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Luib E, Demleitner AF, Cordts I, Westenberg E, Rau P, Pürner D, Haller B, Lingor P. Reduced tear fluid production in neurological diseases: a cohort study in 708 patients. J Neurol 2024; 271:1824-1836. [PMID: 38063868 PMCID: PMC10973005 DOI: 10.1007/s00415-023-12104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Tear fluid (TF) production is an important component of normal ocular function. It is regulated by parasympathetic and sympathetic innervation. Because parasympathetic nerve fibers originate in the brainstem, pathology in this brain region may affect TF production. For example, a reduction in TF production has been described in patients with Parkinson's disease (PD). METHODS TF was collected at one center from 772 individuals, 708 of which were patients with different neurological diseases, and 64 healthy controls. Wetting lengths (WL) were recorded using Schirmer test strips with a collection time of 10 min. RESULTS WL correlated negatively with age and was significantly reduced in subgroups of patients with neurodegenerative diseases (NDDs) (PD, Amyotrophic lateral sclerosis (ALS), other motor neuron diseases (MNDs)), as well as inflammatory/autoimmune/infectious central nervous system (CNS) diseases and vascular CNS diseases (VCDs), even if corrected for age or sex. While temperature had a significant negative effect on TF production, other environmental factors, such as hours of sunlight and humidity, did not. CONCLUSION WL was altered in many neurological diseases compared to healthy controls. Most importantly, we observed a reduction of WL in NDDs, independent of age or sex. This study highlights the potential of WL as an easily obtainable parameter and suggests functional alterations in the autonomic innervation in various neurological disorders.
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Affiliation(s)
- Elena Luib
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Antonia F Demleitner
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Petra Rau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dominik Pürner
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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Widmann M, Gaidai R, Schubert I, Grummt M, Bensen L, Kerling A, Quermann A, Zacher J, Vollrath S, Bizjak DA, Beckendorf C, Egger F, Hasler E, Mellwig KP, Fütterer C, Wimbauer F, Vogel A, Schoenfeld J, Wüstenfeld JC, Kastner T, Barsch F, Friedmann-Bette B, Bloch W, Meyer T, Mayer F, Wolfarth B, Roecker K, Reinsberger C, Haller B, Niess AM. COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance-A Prospective, Observational, Multicenter Cohort Study (CoSmo-S). Sports Med 2024; 54:1033-1049. [PMID: 38206445 PMCID: PMC11052799 DOI: 10.1007/s40279-023-01976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity. OBJECTIVE We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified. METHODS In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses. RESULTS Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period. CONCLUSIONS Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen. TRIAL REGISTRATION NUMBER DRKS00023717; 06.15.2021-retrospectively registered.
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Affiliation(s)
- Manuel Widmann
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany.
| | - Roman Gaidai
- Department of Sports and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Isabel Schubert
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
| | - Maximilian Grummt
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lieselotte Bensen
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Kerling
- Clinic for Rehabilitation and sports medicine, Hannover Medical School, Hannover, Germany
| | - Anne Quermann
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Zacher
- Department of Preventative and Rehabilitative Sports and Performance Medicine, Institute of Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Shirin Vollrath
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Claudia Beckendorf
- Center of Sports Medicine, Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Florian Egger
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Erik Hasler
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Furtwangen University, Furtwangen, Germany
| | - Klaus-Peter Mellwig
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cornelia Fütterer
- School of Medicine, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Fritz Wimbauer
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Azin Vogel
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Julia Schoenfeld
- Department of Prevention and Sports Medicine, University Hospital 'Rechts Der Isar', Technical University of Munich, Munich, Germany
| | - Jan C Wüstenfeld
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Tom Kastner
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Friedrich Barsch
- Medical Faculty, Institute of Exercise and Occupational Medicine, University Freiburg, Freiburg, Germany
| | - Birgit Friedmann-Bette
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Frank Mayer
- Center of Sports Medicine, Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Applied Training Science, Leipzig University, Leipzig, Germany
| | - Kai Roecker
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Furtwangen University, Furtwangen, Germany
| | - Claus Reinsberger
- Department of Sports and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Bernhard Haller
- School of Medicine, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M Niess
- Department of Sports Medicine, Medical Clinic, Medical University Hospital Tuebingen, University Hospital of Tuebingen, Hoppe-Seyler Str. 6, 72076, Tuebingen, Germany
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3
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Ritschl LM, Singer H, Clasen FC, Haller B, Fichter AM, Deppe H, Wolff KD, Weitz J. Oral rehabilitation and associated quality of life following mandibular reconstruction with free fibula flap: a cross-sectional study. Front Oncol 2024; 14:1371405. [PMID: 38562168 PMCID: PMC10982308 DOI: 10.3389/fonc.2024.1371405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Mandibular reconstruction with the free fibula flap (FFF) has become a standardized procedure. The situation is different with oral rehabilitation, so the purpose of this study was to investigate the frequency of implant placement and prosthetic restoration. Additionally, the patients' situation, motivation, and treatment course were structurally assessed. Materials and methods All cases between January 2013 and December 2018 that underwent mandibular reconstruction in our department with a free fibula flap and gave written informed consent to participate were interviewed with two structured questionnaires about their restoration and quality of life. Additionally, medical records, general information, status of implants and therapy, and metric analyses of the inserted implants were performed. Results In total 59 patients were enrolled and analyzed in this monocentric study. Overall, oral rehabilitation was achieved in 23.7% at the time of investigation. In detail, implants were inserted in 37.3% of patients and showed an 83.3% survival of dental implants. Of these implanted patients, dental implants were successfully restored with a prosthetic restoration in 63.6. Within this subgroup, satisfaction with the postoperative aesthetic and functional result was 79.9% and with the oral rehabilitation process was 68.2%. Satisfaction with the implant-borne prosthesis was 87.5%, with non-oral-squamous-cell-carcinoma patients being statistically significantly more content with the handling (p=0.046) and care (p=0.031) of the prosthesis. Discussion Despite the well-reconstructed bony structures, there is a need to increase the effort of achieving oral rehabilitation, especially looking at the patient's persistent motivation for the procedure.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Hannes Singer
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Franz-Carl Clasen
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jochen Weitz
- Department of Oral and Maxillofacial Surgery, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Oral and Maxillofacial Surgery, Josefinum, Augsburg and Private Practice Oral and Maxillofacial Surgery im Pferseepark, Augsburg, Germany
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4
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Tretter C, de Andrade Krätzig N, Pecoraro M, Lange S, Seifert P, von Frankenberg C, Untch J, Zuleger G, Wilhelm M, Zolg DP, Dreyer FS, Bräunlein E, Engleitner T, Uhrig S, Boxberg M, Steiger K, Slotta-Huspenina J, Ochsenreither S, von Bubnoff N, Bauer S, Boerries M, Jost PJ, Schenck K, Dresing I, Bassermann F, Friess H, Reim D, Grützmann K, Pfütze K, Klink B, Schröck E, Haller B, Kuster B, Mann M, Weichert W, Fröhling S, Rad R, Hiltensperger M, Krackhardt AM. Author Correction: Proteogenomic analysis reveals RNA as a source for tumor-agnostic neoantigen identification. Nat Commun 2024; 15:2364. [PMID: 38491045 PMCID: PMC10943035 DOI: 10.1038/s41467-024-46724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Affiliation(s)
- Celina Tretter
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Niklas de Andrade Krätzig
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Matteo Pecoraro
- Department of Proteomics and Signal Transduction, Max Plank Institute of Biochemistry, Munich, Germany
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Sebastian Lange
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Philipp Seifert
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Clara von Frankenberg
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Johannes Untch
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Gabriela Zuleger
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Mathias Wilhelm
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
- Technical University of Munich, TUM School of Life Sciences, Computational Mass Spectrometry, Freising, Germany
| | - Daniel P Zolg
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
| | - Florian S Dreyer
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Eva Bräunlein
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Thomas Engleitner
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Sebastian Uhrig
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Molecular Precision Oncology Program, NCT Heidelberg, Heidelberg, Germany
| | - Melanie Boxberg
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Katja Steiger
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Julia Slotta-Huspenina
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Sebastian Ochsenreither
- German Cancer Consortium (DKTK), partner site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolas von Bubnoff
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), partner site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medical Oncology and Sarcoma Center, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp J Jost
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
- Clinical Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- University Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Kristina Schenck
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Iska Dresing
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Florian Bassermann
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
| | - Helmut Friess
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Daniel Reim
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Konrad Grützmann
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Core Unit Molecular Tumor Diagnostics (CMTD), NCT Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Katrin Pfütze
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Klink
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Evelin Schröck
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
- ERN GENTURIS, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany
| | - Bernhard Haller
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Munich, Germany
| | - Bernhard Kuster
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
- Technical University of Munich, TUM School of Life Sciences, Bavarian Biomolecular Mass Spectrometry Center (BayBioMS), Freising, Germany
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Plank Institute of Biochemistry, Munich, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Stefan Fröhling
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roland Rad
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Michael Hiltensperger
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Angela M Krackhardt
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany.
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany.
- Malteser Krankenhaus St. Franziskus-Hospital, Flensburg, Germany.
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5
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Behzadi ST, Moser R, Kiesl S, Nano J, Peeken JC, Fischer JC, Fallenberg EM, Huber T, Haller B, Klein E, Kiechle M, Combs SE, Borm KJ. Tumor Contact With Internal Mammary Perforator Vessels as Risk Factor for Gross Internal Mammary Lymph Node Involvement in Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00339-0. [PMID: 38458496 DOI: 10.1016/j.ijrobp.2024.02.030] [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] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE The identification of internal mammary lymph node metastases and the assessment of associated risk factors are crucial for adjuvant regional lymph node irradiation in patients with breast cancer. The current study aims to investigate whether tumor contact with internal mammary perforator vessels is associated with gross internal mammary lymph node involvement. METHODS AND MATERIALS We included 297 patients with primary breast cancer and gross internal mammary (IMN+) and/or axillary metastases as well as 230 patients without lymph node metastases. Based on pretreatment dynamic contrast-enhanced magnetic resonance imaging, we assessed contact of the tumor with the internal mammary perforating vessels (IMPV). RESULTS A total of 59 patients had ipsilateral IMN+ (iIMN+), 10 patients had contralateral IMN+ (cIMN+), and 228 patients had ipsilateral axillary metastases without IMN; 230 patients had node-negative breast cancer. In patients with iIMN+, 100% of tumors had contact with ipsilateral IMPV, with 94.9% (n = 56) classified as major contact. In iIMN- patients, major IMPV contact was observed in only 25.3% (n = 116), and 36.2% (n = 166) had no IMPV contact at all. Receiver operating characteristic analysis revealed that "major IMPV contact" was more accurate in predicting iIMN+ (area under the curve, 0.85) compared with a multivariate model combining grade of differentiation, tumor site, size, and molecular subtype (area under the curve, 0.65). Strikingly, among patients with cIMN+, 100% of tumors had contact with a crossing contralateral IMPV, whereas in cIMN- patients, IMPVs to the contralateral side were observed in only 53.4% (iIMN+) and 24.8% (iIMN-), respectively. CONCLUSIONS Tumor contact with the IMPV is highly associated with risk of gross IMN involvement. Further studies are warranted to investigate whether this identified risk factor is also associated with microscopic IMN involvement and whether it can assist in the selection of patients with breast cancer for irradiation of the internal mammary lymph nodes.
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Affiliation(s)
- Sophie T Behzadi
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Rebecca Moser
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Sophia Kiesl
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Jana Nano
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Julius C Fischer
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Eva M Fallenberg
- Department of Radiology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Thomas Huber
- Department of Radiology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany; Deutsches Konsortium für translationale Krebsforschung (DKTK) - Partner Site Munich, Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Munich, Germany
| | - Kai J Borm
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany.
