococcus aureus. Clin Microbiol Infect 2015; 21:1095.e5-9. [PMID: 26344335 DOI: 10.1016/j.cmi.2015.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/09/2015] [Accepted: 08/25/2015] [Indexed: 12/11/2022]
Abstract
To investigate the global occurrence of trimethoprim-sulfamethoxazole resistance and the genetic mechanisms of trimethoprim resistance, we analysed Staphylococcus aureus from travel-associated skin and soft-tissue infections treated at 13 travel clinics in Europe. Thirty-eight per cent (75/196) were trimethoprim-resistant and 21% (41/196) were resistant to trimethoprim-sulfamethoxazole. Among methicillin-resistant S. aureus, these proportions were 30% (7/23) and 17% (4/23), respectively. DfrG explained 92% (69/75) of all trimethoprim resistance in S. aureus. Travel to South Asia was associated with the highest risk of acquiring trimethoprim-sulfamethoxazole-resistant S. aureus. We conclude that globally dfrG is the predominant determinant of trimethoprim resistance in human S. aureus infection.
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Affiliation(s)
- D Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany.
| | - J Schäfer
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - B Friedrich-Jänicke
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Mueller
- Missionsärztliche Klinik, Würzburg, Germany
| | - A Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - A Calvo-Cano
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - N Molhoek
- Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands
| | - H Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - A Kantele
- Department of Medicine, University of Helsinki, Finland; Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - P J J Van Genderen
- Instituut voor Tropische Ziekten, Havenziekenhuis, Rotterdam, The Netherlands
| | - J Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E Caumes
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - C Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - R Fleck
- Tropenklinik, Paul-Lechler-Krankenhaus, Tübingen, Germany
| | - F P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Institute of Public Health, Unit of Epidemiology and Biostatistics, Heidelberg University Hospital, Heidelberg, Germany
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48
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Pestalozzi B, Tausch C, Dedes K, Rochlitz C, Zimmermann S, Von Moos R, Winterhalder R, Ruhstaller T, Mueller A, Buser K, Borner M, Novak U, Uhlmann Nussbaum C, Seifert B, Bigler M, Bize V, Berardi Vilei S, Rageth C, Aebi S. 1943 Adjuvant treatment recommendations for ER+ early breast cancer patients by Swiss tumor boards (SAKK 26/10). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30891-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Machine learning is a pervasive development at the intersection of statistics and computer science. While it can benefit many data-related applications, the technical nature of the research literature and the corresponding algorithms slows down its adoption. Scikit-learn is an open-source software project that aims at making machine learning accessible to all, whether it be in academia or in industry. It benefits from the general-purpose Python language, which is both broadly adopted in the scientific world, and supported by a thriving ecosystem of contributors. Here we give a quick introduction to scikit-learn as well as to machine-learning basics.
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Affiliation(s)
| | | | | | - O. Grisel
- Parietal, INRIA, CEA Institute, France
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50
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Mueller A, Schmohl K, Knoop K, Salb N, Schug C, Hofstetter M, Wechselberger A, Schwenk N, Nelson PJ, Spitzweg C. Analysis of the effects of T3 and T4 on the hypoxia response network of mesenchymal stem cells. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547610] [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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