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Weiß M, Mende E, Schaller N, Krusemark H, Spanier B, Zelger O, Bischof J, Haller B, Halle M, Siegrist M. Adherence and potential factors of adherence to a resistance, coordination and endurance training in older retirement home residents over 6 months. Scand J Med Sci Sports 2024; 34:e14576. [PMID: 38339790 DOI: 10.1111/sms.14576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION High exercise adherence is a key factor for effective exercise programmes. However, little is known about predictors of exercise adherence to a multimodal machine-based training in older retirement home residents. AIMS To assess exercise adherence and potential predictors of adherence. Furthermore, to evaluate user acceptance of the multimodal training and the change in exercise self-efficacy. METHODS In this sub-analysis of the bestform-F study, a total of 77 retirement home residents ≥65 years (mean age: 85.6 ± 6.6 years, 77.9% female) participated in a 6-month machine-based resistance, coordination and endurance training. Attendance to the training was documented for each training session. To identify potential predictors a multiple linear regression model was fitted to the data. Analyzed predictors included age, sex, body mass index (BMI), physical function, exercise self-efficacy, and physical activity history. Different domains of user acceptance (e.g. safety aspects, infrastructure) and exercise self-efficacy were assessed by a questionnaire and the exercise self-efficacy scale (ESES), respectively. RESULTS Mean exercise adherence was 67.2% (median: 74.4%). The regression model (R2 = 0.225, p = 0.033) revealed that the 6-minute walk test (6-MWT) at baseline significantly predicted exercise adherence (β: 0.074, 95% confidence interval (CI): 0.006-0.142, p = 0.033). Different user domains were rated at least as good by 83.9%-96.9% of participants, reflecting high acceptance. No statistically significant change was found for exercise self-efficacy over 6 months (mean change: 0.47 ± 3.08 points, p = 0.156). CONCLUSION Retirement home residents attended more than two thirds of offered training sessions and physical function at baseline was the key factor for predicting adherence. User acceptance of the training devices was highly rated. These findings indicate good potential for implementation of the exercise programme.
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Affiliation(s)
- Michael Weiß
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Esther Mende
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nina Schaller
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helge Krusemark
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bianca Spanier
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Otto Zelger
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Bischof
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
| | - Monika Siegrist
- Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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7
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Knappich C, Kirchhoff F, Fritsche MK, Egert-Schwender S, Wendorff H, Kallmayer M, Haller B, Hyhlik-Duerr A, Reeps C, Eckstein HH, Trenner M. Endovascular aortic repair with sac embolization for the prevention of type II endoleaks (the EVAR-SE study): study protocol for a randomized controlled multicentre study in Germany. Trials 2024; 25:17. [PMID: 38167068 PMCID: PMC10759747 DOI: 10.1186/s13063-023-07888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Beyond a certain threshold diameter, abdominal aortic aneurysms (AAA) are to be treated by open surgical or endovascular aortic aneurysm repair (EVAR). In a quarter of patients who undergo EVAR, inversion of blood flow in the inferior mesenteric artery or lumbar arteries may lead to type II endoleak (T2EL), which is associated with complications (e.g. AAA growth, secondary type I endoleak, rupture). As secondary interventions to treat T2EL often fail and may be highly invasive, prevention of T2EL is desirable. The present study aims to assess the efficacy of sac embolization (SE) with metal coils during EVAR to prevent T2EL in patients at high risk. METHODS Over a 24-month recruitment period, a total of 100 patients undergoing EVAR in four vascular centres (i.e. Klinikum rechts der Isar of the Technical University of Munich, University Hospital Augsburg, University Hospital Dresden, St. Joseph's Hospital Wiesbaden) are to be included in the present study. Patients at high risk for T2EL (i.e. ≥ 5 efferent vessels covered by endograft or aneurysmal thrombus volume <40%) are randomized to one group receiving standard EVAR and another group receiving EVAR with SE. Follow-up assessments postoperatively, after 30 days, and 6 months involve contrast-enhanced ultrasound scans (CEUS) and after 12 months an additional computed tomography angiography (CTA) scan. The presence of T2EL detected by CEUS or CTA after 12 months is the primary endpoint. Secondary endpoints comprise quality of life (quantified by the SF-36 questionnaire), reintervention rate, occurrence of type I/III endoleak, aortic rupture, death, alteration of aneurysm volume, or diameter. Standardized evaluation of CTA scans happens through a core lab. The study will be terminated after the final follow-up visit of the ultimate patient. DISCUSSION Although preexisting studies repeatedly indicated a beneficial effect of SE on T2EL rates after EVAR, patient relevant outcomes have not been assessed until now. The present study is the first randomized controlled multicentre study to assess the impact of SE on quality of life. Further unique features include employment of easily assessable high-risk criteria, a contemporary follow-up protocol, and approval to use any commercially available coil material. Overcoming limitations of previous studies might help SE to be implemented in daily practice and to enhance patient safety. TRIAL REGISTRATION ClinicalTrials.gov NCT05665101. Registered on 23 December 2022.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.
| | - Felix Kirchhoff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Marie-Kristin Fritsche
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heiko Wendorff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Bernhard Haller
- Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | | | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
- Division of Vascular Medicine, St. Josefs Hospital, Wiesbaden, Germany
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Steinhelfer L, Lunger L, Cala L, Pfob CH, Lapa C, Hartrampf PE, Buck AK, Schäfer H, Schmaderer C, Tauber R, Brosch-Lenz J, Haller B, Meissner VH, Knorr K, Weber WA, Eiber M. Long-Term Nephrotoxicity of 177Lu-PSMA Radioligand Therapy. J Nucl Med 2024; 65:79-84. [PMID: 37857504 DOI: 10.2967/jnumed.123.265986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
β-emitting 177Lu targeting prostate-specific membrane antigen (PSMA) is an approved treatment option for metastatic castration-resistant prostate cancer. Data on its long-term nephrotoxicity are sparse. This study aimed to retrospectively evaluate post-177Lu-PSMA estimated glomerular filtration rate (eGFR) dynamics for at least 12 mo in a cohort of metastatic castration-resistant prostate cancer patients. Methods: The institutional databases of 3 German tertiary referral centers identified 106 patients who underwent at least 4 cycles of 177Lu-PSMA and had at least 12 mo of eGFR follow-up data. eGFR (by the Chronic Kidney Disease Epidemiology Collaboration formula) at 3, 6, and 12 mo after 177Lu-PSMA radioligand therapy was estimated using monoexponentially fitted curves through available eGFR data. eGFR changes were grouped (≥15%-<30%, moderate; ≥30%-<40%, severe; and ≥40%, very severe). Associations between eGFR changes (%) and nephrotoxic risk factors, prior treatment lines, and number of 177Lu-PSMA cycles were analyzed using multivariable linear regression. Results: At least moderate eGFR decreases were present in 45% (48/106) of patients; of those, nearly half (23/48) had a severe or very severe eGFR decrease. A higher number of risk factors at baseline (-4.51, P = 0.03) was associated with a greater eGFR decrease. Limitations of the study were the retrospective design, lack of a control group, and limited number of patients with a follow-up longer than 1 y. Conclusion: A considerable proportion of patients may experience moderate or severe decreases in eGFR 1 y from initiation of 177Lu-PSMA. A higher number of risk factors at baseline seems to aggravate loss of renal function. Further prospective trials are warranted to estimate the nephrotoxic potential of 177Lu-PSMA.
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Affiliation(s)
- Lisa Steinhelfer
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Lunger
- Department of Urology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany;
| | - Lisena Cala
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian H Pfob
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Wurzburg, Wurzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Wurzburg, Wurzburg, Germany
| | - Hannah Schäfer
- Department of Nephrology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Robert Tauber
- Department of Urology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Brosch-Lenz
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karina Knorr
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Wettengel JM, Strehle K, von Lucke C, Roggendorf H, Jeske SD, Christa C, Zelger O, Haller B, Protzer U, Knolle PA. Improved detection of infection with SARS-CoV-2 Omicron variants of concern in healthcare workers by a second-generation rapid antigen test. Microbiol Spectr 2023; 11:e0176823. [PMID: 37831440 PMCID: PMC10714798 DOI: 10.1128/spectrum.01768-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
IMPORTANCE The results from this study demonstrate the usefulness of a second-generation rapid antigen test for early detection of infection with the SARS-CoV-2 Omicron variant of concern (VoC) and reveal a higher sensitivity to detect immune escape Omicron VoCs compared to a first-generation rapid antigen test (89.4% vs 83.7%) in the high-risk group of healthcare workers.
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Affiliation(s)
- Jochen M. Wettengel
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
| | - Katharina Strehle
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Catharina von Lucke
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Hedwig Roggendorf
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Samuel D. Jeske
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
| | - Catharina Christa
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
| | - Otto Zelger
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Bernhard Haller
- Institute for AI and Informatics in Medicine Statistics, School of Medicine and Health, TUM, München, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
- Institute of Virology, Helmholtz Munich, München, Germany
| | - Percy A. Knolle
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
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10
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Feuerriegel GC, Kronthaler S, Weiss K, Haller B, Leonhardt Y, Neumann J, Pfeiffer D, Hesse N, Erber B, Schwaiger BJ, Makowski MR, Woertler K, Karampinos DC, Wurm M, Gersing AS. Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT. Eur Radiol 2023; 33:8617-8626. [PMID: 37453986 PMCID: PMC10667374 DOI: 10.1007/s00330-023-09939-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies. MATERIALS AND METHODS Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student's t-test, and Pearson's correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen's κ and intraclass correlation coefficient. RESULTS All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT. CONCLUSION Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT. CLINICAL RELEVANCE STATEMENT In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure. KEY POINTS • No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images. • Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts. • The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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Rubisch HPK, Blaschke AL, Berberat PO, Fuetterer CS, Haller B, Gartmeier M. Student mistakes and teacher reactions in bedside teaching. Adv Health Sci Educ Theory Pract 2023; 28:1523-1556. [PMID: 37170035 PMCID: PMC10174607 DOI: 10.1007/s10459-023-10233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.
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Affiliation(s)
- Hannah P K Rubisch
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Blaschke
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Pascal O Berberat
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Cornelia S Fuetterer
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Martin Gartmeier
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
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Pürner D, Hormozi M, Weiß D, Barbe MT, Jergas H, Prell T, Gülke E, Pötter-Nerger M, Falkenburger B, Klingelhöfer L, Gutsmiedl PK, Haslinger B, Jochim AM, Wolff A, Schröter N, Rijntjes M, van Riesen C, Scheller U, Wolz M, Amouzandeh A, Ebersbach G, Gruber D, Kohl Z, Maetzler W, Paschen S, Pérez-González P, Rozanski V, Schwarz J, Südmeyer M, Torka E, Wesbuer S, Bornmann S, Flöel A, Ip CW, Krause P, Kühn AA, Csoti I, Herting B, van de Loo S, Basheer AA, Liszka R, Jost WH, Koschel J, Haller B, Lingor P. Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease. Neurology 2023; 101:e2078-e2093. [PMID: 37914414 PMCID: PMC10663029 DOI: 10.1212/wnl.0000000000207858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Advanced therapies (ATs; deep brain stimulation [DBS] or pump therapies: continuous subcutaneous apomorphine infusion [CSAI], levodopa/carbidopa intestinal gel [LCIG]) are used in later stages of Parkinson disease (PD). However, decreasing efficacy over time and/or side effects may require an AT change or combination in individual patients. Current knowledge about changing or combining ATs is limited to mostly retrospective and small-scale studies. The nationwide case collection Combinations of Advanced Therapies in PD assessed simultaneous or sequential AT combinations in Germany since 2005 to analyze their clinical outcome, their side effects, and the reasons for AT modifications. METHODS Data were acquired retrospectively by modular questionnaires in 22 PD centers throughout Germany based on clinical records and comprised general information about the centers/patients, clinical (Mini-Mental Status Test/Montréal Cognitive Assessment, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS], side effects, reasons for AT modification), and therapeutical (ATs with specifications, oral medication) data. Data assessment started with initiation of the second AT. RESULTS A total of 148 AT modifications in 116 patients were associated with significantly improved objective (median decrease of MDS-UPDRS Part III 4.0 points [p < 0.001], of MDS-UPDRS Part IV 6.0 points [p < 0.001], of MDS-UPDRS Part IV-off-time item 1.0 points [p < 0.001]) and subjective clinical outcome and decreasing side effect rates. Main reasons for an AT modification were insufficient symptom control and side effects of the previous therapy. Subgroup analyses suggest addition of DBS in AT patients with leading dyskinesia, addition of LCIG for leading other cardinal motor symptoms, and addition of LCIG or CSAI for dominant off-time. The most long-lasting therapy-until requiring a modification-was DBS. DISCUSSION Changing or combining ATs may be beneficial when 1 AT is insufficient in efficacy or side effects. The outcome of an AT combination is comparable with the clinical benefit by introducing the first AT. The added AT should be chosen dependent on dominant clinical symptoms and adverse effects. Furthermore, prospective trials are needed to confirm the results of this exploratory case collection. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that, in patients with PD, changing or combining ATs is associated with an improvement in the MDS-UPDRS or subjective symptom reporting.
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Affiliation(s)
- Dominik Pürner
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Mohammad Hormozi
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Daniel Weiß
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Michael T Barbe
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Hannah Jergas
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Tino Prell
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Eileen Gülke
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Monika Pötter-Nerger
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Björn Falkenburger
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Lisa Klingelhöfer
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Pia K Gutsmiedl
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Bernhard Haslinger
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Angela M Jochim
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Andreas Wolff
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Nils Schröter
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Michel Rijntjes
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Christoph van Riesen
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Ute Scheller
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Martin Wolz
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Ali Amouzandeh
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Georg Ebersbach
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Doreen Gruber
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Zacharias Kohl
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Walter Maetzler
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Steffen Paschen
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Pablo Pérez-González
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Verena Rozanski
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Johannes Schwarz
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Martin Südmeyer
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Elisabeth Torka
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Simone Wesbuer
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Sarah Bornmann
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Agnes Flöel
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Chi Wang Ip
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Patricia Krause
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Andrea A Kühn
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Ilona Csoti
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Birgit Herting
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Simone van de Loo
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Aniz Ahammed Basheer
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Robert Liszka
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Wolfgang H Jost
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Jiri Koschel
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Bernhard Haller
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany
| | - Paul Lingor
- From the Klinik und Poliklinik für Neurologie (D.P., P.K.G., B. Haslinger, A.M.J., A.W., P.L.), Klinikum rechts der Isar der TU München, Munich; Neurologische Universitätsklinik (M.H., D.W.), Universitätsklinikum Tübingen; Klinik und Poliklinik für Neurologie (M.T.B., H.J.), Uniklinik Köln, Cologne; Klinik für Neurologie (T.P.), Universitätsklinikum Jena; Universitätsklinik und Poliklinik für Altersmedizin (T.P.), Universitätsmedizin Halle (Saale); Klinik und Poliklinik für Neurologie (E.G., M.P.-N.), Universitätsklinikum Hamburg-Eppendorf, Hamburg; Klinik und Poliklinik für Neurologie (B.F., L.K.), Universitätsklinikum Carl Gustav Carus an der TU Dresden; Klinik für Neurologie und Neurophysiologie (N.S., M.R.), Universitätsklinikum Freiburg; Klinik für Neurologie (C.v.R., U.S.), Universitätsmedizin Göttingen; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (C.v.R.), Standort Göttingen; Klinik für Neurologie (M.W.), Elblandklinikum Meißen, Meissen; Klinik für Neurologie (A.A., M.S.), Klinikum Ernst von Bergmann Potsdam; Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson (G.E., D.G.), Beelitz-Heilstätten, Beelitz; Klinik und Poliklinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg (Z.K., E.T.); Klinik für Neurologie (W.M., S.P.), Universitätsklinikum Schleswig-Holstein, Campus Kiel; Klinik für Neurologie (P.P.-G., S.W.), Christophorus-Klinik Dülmen; Parkinson Fachklinik Haag i. OB (V.R., J.S.); Klinik und Poliklinik für Neurologie (S.B., A.F.), Universitätsmedizin Greifswald; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (A.F.), Standort Rostock/Greifswald; Neurologische Klinik und Poliklinik (C.W.I.), Universitätsklinikum Würzburg; Klinik für Neurologie (P.K.), Charité-Universitätsmedizin Berlin; Klinik für Neurologie (A.A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin; Gertrudis-Klinik Biskirchen (I.C.), Parkinson-Zentrum, Leun-Biskirchen; Klinik für Neurologie und Gerontoneurologie (B. Herting, S.v.d.L.), DIAKONEO Diak Klinikum, Diakonie-Klinikum Schwäbisch Hall; Klinik für Neurologie (A.A.B., R.L.), Marienhaus Klinikum St. Wendel-Ottweiler; Parkinson-Klinik Ortenau (W.H.J., J.K.), Wolfach; Institut für KI und Informatik in der Medizin (B. Haller), Klinikum rechts der Isar der TU München, Munich; Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE) (P.L.), Standort München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (P.L.), Germany.
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13
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Klenk C, Erber J, Fresacher D, Röhrl S, Lengl M, Heim D, Irl H, Schlegel M, Haller B, Lahmer T, Diepold K, Rasch S, Hayden O. Platelet aggregates detected using quantitative phase imaging associate with COVID-19 severity. Commun Med (Lond) 2023; 3:161. [PMID: 37935793 PMCID: PMC10630365 DOI: 10.1038/s43856-023-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinical spectrum of acute SARS-CoV-2 infection ranges from an asymptomatic to life-threatening disease. Considering the broad spectrum of severity, reliable biomarkers are required for early risk stratification and prediction of clinical outcomes. Despite numerous efforts, no COVID-19-specific biomarker has been established to guide further diagnostic or even therapeutic approaches, most likely due to insufficient validation, methodical complexity, or economic factors. COVID-19-associated coagulopathy is a hallmark of the disease and is mainly attributed to dysregulated immunothrombosis. This process describes an intricate interplay of platelets, innate immune cells, the coagulation cascade, and the vascular endothelium leading to both micro- and macrothrombotic complications. In this context, increased levels of immunothrombotic components, including platelet and platelet-leukocyte aggregates, have been described and linked to COVID-19 severity. METHODS Here, we describe a label-free quantitative phase imaging approach, allowing the identification of cell-aggregates and their components at single-cell resolution within 30 min, which prospectively qualifies the method as point-of-care (POC) testing. RESULTS We find a significant association between the severity of COVID-19 and the amount of platelet and platelet-leukocyte aggregates. Additionally, we observe a linkage between severity, aggregate composition, and size distribution of platelets in aggregates. CONCLUSIONS This study presents a POC-compatible method for rapid quantitative analysis of blood cell aggregates in patients with COVID-19.
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Affiliation(s)
- Christian Klenk
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
| | - Johanna Erber
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - David Fresacher
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Stefan Röhrl
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Manuel Lengl
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Dominik Heim
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
| | - Hedwig Irl
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Martin Schlegel
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Bernhard Haller
- TUM School of Medicine and Health, Department of Clinical Medicine - Institute of AI and Informatics in Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Tobias Lahmer
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Klaus Diepold
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Sebastian Rasch
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Oliver Hayden
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany.
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14
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Kuchler T, Günthner R, Ribeiro A, Hausinger R, Streese L, Wöhnl A, Kesseler V, Negele J, Assali T, Carbajo-Lozoya J, Lech M, Schneider H, Adorjan K, Stubbe HC, Hanssen H, Kotilar K, Haller B, Heemann U, Schmaderer C. Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation. Angiogenesis 2023; 26:547-563. [PMID: 37507580 PMCID: PMC10542303 DOI: 10.1007/s10456-023-09885-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Post-COVID-19 syndrome (PCS) is a lingering disease with ongoing symptoms such as fatigue and cognitive impairment resulting in a high impact on the daily life of patients. Understanding the pathophysiology of PCS is a public health priority, as it still poses a diagnostic and treatment challenge for physicians. METHODS In this prospective observational cohort study, we analyzed the retinal microcirculation using Retinal Vessel Analysis (RVA) in a cohort of patients with PCS and compared it to an age- and gender-matched healthy cohort (n = 41, matched out of n = 204). MEASUREMENTS AND MAIN RESULTS PCS patients exhibit persistent endothelial dysfunction (ED), as indicated by significantly lower venular flicker-induced dilation (vFID; 3.42% ± 1.77% vs. 4.64% ± 2.59%; p = 0.02), narrower central retinal artery equivalent (CRAE; 178.1 [167.5-190.2] vs. 189.1 [179.4-197.2], p = 0.01) and lower arteriolar-venular ratio (AVR; (0.84 [0.8-0.9] vs. 0.88 [0.8-0.9], p = 0.007). When combining AVR and vFID, predicted scores reached good ability to discriminate groups (area under the curve: 0.75). Higher PCS severity scores correlated with lower AVR (R = - 0.37 p = 0.017). The association of microvascular changes with PCS severity were amplified in PCS patients exhibiting higher levels of inflammatory parameters. CONCLUSION Our results demonstrate that prolonged endothelial dysfunction is a hallmark of PCS, and impairments of the microcirculation seem to explain ongoing symptoms in patients. As potential therapies for PCS emerge, RVA parameters may become relevant as clinical biomarkers for diagnosis and therapy management. TRIAL REGISTRATION This study was previously registered at ClinicalTrials ("All Eyes on PCS-Analysis of the Retinal Microvasculature in Patients with Post-COVID-19 Syndrome". NCT05635552. https://clinicaltrials.gov/ct2/show/NCT05635552 ). Persistent endothelial dysfunction in post-COVID-19 syndrome. Acute SARS-CoV-2 infection indirectly or directly causes endotheliitis in patients. N = 41 PCS patients were recruited and retinal vessel analysis was performed to assess microvascular endothelial function. Images of SVA and DVA are illustrative for RVA data analysis. For each PCS patient and healthy cohort, venular vessel diameter of the three measurement cycles was calculated and plotted on a diameter-time curve. Patients exhibited reduced flicker-induced dilation in veins (vFID) measured by dynamic vessel analysis (DVA) and lower central retinal arteriolar equivalent (CRAE) and arteriolar-venular ratio (AVR) and a tendency towards higher central retinal venular equivalent (CRVE) when compared to SARS-CoV-2 infection naïve participants. Created with BioRender.com.
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Affiliation(s)
- Timon Kuchler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribeiro
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Renate Hausinger
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Streese
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Anna Wöhnl
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Veronika Kesseler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johanna Negele
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tarek Assali
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Javier Carbajo-Lozoya
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Heike Schneider
- School of Medicine, Klinikum Rechts Der Isar, Department of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Christian Stubbe
- Medizinische Klinik Und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, University of Basel, Basel, Switzerland
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- School of Medicine, Institute for AI and Informatics in Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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15
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Lechner K, Bock M, von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F. Trans-fatty acid blood levels of industrial but not natural origin are associated with cardiovascular risk factors in patients with HFpEF: a secondary analysis of the Aldo-DHF trial. Clin Res Cardiol 2023; 112:1541-1554. [PMID: 36640187 PMCID: PMC10584704 DOI: 10.1007/s00392-022-02143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown. METHODS This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e' 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman's correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months. RESULTS Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function. CONCLUSIONS In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.
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Affiliation(s)
- Katharina Lechner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Bock
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | | | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elke Lorenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Göttingen, Göttingen, Germany
| | - André Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Frank Edelmann
- Department of Cardiology, Campus Virchow Klinikum (CVK), Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
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16
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Kuchler T, Günthner R, Ribeiro A, Hausinger R, Streese L, Wöhnl A, Kesseler V, Negele J, Assali T, Carbajo-Lozoya J, Lech M, Schneider H, Adorjan K, Stubbe HC, Hanssen H, Kotilar K, Haller B, Heemann U, Schmaderer C. Correction: Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation. Angiogenesis 2023; 26:565. [PMID: 37612533 PMCID: PMC10542566 DOI: 10.1007/s10456-023-09892-7] [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: 08/25/2023]
Affiliation(s)
- Timon Kuchler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribeiro
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Renate Hausinger
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Streese
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Anna Wöhnl
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Veronika Kesseler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johanna Negele
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tarek Assali
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Javier Carbajo-Lozoya
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Heike Schneider
- School of Medicine, Klinikum Rechts Der Isar, Department of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Christian Stubbe
- Medizinische Klinik Und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, University of Basel, Basel, Switzerland
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- School of Medicine, Institute for AI and Informatics in Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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17
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Wahida A, Schmaderer C, Büttner-Herold M, Branca C, Donakonda S, Haberfellner F, Torrez C, Schmitz J, Schulze T, Seibt T, Öllinger R, Engleitner T, Haller B, Steiger K, Günthner R, Lorenz G, Yabal M, Bachmann Q, Braunisch MC, Moog P, Matevossian E, Aßfalg V, Thorban S, Renders L, Späth MR, Müller RU, Stippel DL, Weichert W, Slotta-Huspenina J, von Vietinghoff S, Viklicky O, Green DR, Rad R, Amann K, Linkermann A, Bräsen JH, Heemann U, Kemmner S. High RIPK3 expression is associated with a higher risk of early kidney transplant failure. iScience 2023; 26:107879. [PMID: 37868627 PMCID: PMC10585402 DOI: 10.1016/j.isci.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/05/2022] [Accepted: 09/07/2023] [Indexed: 10/24/2023] Open
Abstract
Renal ischemia-reperfusion injury (IRI) is associated with reduced allograft survival, and each additional hour of cold ischemia time increases the risk of graft failure and mortality following renal transplantation. Receptor-interacting protein kinase 3 (RIPK3) is a key effector of necroptosis, a regulated form of cell death. Here, we evaluate the first-in-human RIPK3 expression dataset following IRI in kidney transplantation. The primary analysis included 374 baseline biopsy samples obtained from renal allografts 10 minutes after onset of reperfusion. RIPK3 was primarily detected in proximal tubular cells and distal tubular cells, both of which are affected by IRI. Time-to-event analysis revealed that high RIPK3 expression is associated with a significantly higher risk of one-year transplant failure and prognostic for one-year (death-censored) transplant failure independent of donor and recipient associated risk factors in multivariable analyses. The RIPK3 score also correlated with deceased donation, cold ischemia time and the extent of tubular injury.
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Affiliation(s)
- Adam Wahida
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nurnberg, Erlangen, Germany
| | - Caterina Branca
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sainitin Donakonda
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Flora Haberfellner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Carlos Torrez
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Jessica Schmitz
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Tobias Schulze
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Seibt
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Engleitner
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Monica Yabal
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Quirin Bachmann
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias C. Braunisch
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Philipp Moog
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Edouard Matevossian
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Volker Aßfalg
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Thorban
- Institute of Molecular Immunology and Experimental Oncology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin R. Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dirk L. Stippel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Wilko Weichert
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sibylle von Vietinghoff
- Nephrology Section, Medical Clinic 1, University Hospital Bonn, Rheinische Friedrich Wilhelm University of Bonn, Bonn, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Douglas R. Green
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Roland Rad
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Kerstin Amann
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nurnberg, Erlangen, Germany
| | - Andreas Linkermann
- Division of Nephrology, Clinic of Internal Medicine 3, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
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18
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Siegrist M, Schaller N, Weiß M, Isaak J, Schmid V, Köppel E, Weichenberger M, Mende E, Haller B, Halle M. Study protocol of a cluster-randomised controlled trial assessing a multimodal machine-based exercise training programme in senior care facilities over 6 months - the bestform study (best function of range of motion). BMC Geriatr 2023; 23:505. [PMID: 37605110 PMCID: PMC10463394 DOI: 10.1186/s12877-023-04176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Physical functioning is a crucial factor for independence and quality of life in old age. The aim of the "bestform-Best function of range of motion" trial is to investigate the effects of a 6 months multimodal machine-based strength, coordination and endurance training on physical function, risk of falls and health parameters in older adults. METHODS Bestform is a cluster-randomised trial including older adults ≥ 65 years living in senior care facilities in Southern Germany. Senior care facilities are randomly allocated to the control group with usual care (n ≥ 10 care facilities) and to the intervention group (n ≥ 10 care facilities), overall including ≥ 400 seniors. Residents belonging to the intervention group are offered a supervised machine-based exercise training programme twice weekly over 45-60 min over six months in small groups, while those in the usual care facilities will not receive active intervention. The primary outcome is the change in Short Physical Performance Battery over six months between groups. Secondary outcomes are change in risk of falling, fear of falling, number of falls and fall-related injuries, physical exercise capacity, handgrip strength, body composition, cardiac function, blood parameters, quality of life, risk of sarcopenia, activities of daily living, and cognition over three and six months. DISCUSSION The bestform study investigates the change in physical function between seniors performing exercise intervention versus usual care over six months. The results of the study will contribute to the development of effective physical activity concepts in senior care facilities. TRIAL REGISTRATION ClinicalTrials.gov: NCT04207307. Registered December 2019.
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Affiliation(s)
- M Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany.
| | - N Schaller
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - M Weiß
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - J Isaak
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - V Schmid
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - E Köppel
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - M Weichenberger
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - E Mende
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
| | - B Haller
- Institute of AI and Informatics in Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - M Halle
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Georg-Brauchle-Ring 56, Munich, 80992, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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19
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Tretter C, de Andrade Krätzig N, Pecoraro M, Lange S, Seifert P, von Frankenberg C, Untch J, Zuleger G, Wilhelm M, Zolg DP, Dreyer FS, Bräunlein E, Engleitner T, Uhrig S, Boxberg M, Steiger K, Slotta-Huspenina J, Ochsenreither S, von Bubnoff N, Bauer S, Boerries M, Jost PJ, Schenck K, Dresing I, Bassermann F, Friess H, Reim D, Grützmann K, Pfütze K, Klink B, Schröck E, Haller B, Kuster B, Mann M, Weichert W, Fröhling S, Rad R, Hiltensperger M, Krackhardt AM. Proteogenomic analysis reveals RNA as a source for tumor-agnostic neoantigen identification. Nat Commun 2023; 14:4632. [PMID: 37532709 PMCID: PMC10397250 DOI: 10.1038/s41467-023-39570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Systemic pan-tumor analyses may reveal the significance of common features implicated in cancer immunogenicity and patient survival. Here, we provide a comprehensive multi-omics data set for 32 patients across 25 tumor types for proteogenomic-based discovery of neoantigens. By using an optimized computational approach, we discover a large number of tumor-specific and tumor-associated antigens. To create a pipeline for the identification of neoantigens in our cohort, we combine DNA and RNA sequencing with MS-based immunopeptidomics of tumor specimens, followed by the assessment of their immunogenicity and an in-depth validation process. We detect a broad variety of non-canonical HLA-binding peptides in the majority of patients demonstrating partially immunogenicity. Our validation process allows for the selection of 32 potential neoantigen candidates. The majority of neoantigen candidates originates from variants identified in the RNA data set, illustrating the relevance of RNA as a still understudied source of cancer antigens. This study underlines the importance of RNA-centered variant detection for the identification of shared biomarkers and potentially relevant neoantigen candidates.
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Affiliation(s)
- Celina Tretter
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Niklas de Andrade Krätzig
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Matteo Pecoraro
- Department of Proteomics and Signal Transduction, Max Plank Institute of Biochemistry, Munich, Germany
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Sebastian Lange
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Philipp Seifert
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Clara von Frankenberg
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Johannes Untch
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Gabriela Zuleger
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Mathias Wilhelm
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
- Technical University of Munich, TUM School of Life Sciences, Computational Mass Spectrometry, Freising, Germany
| | - Daniel P Zolg
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
| | - Florian S Dreyer
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Eva Bräunlein
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Thomas Engleitner
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Sebastian Uhrig
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Molecular Precision Oncology Program, NCT Heidelberg, Heidelberg, Germany
| | - Melanie Boxberg
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Katja Steiger
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Julia Slotta-Huspenina
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Sebastian Ochsenreither
- German Cancer Consortium (DKTK), partner site Berlin and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolas von Bubnoff
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), partner site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medical Oncology and Sarcoma Center, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp J Jost
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
- Clinical Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- University Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Kristina Schenck
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Iska Dresing
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Florian Bassermann
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
| | - Helmut Friess
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Daniel Reim
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Konrad Grützmann
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Core Unit Molecular Tumor Diagnostics (CMTD), NCT Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Katrin Pfütze
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Klink
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Evelin Schröck
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
- ERN GENTURIS, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany
| | - Bernhard Haller
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Munich, Germany
| | - Bernhard Kuster
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Life Sciences, Chair of Proteomics and Bioanalytics, Freising, Germany
- Technical University of Munich, TUM School of Life Sciences, Bavarian Biomolecular Mass Spectrometry Center (BayBioMS), Freising, Germany
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Plank Institute of Biochemistry, Munich, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Munich, Germany
| | - Stefan Fröhling
- German Cancer Consortium (DKTK), partner site Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roland Rad
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IInd Medical Department, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- Technical University of Munich, TUM School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Michael Hiltensperger
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany
| | - Angela M Krackhardt
- German Cancer Consortium (DKTK), partner site Munich and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, IIIrd Medical Department, Munich, Germany.
- Technical University of Munich, TUM School of Medicine, Center for Translational Cancer Research (TranslaTUM), Munich, Germany.
- Malteser Krankenhaus St. Franziskus-Hospital, Flensburg, Germany.
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20
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Johnson F, Hofauer B, Wirth M, Wollenberg B, Stögbauer F, Notohamiprodjo S, Haller B, Reschke R, Knopf A, Strassen U. Novel Discovery of the Somatostatin Receptor (SSTR2) in Pleomorphic Adenomas via Immunohistochemical Analysis of Tumors of the Salivary Glands. Cancers (Basel) 2023; 15:3917. [PMID: 37568733 PMCID: PMC10417029 DOI: 10.3390/cancers15153917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/09/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Reliable preoperative diagnosis between salivary gland tumor entities is difficult. In this monocentric retrospective study, we examined the somatostatin receptor 2 (SSTR2) status of salivary gland tumors after salivary gland tumor resection via immunohistochemistry (IHC), and stains were compared in analogy to the HER2 mamma scale. A total of 42.3% of all pleomorphic adenoma (PA) tumors (42 of 99, 95% confidence interval 32.5-52.8%) demonstrated ≥20% of cells displaying the SSTR2 as compared to just 1% of all other tumors (1/160, 95% CI 0.02-3.4%). The other tumor was a neuroendocrine carcinoma. PA had a higher intensity of SSTR2 staining, with 90.9% staining ≥ an intensity of 2 (moderate). Tumors with an intensity of SSTR2 expression equal to or greater than 2 had an 89.9% likelihood of being a PA (95% CI: 82.2-95.0%, AUC: 0.928). Only one Warthin tumor demonstrated a 'strong' SSTR2 staining intensity. No Warthin tumor showed a percentage of cells staining for SSTR2 above ≥20%. This result demonstrates consistent and strong expression of SSTR2 in PAs as compared to Warthin tumors, which may allow physicians to utilize radioligand-somatostatin analog PET CT/MR imaging to diagnose the PA. SSTR2 positivity, if shown to be clinically relevant, may allow peptide receptor radionuclide therapy in the future.
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Affiliation(s)
- Felix Johnson
- Department of Otorhinolaryngology, University Clinic of Innsbruck, 6020 Innsbruck, Austria
| | - Benedikt Hofauer
- Department of Otorhinolaryngology, University Clinic of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Wirth
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Fabian Stögbauer
- Institute of General and Surgical Pathology, TUM School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Susan Notohamiprodjo
- Department of Nuclear Medicine, Technical University of Munich (TUM), 85354 Freising, Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, 81675 München, Germany
| | - Robin Reschke
- Department of Dermatology and Venereology, Universitätsklinikum Hamburg-Eppendorf, Fleur Hiege Center for Skin Cancer Research, 20246 Hamburg, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, Head and Neck Surgery, Albert-Ludwigs-Universität Freiburg, 79085 Freiburg, Germany
| | - Ulrich Strassen
- Department of Otorhinolaryngology, Technical University of Munich (TUM), 85354 Freising, Germany
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21
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Schiefenhövel F, Berger C, Penkova L, Grubitzsch H, Haller B, Meyer A, Heringlake M, Sander M, Erb JM, Balzer F, Treskatsch S. Influence of timing of Levosimendan administration on outcomes in cardiac surgery. Front Cardiovasc Med 2023; 10:1213696. [PMID: 37564910 PMCID: PMC10410848 DOI: 10.3389/fcvm.2023.1213696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Though a subgroup analysis has shown improved survival for patients suffering severely reduced ventricular function undergoing coronary artery bypass grafting, RCTs were not able to demonstrate overall beneficial effects of perioperative Levosimendan in cardiac surgery. This might be due to Levosimendan's pharmacokinetics reaching a steady-state concentration only 4-8 h after administration. Thus, this study now analysed the influence of timing of Levosimendan administration on perioperative outcome in cardiac surgery patients preoperatively presenting with severely reduced ventricular function and therefore considered at high-risk for intra- or postoperative low cardiac output syndrome. We hypothesized that prolonged preoperative Levosimendan administration ("preconditioning") would reduce mortality. Methods All adult patients undergoing cardiac surgery between 2006 and 2018 perioperatively receiving Levosimendan were included in this retrospective, observational cohort study (n = 498). Patients were stratified into 3 groups: Levosimendan started on the day prior to surgery ("preop"), Levosimendan started on the day of surgery ("intraop") or post ICU admission ("postop"). After propensity score matching (PSM) was performed, outcomes defined according to proposed standard definitions for perioperative outcome research were compared between groups. Results After PSM, there were no significant differences in patients' characteristics, comorbidities and type/priority of surgery between groups. Compared to intraop or postop Levosimendan treatment, preop treated patients had significantly lower in-hospital-mortality (preop vs. intraop. vs. postop = 16,7% vs. 33,3% vs. 42,3%), duration of mechanical ventilation and rate of continuous renal replacement therapy. Conclusions Prolonged preoperative treatment with Levosimendan of cardiac surgery patients preoperatively presenting with severely reduced left ventricular function might be beneficial in terms of postoperative outcome. Our results are in line with recent experts' recommendations concerning the prolonged perioperative use of Levosimendan. We strongly recommend that future randomized trials include this "preconditioning" treatment as an experimental arm.
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Affiliation(s)
- Fridtjof Schiefenhövel
- Department of Anaesthesiology and Intensive Care (AINS), Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence and Informatics in Medicine (AIIM), Chair of Medical Informatics, Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Christian Berger
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Liubov Penkova
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Mitte and Charité Campus Virchow, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Klinik für Kardiovaskuläre Chirurgie, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Bernhard Haller
- Institute for Artificial Intelligence and Informatics in Medicine (AIIM), Chair of Medical Informatics, Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Meyer
- Klinik für Kardiovaskuläre Chirurgie, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matthias Heringlake
- Department of Anaesthesia, Heart and Diabetes Center, Klinikum Karlsburg, Karlsburg, Germany
| | - Michael Sander
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen UKGM, Justus-Liebig University Gießen, Gießen, Germany
| | - Joachim M. Erb
- Clinic for Anaesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Felix Balzer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
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22
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Knoke J, Raab R, Geyer K, Spies M, Haller B, Hauner H. Antibiotic Treatment During Pregnancy and the First Six Months Postpartum - a Secondary Analysis of the "Healthy Living in Pregnancy" (GeliS) Study. Geburtshilfe Frauenheilkd 2023; 83:850-861. [PMID: 37564896 PMCID: PMC10410684 DOI: 10.1055/a-2091-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Antibiotic therapies for the treatment of bacterial infections pose a particular challenge during pregnancy and breastfeeding. For Germany, there is hardly any information on the frequency of antibiotic use during this phase. Our analysis uses data from the "Healthy Living in Pregnancy" (GeliS) study to describe antibiotic treatments during pregnancy and in the first six months after birth (postpartum), and to compare their use with existing recommendations. Methods This is a retrospective secondary analysis of the GeliS study. In the cluster randomized lifestyle intervention study, detailed information on antibiotic therapies during pregnancy and postpartum was collected using surveys. Chi-square tests and generalized estimating equations were used for evaluation. Results Of the 1636 women included in the analysis, 21% reported antibiotic treatment at least once during pregnancy (14%) or in the first six months postpartum (7%). During pregnancy, the antibiotic therapies of women increased from 1.7% in the first trimester to 6.5% in the third trimester. Common reasons for treatment were urinary tract infections (7.3% of women), ear, nose, throat (ENT) infections (3.6%), and birth complications (2.6%). The information on the prescribed preparations corresponded to the current recommendations. A significant increase in the frequency of treatment with antibiotics was observed in the lifestyle intervention group (p < 0.001), in participants without a partner (p < 0.001), and in women who breastfed their children (p = 0.005) or gave birth by caesarean section (p = 0.003) or prematurely (p = 0.012). Other socioeconomic or lifestyle factors were not significant. Conclusion Approximately one in five women receives at least one antibiotic treatment during pregnancy and breastfeeding that meets current treatment recommendations. Treatment with antibiotics is more common in premature births, caesarean sections, and breastfeeding women.
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Affiliation(s)
- Johanna Knoke
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Roxana Raab
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Kristina Geyer
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Monika Spies
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
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23
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Ulrich JD, Rechberger P, Bachmann J, Herner A, V Figura G, Lahmer T, Phillip V, Mayr U, Haller B, Jesinghaus M, Schmid RM, Abdelhafez M, Schlag C. Efficacy and Safety of Cold Snare Polypectomy of Colorectal Polyps 10-15 mm with a Hybrid Snare: A Prospective Observational Pilot Study. Digestion 2023; 104:391-399. [PMID: 37331350 DOI: 10.1159/000530642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/03/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is a safe and effective procedure for small colorectal polyps ≤9 mm. There are only limited data regarding CSP of larger neoplastic lesions. This study evaluated the efficacy and safety of CSP for polyps between 10 and 15 mm in size. METHODS In this prospective single-arm observational pilot study, patients with a least one polyp 10-15 mm were included. These polyps were preferably removed by CSP using a dedicated hybrid snare. The primary outcome was the histological complete resection rate (CRR) determined by pathologically negative margins of the specimen and no neoplastic tissue obtained from biopsies of the resection site margin. Secondary outcomes were en bloc resection rate, failure of CSP, and incidence of adverse events. RESULTS A total of 61 neoplastic polyps were removed from 39 patients. Overall CRR was 80.3% (49/61). CSP was feasible in 78.7% (48/61) of polyps and the CRR in this group was 85.4% (41/48). When CSP failed (13/61; 21.3%), lesions were successfully resected by immediate HSP using the same snare with a CRR of 61.5% (8/13) in this group. One patient presented delayed hemorrhage after HSP of a polyp but successful hemostasis was achieved with two hemoclips. No other adverse events occurred. No recurrence was seen on follow-up colonoscopy in cases with incomplete resected polyps. CONCLUSION CSP seems to be efficient and safe in removing colorectal polyps up to 15 mm. A hybrid snare seems to be particularly advantageous for these polyps as it allows immediate conversion to HSP if CSP might fail in larger polyps. This trial is registered at ClinicalTrials.gov (NCT04464837).
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Affiliation(s)
- Jörg D Ulrich
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
| | - Paul Rechberger
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jeannine Bachmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Herner
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
| | - Guido V Figura
- Private Practice for Gastroenterology and Endoscopy, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Philipps-Universität Marburg, Marburg, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Schlag
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
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24
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Karimzadeh A, Heck M, Tauber R, Solaris E, Nekolla S, Knorr K, Haller B, D'Alessandria C, Weber WA, Eiber M, Rauscher I. The Impact of PSMA PET-Based Eligibility Criteria Used in the Prospective Phase II TheraP Trial in Metastatic Castration-Resistant Prostate Cancer Patients Undergoing Prostate-Specific Membrane Antigen-Targeted Radioligand Therapy. J Nucl Med 2023:jnumed.122.265346. [PMID: 37290796 DOI: 10.2967/jnumed.122.265346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/24/2023] [Indexed: 06/10/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) has shown encouraging results for treatment of metastatic castration-resistant prostate cancer (mCRPC) in the prospective, multicenter, randomized phase II TheraP study. The inclusion criteria for that study comprised a pretherapeutic 68Ga-PSMA-11 PET scan showing sufficient tumor uptake using a predefined threshold and the absence of 18F-FDG-positive, PSMA ligand-negative tumor lesions. However, the prognostic value of these PET-based inclusion criteria remains unclear. Therefore, we evaluated the outcome of mCRPC patients treated with PSMA RLT using TheraP as well as other TheraP-based PET inclusion criteria. Methods: First, patients were dichotomized into 2 groups whose PSMA PET scans did (TheraP contrast-enhanced PSMA [cePSMA] PET-positive) or did not (TheraP cePSMA PET-negative) fulfill the inclusion criteria of TheraP. Notably, unlike in TheraP, 18F-FDG PET was not performed on our patients. Prostate-specific antigen (PSA) response (PSA decline ≥ 50% from baseline), PSA progression-free survival, and overall survival (OS) were compared. Additionally, patients were further dichotomized according to predefined SUVmax thresholds different from those used in TheraP to analyze their potential impact on outcome as well. Results: In total, 107 mCRPC patients were included in this analysis (TheraP cePSMA PET-positive, n = 77; TheraP cePSMA PET-negative, n = 30). PSA response rates were higher in TheraP cePSMA PET-positive patients than in TheraP cePSMA PET-negative patients (54.5% vs. 20%, respectively; P = 0.0012). The median PSA progression-free survival (P = 0.007) and OS (P = 0.0007) of patients were significantly longer in the TheraP cePSMA PET-positive group than in the TheraP cePSMA PET-negative group. Moreover, being in the TheraP cePSMA PET-positive group was identified as a significant prognosticator of longer OS (P = 0.003). The application of different SUVmax thresholds for a single hottest lesion demonstrated no influence on outcome in patients eligible for PSMA RLT. Conclusion: Patient selection for PSMA RLT according to the inclusion criteria of TheraP led to a better treatment response and outcome in our preselected patient cohort. However, a relevant number of patients not fulfilling these criteria also showed substantial rates of response.
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Affiliation(s)
- Amir Karimzadeh
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Heck
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Robert Tauber
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Esteban Solaris
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Nekolla
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Karina Knorr
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Calogero D'Alessandria
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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25
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Holzmann-Littig C, Stadler D, Popp M, Kranke P, Fichtner F, Schmaderer C, Renders L, Braunisch MC, Assali T, Platen L, Wijnen-Meijer M, Lühnen J, Steckelberg A, Pfadenhauer L, Haller B, Fuetterer C, Seeber C, Schaaf C. Locating Medical Information during an Infodemic: Information Seeking Behavior and Strategies of Health-Care Workers in Germany. Healthcare (Basel) 2023; 11:healthcare11111602. [PMID: 37297742 DOI: 10.3390/healthcare11111602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/14/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to a flood of-often contradictory-evidence. HCWs had to develop strategies to locate information that supported their work. We investigated the information-seeking of different HCW groups in Germany. METHODS In December 2020, we conducted online surveys on COVID-19 information sources, strategies, assigned trustworthiness, and barriers-and in February 2021, on COVID-19 vaccination information sources. Results were analyzed descriptively; group comparisons were performed using χ2-tests. RESULTS For general COVID-19-related medical information (413 participants), non-physicians most often selected official websites (57%), TV (57%), and e-mail/newsletters (46%) as preferred information sources-physicians chose official websites (63%), e-mail/newsletters (56%), and professional journals (55%). Non-physician HCWs used Facebook/YouTube more frequently. The main barriers were insufficient time and access issues. Non-physicians chose abstracts (66%), videos (45%), and webinars (40%) as preferred information strategy; physicians: overviews with algorithms (66%), abstracts (62%), webinars (48%). Information seeking on COVID-19 vaccination (2700 participants) was quite similar, however, with newspapers being more often used by non-physicians (63%) vs. physician HCWs (70%). CONCLUSION Non-physician HCWs more often consulted public information sources. Employers/institutions should ensure the supply of professional, targeted COVID-19 information for different HCW groups.
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Affiliation(s)
- Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM Medical Education Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - David Stadler
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080 Wuerzburg, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080 Wuerzburg, Germany
| | - Falk Fichtner
- Faculty of Medicine, Clinic and Polyclinic for Anesthesiology and Intensive Care, University of Leipzig, 04103 Leipzig, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Matthias Christoph Braunisch
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Tarek Assali
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Louise Platen
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Marjo Wijnen-Meijer
- TUM Medical Education Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Julia Lühnen
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Clinic for Internal Medicine I, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Lisa Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, 81377 Munich, Germany
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Cornelia Fuetterer
- Institute of AI and Informatics in Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Christian Seeber
- Faculty of Medicine, Clinic and Polyclinic for Anesthesiology and Intensive Care, University of Leipzig, 04103 Leipzig, Germany
| | - Christian Schaaf
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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26
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Wolff AW, Haller B, Demleitner AF, Pürner D, Niederschweiberer J, Cordts I, Westenberg E, Lingor P. Long-Lasting Impact of the COVID-19 Pandemic on Patients with Parkinson's Disease and Their Relatives. Mov Disord Clin Pract 2023; 10:819-823. [PMID: 37205245 PMCID: PMC10187008 DOI: 10.1002/mdc3.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/09/2023] [Accepted: 03/03/2023] [Indexed: 05/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has heavily impacted medical care of patients with Parkinson's disease (PwP). Objective To assess the longitudinal impact of the COVID-19 pandemic on PwP and their relatives in Germany. Methods Two online, nationwide, cross-sectional surveys were conducted from December 2020 to March 2021 and from July to September 2021. Results A total of 342 PwP and 113 relatives participated. Despite partial resumption of social and group activities, healthcare was continuously disrupted during times of loosened restrictions. Respondents' willingness to use telehealth infrastructure increased, yet the availability remained low. PwP reported worsened symptoms and further deterioration during the pandemic, resulting in an increase in new symptoms and relatives' burden. We identified patients at particular risk: young patients and those with long disease duration. Conclusions The COVID-19 pandemic persistently disrupts the care and quality of life of PwP. Although willingness to use telemedicine services has increased, its availability needs to be improved.
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Affiliation(s)
- Andreas Wolfgang Wolff
- Department of Neurology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of MunichMunichGermany
| | | | - Dominik Pürner
- Department of Neurology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | | | - Isabell Cordts
- Department of Neurology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Erica Westenberg
- Department of Neurology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Paul Lingor
- Department of Neurology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
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Kauke-Navarro M, Knoedler S, Panayi AC, Knoedler L, Haller B, Parikh N, Huelsboemer L, Stoegner VA, Kiefer J, Eisenhardt SU, Azzi J, Pomahac B. Correlation between facial vascularized composite allotransplantation rejection and laboratory markers: Insights from a retrospective study of eight patients. J Plast Reconstr Aesthet Surg 2023; 83:155-164. [PMID: 37276734 DOI: 10.1016/j.bjps.2023.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The field of facial vascularized composite allotransplantation (fVCA) is still new and a limited number of patients have undergone the procedure. This has led to a lack of understanding about the impact of fVCA rejection on standard laboratory markers (e.g., CBC, BMP, CRP) for the acute management of these patients. It is not clear if rejection elicits a systemic inflammatory response that influences common inflammatory markers such as WBC and CRP. A comprehensive understanding of changes in these markers could help in the management of fVCA patients in the acute setting. METHODS The medical records of 8 fVCA patients with a total of 9 transplants were reviewed retrospectively, and data on standard laboratory values (CBC, BMP, LFTs, CRP) and vital signs were extracted. To examine the relationship between laboratory values and rejection status, linear mixed models were used to analyze the data, taking into account their longitudinal nature (repeated measures). RESULTS A statistically significant relationship was found between the Banff grade of rejection and the relative number of basophils in the patient's blood during rejection (p = 0.005). In addition, in patients with clinical signs of rejection (e.g., facial erythema, edema) and skin biopsy showing Banff ≥ II, CRP was found to be significantly elevated (p = 0.03). The WBC count remained stable during rejection, and the relative number of neutrophils was lower at the time of rejection, indicating possible consumption at the site of rejection. CONCLUSION During fVCA rejection, most standard laboratory parameters and vital signs appear to be stable. However, the levels of CRP and basophils were elevated during rejection, while the neutrophil count was lower. Leukocytosis can likely be used as a marker of microbial infection in fVCA patients, as WBC does not seem to increase at the time of allograft rejection.
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Affiliation(s)
- Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Neil Parikh
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lioba Huelsboemer
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Viola Antonia Stoegner
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Jurij Kiefer
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Jamil Azzi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital, Boston, MA, USA
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
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Hausinger RI, Bachmann Q, Crone-Rawe T, Hannane N, Monsef I, Haller B, Heemann U, Skoetz N, Kreuzberger N, Schmaderer C. Effectiveness, Immunogenicity and Harms of Additional SARS-CoV-2 Vaccine Doses in Kidney Transplant Recipients: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11040863. [PMID: 37112775 PMCID: PMC10141039 DOI: 10.3390/vaccines11040863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Kidney transplant recipients (KTRs) who have a highly impaired immune response are in need of intensified and safe vaccination strategies to achieve seroconversion and prevent severe disease. METHODS We searched the Web of Science Core Collection, the Cochrane COVID-19 Study Register and the WHO COVID-19 global literature on coronavirus disease from January 2020 to 22 July 2022 for prospective studies that assessed immunogenicity and efficacy after three or more SARS-CoV-2 vaccine doses. RESULTS In 37 studies on 3429 patients, de novo seroconversion after three and four vaccine doses ranged from 32 to 60% and 25 to 37%. Variant-specific neutralization was 59 to 70% for Delta and 12 to 52% for Omicron. Severe disease after infection was rarely reported but all concerned KTRs lacked immune responses after vaccination. Studies investigating the clinical course of COVID-19 found remarkably higher rates of severe disease than in the general population. Serious adverse events and acute graft rejections were very rare. Substantial heterogeneity between the studies limited their comparability and summary. CONCLUSION Additional SARS-CoV-2 vaccine doses are potent and safe in general terms as well as regarding transplant-specific outcomes whilst the Omicron wave remains a significant threat to KTRs without adequate immune responses.
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Affiliation(s)
- Renate Ilona Hausinger
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Quirin Bachmann
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Timotius Crone-Rawe
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nora Hannane
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Ina Monsef
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Bernhard Haller
- Institute for AI and Informatics in Medicine, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum Rechts der Isar, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
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Suren C, Lazic I, Haller B, Pohlig F, von Eisenhart-Rothe R, Prodinger P. The synovial fluid calprotectin lateral flow test for the diagnosis of chronic prosthetic joint infection in failed primary and revision total hip and knee arthroplasty. Int Orthop 2023; 47:929-944. [PMID: 36656361 PMCID: PMC10014771 DOI: 10.1007/s00264-023-05691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The diagnostic criteria of prosthetic joint infection (PJI) recommended by the most commonly used diagnostic algorithms can be obscured or distorted by other inflammatory processes or aseptic pathology. Furthermore, the most reliable diagnostic criteria are garnered during revision surgery. A robust, reliable addition to the preoperative diagnostic cascade is warranted. Calprotectin has been shown to be an excellent diagnostic marker for PJI. In this study, we aimed to evaluate a lateral flow test (LFT) in the challenging patient cohort of a national referral centre for revision arthroplasty. METHODS Beginning in March 2019, we prospectively included patients scheduled for arthroplasty exchange of a total hip (THA) or knee arthroplasty (TKA). Synovial fluid samples were collected intra-operatively. We used the International Consensus Meeting of 2018 (ICM) score as the gold standard. We then compared the pre-operative ICM score with the LFT result to calculate its diagnostic accuracy as a standalone pre-operative marker and in combination with the ICM score as part of an expanded diagnostic workup. RESULTS A total of 137 patients with a mean age of 67 (± 13) years with 53 THA and 84 TKA were included. Ninety-nine patients (72.8%) were not infected, 34 (25.0) were infected, and four (2.9%) had an inconclusive final score and could not be classified after surgery. The calprotectin LFT had a sensitivity (95% confidence interval) of 0.94 (0.80-0.99) and a specificity of 0.87 (0.79-0.93). The area under the receiver operating characteristic curve (AUC) for the calprotectin LFT was 0.94 (0.89-0.99). In nine cases with an inconclusive pre-operative ICM score, the calprotectin LFT would have led to the correct diagnosis of PJI. CONCLUSIONS The synovial fluid calprotectin LFT shows excellent diagnostic metrics both as a rule-in and a rule-out test, even in a challenging patient cohort with cases of severe osteolysis, wear disease, numerous preceding surgeries, and poor soft tissue conditions, which can impair the common diagnostic criteria. As it is available pre-operatively, this test might prove to be a very useful addition to the diagnostic algorithm.
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Affiliation(s)
- Christian Suren
- Center for Orthopedics, Trauma Surgery and Sports Medicine, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
| | - Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- Artificial Intelligence and Informatics in Medicine (AIIM), Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Peter Prodinger
- Department of Trauma Surgery and Orthopedics, Norbert-Kerkel-Platz, Krankenhaus Agatharied, Hausham, Germany
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Lobmaier SM, Graupner O, Ortiz JU, Haller B, Ried C, Wildner N, Abel K, Kuschel B, Rieger-Fackeldey E, Oberhoffer R, Wacker-Gussmann A. Perinatal Outcome and its Prediction Using Longitudinal Feto-Maternal Doppler Follow-Up in Late Onset Small for Gestational Age Fetuses - A Prospective Cohort Study. Ultraschall Med 2023; 44:e108-e117. [PMID: 34102686 DOI: 10.1055/a-1493-2367] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements. METHODS Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included. The whole SGA group was divided into the FGR subgroup or SGA percentile 3-10 subgroup. The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI. APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit. Induction of labor was indicated according to a stage-based protocol. RESULTS A total of 149 SGA and 143 control fetuses were included. The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %). Most SGA cases ended up in induction of labor (61 % vs. 31 %, p < 0.001). The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60. The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63). CONCLUSION SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol. Prediction of APO is best for SGA and FGR using the "worst" CPR or mUtA PI but it remains moderate.
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Affiliation(s)
- Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Oliver Graupner
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Bernhard Haller
- University Hospital rechts der Isar, Technical University of Munich, Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), Munich, Germany
| | - Christina Ried
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Nadia Wildner
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Kathrin Abel
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Eshter Rieger-Fackeldey
- Department Neonatology, Technical University of Munich Hospital rechts der Isar, München, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, München, Germany
- Preventive and Rehabilitative Sports Medicine, Technical University of Munich, München, Germany
| | - Annette Wacker-Gussmann
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, München, Germany
- Preventive and Rehabilitative Sports Medicine, Technical University of Munich, München, Germany
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31
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Schuster H, Haller B, Sancak S, Erber J, Schmid RM, Lahmer T, Rasch S. Transpulmonary thermodilution: A revised correction formula for global end-diastolic volume index derived after femoral indicator injection. Math Biosci Eng 2023; 20:9876-9890. [PMID: 37322915 DOI: 10.3934/mbe.2023433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Transpulmonary thermodilution (TPTD) is usually performed by jugular indicator injection. In clinical practice, femoral venous access is often used instead, resulting in substantial overestimation of global end-diastolic volume index (GEDVI). A correction formula compensates for that. The objective of this study is to first evaluate the efficacy of the currently implemented correction function and then further improve this formula. METHODS The performance of the established correction formula was investigated in our prospectively collected dataset of 98 TPTD measurements from 38 patients with both, jugular and femoral venous access. Subsequently, a new correction formula was developed: cross validation revealed the favourite covariate combination and a general estimating equation provided the final version, which was tested in a retrospective validation on an external dataset. RESULTS Investigating the current correction function revealed a considerable reduction of bias compared to no correction. Concerning the objective of formula development, the covariate combination of GEDVI obtained after femoral indicator injection, age and body surface area is even favoured, when compared to the parameters of the previously published correction formula, as a further reduction of mean absolute error (68 vs. 61 ml/m2), a better correlation (0.90 vs. 0.91) and an increased adjusted R2 (0.72 vs 0.78) is noticed in the cross validation results. Of particular clinical importance is, that more measurements were correctly assigned to the same GEDVI category (decreased / normal / increased) using the revised formula, compared with the gold standard of jugular indicator injection (72.4 vs. 74.5%). In a retrospective validation, the newly developed formula showed a greater reduction of bias (to 2 vs. 6 %) than the currently implemented formula. CONCLUSIONS The currently implemented correction function partly compensates for GEDVI overestimation. Applying the new correction formula on GEDVI measured after femoral indicator administration enhances the informative value and reliability of this preload parameter.
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Affiliation(s)
- Hannah Schuster
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sengül Sancak
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine Ⅱ, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Karimzadeh A, Heck M, Tauber R, Knorr K, Haller B, D'Alessandria C, Weber WA, Eiber M, Rauscher I. 177Lu-PSMA-I&T for Treatment of Metastatic Castration-Resistant Prostate Cancer: Prognostic Value of Scintigraphic and Clinical Biomarkers. J Nucl Med 2023; 64:402-409. [PMID: 36137758 DOI: 10.2967/jnumed.122.264402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective analysis was to determine prostate-specific antigen (PSA) response, PSA progression-free survival (PFS), and overall survival (OS) in a large cohort of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with 177Lu-PSMA-I&T and to identify clinical and scintigraphic prognostic factors for outcome. Methods: In total, 301 consecutive mCRPC patients were included in this analysis. Prognostic factors included clinical parameters, routine laboratory parameters, and findings on posttreatment scintigraphy. Scintigraphic tumor uptake of 177Lu-PSMA-I&T was compared with salivary gland uptake and classified as high or low. The longest extent of skeletal metastatic disease was measured, and its changes during therapy were used to define scintigraphic progression, response, and stable disease. A PSA response of at least 50%, PSA PFS, and OS were calculated. Results: In total, 1,138 cycles (median, 3 cycles per patient) of 177Lu-PSMA-I&T using a standard activity of 7.4 GBq were applied intravenously every 4-10 wk (median, 6 wk). Overall, 34% (95% CI, 28%-38%) of patients showed a PSA response of at least 50%, and the median PSA PFS and OS of the total patient cohort were 16.0 wk (95% CI, 12.1-19.9) and 13.8 mo (95% CI, 12.4-15.5), respectively. Patients with high scintigraphic tumor uptake showed a higher PSA response rate of at least 50% (45.7% vs. 10.4%; P < 0.0001) and a significantly reduced risk of PSA progression (median event time, 24.9 vs. 9.0 wk; hazard ratio, 0.3; 95% CI, 0.2-0.5; P < 0.0001). In our data, risk of death was not significantly different between patients with high scintigraphic uptake and those with low scintigraphic uptake (median, 14.4 vs. 12.4 mo; hazard ratio, 0.9; 95% CI, 0.6-1.3; P = 0.6). In a multivariable analysis, the following pretherapeutic prognostic factors for OS were identified: alkaline phosphatase, lactate dehydrogenase, and PSA levels; prior chemotherapy; and the presence of visceral metastases. Scintigraphic response was a strong prognostic factor for PSA response, PSA PFS, and OS after 1 treatment cycle. Conclusion: This retrospective analysis of a large group of consecutive patients corroborates previous clinical experience for 177Lu-PSMA-I&T in mCRPC and establishes previously proposed prognostic factors. The skeletal tumor extent and its changes were identified as new potential biomarkers to predict the outcome of therapy after the first treatment cycle.
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Affiliation(s)
- Amir Karimzadeh
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany; .,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Heck
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Robert Tauber
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Karina Knorr
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Calogero D'Alessandria
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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Schoenfeld J, Roeh A, Holdenrieder S, von Korn P, Haller B, Krueger K, Falkai P, Halle M, Hasan A, Scherr J. High-mobility group box 1 protein, receptor for advanced glycation end products and nucleosomes increases after marathon. Front Physiol 2023; 14:1118127. [PMID: 36866178 PMCID: PMC9971726 DOI: 10.3389/fphys.2023.1118127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Background: Prolonged and strenuous exercise has been linked to potential exercise-induced myocardial damages. One potential key to unmask the discussed underlying mechanisms of this subclinical cardiac damage could be markers of immunogenic cell damage (ICD). We investigated the kinetics of high-mobility group box 1 protein (HMGB1), soluble receptor for advanced glycation end products (sRAGE), nucleosomes, high sensitive troponin T (hs-TnT) and high sensitive C-reactive protein (hs-CRP) before and up to 12 weeks post-race and described associations with routine laboratory markers and physiological covariates. Methods: In our prospective longitudinal study, 51 adults (82% males; 43 ± 9 years) were included. All participants underwent a cardiopulmonary evaluation 10-12 weeks pre-race. HMGB1, sRAGE, nucleosomes, hs-TnT and, hs-CRP were analysed 10-12 weeks prior, 1-2 weeks before, immediately, 24 h, 72 h, and 12 weeks post-race. Results: HMGB1, sRAGE, nucleosomes and hs-TnT increased significantly from pre- to immediately post-race (0.82-2.79 ng/mL; 1132-1388 pg/mL; 9.24-56.65 ng/mL; 6-27 ng/L; p < 0.001) and returned to baseline within 24-72 h. Hs-CRP increased significantly 24 h post-race (0.88-11.5 mg/L; p < 0.001). Change in sRAGE was positively associated with change in hs-TnT (rs = 0.352, p = 0.011). Longer marathon finishing time was significantly associated with decreased levels of sRAGE [-9.2 pg/mL (β = -9.2, SE = 2.2, p < 0.001)]. Conclusion: Prolonged and strenuous exercise increases markers of ICD immediately post-race, followed by a decrease within 72 h. An acute marathon event results in transient alterations of ICD, we assume that this is not solely driven by myocyte damages.
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Affiliation(s)
- Julia Schoenfeld
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Pia von Korn
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kimberly Krueger
- Institute of Laboratory Medicine, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Johannes Scherr
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,*Correspondence: Johannes Scherr,
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Heitkamp M, Spanier B, von Korn P, Knapp S, Groß C, Haller B, Halle M. Feasibility of a 12-Month Exercise Intervention in Postsurgical Colorectal Cancer Patients. Transl Sports Med 2023; 2023:4488334. [PMID: 38654917 PMCID: PMC11022773 DOI: 10.1155/2023/4488334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/19/2022] [Accepted: 12/25/2022] [Indexed: 04/26/2024]
Abstract
Background Extensive physical activity (PA; ≥18 MET∗h/week, MET metabolic equivalent of tasks hours) postcancer diagnosis has shown favorable effects on colorectal cancer disease-free survival. However, the feasibility of introducing this high volume of PA in this patient group is unclear. Therefore, the aim of the F-PROTECT study was to evaluate the feasibility of extensive and prolonged PA (≥18 MET∗h/week over 12 months) in colorectal cancer patients with the primary objectives to (1) recruit 50 patients within 12 months and (2) reach an attendance rate of ≥70%. Methods Single-armed, bicentric, prospective intervention study in colorectal cancer patients (≤80 years; UICC II/III Union for International Cancer Control) after histopathological confirmed R0-resection who were consecutively recruited from visceral surgery units of 10 clinics in Germany. Recruitment rates were calculated using screening logs. Intervention was a 12-month endurance-focused exercise program with supervised and home-based training. Attendance rates defined as ≥70% participation in training sessions were calculated by training diaries. Results Out of 521 patients who were screened for eligibility, 50 (23 female; 59 ± 10 years, UICC 44% II, 56% III; adjuvant chemotherapy 60%) were recruited within 15 months. Mean duration between surgery and first training was 103 ± 57 days. Training attendance rate was 64% (including 9 dropouts). Six (12%) participants reached ≥18 MET∗h/week in ≥70% of training sessions between 4-12 months. 28 adverse events (n = 9 serious) occurred, however, were not assessed as training related. Conclusions The present intervention involving a combination of supervised and home-based exercise training in postsurgical colorectal cancer patients was not feasible. Strategies specifically designed for this patient group must be developed and investigated to motivate long-term PA. Registration. The study was prospectively registered at clinicaltrials.gov (NCT01991847).
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Affiliation(s)
- Melanie Heitkamp
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
| | - Bianca Spanier
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
| | - Pia von Korn
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
| | - Sebastian Knapp
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
| | - Claudia Groß
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital “Klinikum Rechts der Isar”, Technical University of Munich (TUM), Munich, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung, DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Hapfelmeier A, Hornung R, Haller B. Efficient permutation testing of variable importance measures by the example of random forests. Comput Stat Data Anal 2023. [DOI: 10.1016/j.csda.2022.107689] [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: 01/08/2023]
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36
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Günthner R, Streese L, Angermann S, Lorenz G, Braunisch MC, Matschkal J, Hausinger R, Stadler D, Haller B, Heemann U, Kotliar K, Hanssen H, Schmaderer C. Mortality prediction of retinal vessel diameters and function in a long-term follow-up of haemodialysis patients. Cardiovasc Res 2022; 118:3239-3249. [PMID: 35576475 DOI: 10.1093/cvr/cvac073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 01/25/2023] Open
Abstract
AIM Retinal vessel diameters are candidate biomarkers of mortality prediction in large population-based studies. We aimed to investigate the predictive value of retinal vessel diameters and flicker-induced retinal arteriolar and venular dilation on all-cause mortality in long-term follow-up of haemodialysis patients. METHODS AND RESULTS Retinal vessel diameters as well as maximum arteriolar (aMax) and venular dilation (vMax) were investigated in 275 and 214 haemodialysis patients, respectively. Patients were observed in a long-term follow-up for a median period of 73 months. About 36% (76/214) and 41% (113/275) of patients died. Arteriolar and venular diameters were 175 ± 19 and 208 ± 20 µm, respectively. Median aMax and vMax were 1.6 (0.3-3.3) and 3.2 (2.0-5.1)%. Patients within the lowest tertile of vMax showed lower 5-year survival rates compared with the highest tertile (50.6 vs. 82.1%) and also exhibited a higher incidence of infection-related deaths (21.7 vs. 4.0%). Univariate hazard ratio (HR) per standard deviation increase of vMax for all-cause mortality was 0.69 (0.54-0.88) and was even more pronounced for infection-related mortality [HR 0.53 (0.33-0.83)]. Regarding all-cause mortality, multivariate adjustment for eight non-retinal mortality predictors including interleukin-6 did not attenuate the HR relevantly [0.73 (0.54-0.98)]. Arteriolar and venular diameters did not predict all-cause nor cardiovascular and infection-related mortality. CONCLUSIONS Long-term follow-up of patients on haemodialysis demonstrated the potential of retinal venular dilation capacity for mortality prediction, which was most pronounced for infection-related mortality. In the same cohort, retinal arteriolar and venular diameters showed no predictive value for hard endpoints. Retinal venular dilation but not arteriolar and venular diameters is a valuable diagnostic biomarker for risk prediction in patients with end-stage renal disease and should be considered for monitoring of critically ill patients.
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Affiliation(s)
- Roman Günthner
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas Streese
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Susanne Angermann
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias C Braunisch
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Julia Matschkal
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Renate Hausinger
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - David Stadler
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bernhard Haller
- Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Jülich, Germany
| | - Henner Hanssen
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Rinecker J, Roesch R, Krippgans S, Nieberler M, Stark L, Stangl S, Haller B, Fritsche K, Multhoff G, Knopf A, Winter C, Wollenberg B, Wirth M. Comparing TIMP-1 and Hsp70 in Blood and Saliva as Potential Prognostic Markers in HNSCC. Biomedicines 2022; 10:biomedicines10123225. [PMID: 36551979 PMCID: PMC9775946 DOI: 10.3390/biomedicines10123225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Currently, there is no clinically used liquid biomarker in head and neck squamous cell carcinoma (HNSCC) patients. One reason could be the limited shedding of tumor material in early disease stages. Molecular diagnostics assessing both blood and especially saliva could potentially improve the accuracy of biomarkers. In this prospective study, two markers, tissue inhibitor of metalloprotease-1 (TIMP-1) and heat shock protein 70 (Hsp70), were analyzed in HNSCC patients. The purpose of the study was to evaluate differences between saliva and serum as sample material. Further, their prognostic and predictive value and usefulness for early detection was assessed. (2) Methods: A total of 73 HNSCC patients were prospectively monitored by collecting blood and saliva before, during, and after therapy, as well as in the follow-up period between 2018 and 2021. In total, 212 serum and 194 saliva samples were collected. A control group consisting of 40 subjects (15 patients with local infections in the head and neck area and 25 without infections) were examined as well. The collected samples were evaluated for the two proteins by using an enzyme-linked immunosorbent assay (ELISA). (3) RESULTS: The TIMP-1 concentration correlated significantly in blood and saliva, whereas the Hsp70 concentration did not. Saliva TIMP-1 was significantly higher in tumor patients compared to the control group (p = 0.013). High pretreatment TIMP-1 saliva levels were associated with significantly poorer disease-free survival (DFS) (p = 0.02). A high saliva TIMP-1/Hsp70 ratio was significantly associated with poorer DFS (HR: 1.4; 95% CI: 1.04-1.88; p = 0.026) and a high TIMP-1 serum concentration was significantly associated with poorer PFS (HR: 1.9; 95% CI: 1.2, 2.8; p = 0.003) and poorer overall survival (OS) (HR: 2.9; 95% CI: 1.4, 5.9; p = 0.003) in the Cox proportional hazards model. The saliva TIMP-1 to Hsp70 ratio was significantly higher at the time of recurrence (p = 0.015). Conclusion: TIMP-1 in serum is a promising prognostic marker for HNSCC. Saliva TIMP-1 and the saliva TIMP-1 to Hsp70 ratio provides additional information on the disease-free survival.
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Affiliation(s)
- Jakob Rinecker
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical, School of Medicine, University of Munich, 81675 Munich, Germany
| | - Romina Roesch
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Sara Krippgans
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Leonhard Stark
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical, School of Medicine, University of Munich, 81675 Munich, Germany
| | - Stefan Stangl
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Kristin Fritsche
- Department of Vascular and Endovascular Surgery, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Andreas Knopf
- Department of Otolaryngology Head and Neck Surgery, Albert—Ludwigs-University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical, School of Medicine, University of Munich, 81675 Munich, Germany
| | - Markus Wirth
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical, School of Medicine, University of Munich, 81675 Munich, Germany
- Correspondence:
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Kroenke M, Schweiger L, Horn T, Haller B, Schwamborn K, Wurzer A, Maurer T, Wester HJ, Eiber M, Rauscher I. Validation of 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET Imaging Results with Histopathology from Salvage Surgery in Patients with Biochemical Recurrence of Prostate Cancer. J Nucl Med 2022; 63:1809-1814. [PMID: 35393348 PMCID: PMC9730917 DOI: 10.2967/jnumed.121.263707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/28/2022] [Indexed: 01/11/2023] Open
Abstract
18F-rhPSMA-7, and its single diastereoisomer form, 18F-rhPSMA-7.3, are prostate-specific membrane antigen (PSMA)-targeting radiopharmaceuticals. Here, we investigated their accuracy for the assessment of lymph node (LN) metastases validated by histopathology. Methods: Data from 58 patients with biochemical recurrence of prostate cancer after radical prostatectomy receiving salvage surgery after PET imaging with 18F-rhPSMA-7 or 18F-rhPSMA-7.3 were retrospectively reviewed. Two nuclear medicine physicians reviewed all PET scans and morphologic imaging in consensus. Readers were masked from the results of histopathology. PET and morphologic imaging were correlated with histopathology from resected LNs. Results: In 75 of 150 resected regions in 54 of 58 patients, tumor lesions were present in histopathology. The template-based specificity of PET (18F-rhPSMA-7 and 18F-rhPSMA-7.3 combined) and morphologic imaging was 93.3% and 100%, respectively. However, 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET detected metastases in 61 of 75 histopathologically proven metastatic LN fields (81.3%) whereas morphologic imaging was positive in only 9 of 75 (12.0%). The positive predictive value was 92.4% for 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET and 100% for morphologic imaging. 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET performance was significantly superior to morphologic imaging (difference in the areas under the receiver-operating-characteristic curves, 0.222; 95% CI, 0.147-0.298; P < 0.001). The mean size of PET-positive and histologically confirmed LN metastases was 6.3 ± 3.1 mm (range, 2-15 mm) compared with a mean size of 9.8 ± 2.5 mm (range, 7-15 mm) on morphologic imaging. Conclusion: 18F-rhPSMA-7 and 18F-rhPSMA-7.3 PET offer a high positive predictive value comparable to that reported for 68Ga-PSMA-11 and represent a valuable tool for guiding salvage lymphadenectomy.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Department of Radiology and Nuclear Medicine, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Lilit Schweiger
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kristina Schwamborn
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Wurzer
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Jürgen Wester
- Chair of Radiopharmacy, School of Medicine, Technical University of Munich, Munich, Germany; and
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany;,Bavarian Cancer Research Center (BZKF), Munich, Germany
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39
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Mueller S, Cervenka M, Winzer EB, Gevaert AB, Fegers-Wustrow I, Haller B, Edelmann F, Christle JW, Haykowsky MJ, Linke A, Adams V, Pieske B, Van Craenenbroeck E, Halle M. Associations between training characteristics and change in peak oxygen consumption following exercise training in patients with heart failure with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2476] [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
Introduction
In heart failure with preserved ejection fraction (HFpEF), moderate continuous training (MCT) and high-intensity interval training (HIIT) are both effective in increasing peak oxygen uptake (peak V̇O2).
Purpose
The aim of this study was to investigate the association of training characteristics (i.e. average sessions/week, average duration/week, mean intensity) and change in peak V̇O2 following 3 months of MCT and HIIT in patients with HFpEF.
Methods
Among 120 patients who were randomized to MCT (5x40 min/week at 35–50% heart rate reserve [HRR]) or HIIT (3x38 min/week at 80–90% HRR), those who completed 3-month follow-up (N=107) were considered for this analysis. Training duration and heart rates [HR] were recorded with a smartphone application, evaluated with a customized software and manually checked for plausibility. If HR measurements were classified as invalid/unreliable (e.g. very strong fluctuations), patients were excluded from analysis. Intensities were calculated as average % HRR of total sessions in MCT and the average of the highest % HRR values of all intervals in HIIT. Associations between training characteristics and change in peak V̇O2 were evaluated using univariate and multivariate regression analyses. Individual HR-V̇O2 relationships were used to calculate and compare energy expenditure (MET-minutes) in MCT and HIIT.
Results
After excluding 16 patients due to invalid/unreliable HR data, 91 patients (67% female, 69±7 years) were included in this analysis. On average, MCT patients (N=45) performed 4.0±1.2 sessions/week (162±52 min/week) at 47.4±6.7% HRR, while HIIT patients (N=46) performed 2.4±0.8 sessions/week (96±40 min/week) at 81.8±11.8% HRR. Peak V̇O2 was improved by 1.70±2.35 ml/kg/min in MCT and 1.46±2.98 ml/kg/min in HIIT (difference: 0.24 [95% CI, −0.87 to 1.34], p=0.67). The associations between training characteristics and change in peak V̇O2 are shown in Fig.1. Mean % HRR was not significantly associated with the change in peak V̇O2 in the HIIT group, whereas in MCT, mean duration/week and mean intensity were of similar relative importance (standardized coefficients) and explained up to 26% of the variation in change in peak V̇O2 (Table 1). Average weekly MET-minutes above rest were 451±260 for MCT and 389±375 for HIIT (difference: 62 [95% CI, −71 to 195], p=0.36). After adjustment for MET-minutes, the difference in change in peak V̇O2 between groups diminished to 0.09 ml/kg/min (95% CI, −0.97 to 1.16; p=0.98).
Conclusions
Weekly duration and mean % HRR had a similar predictive ability for the change in peak V̇O2 following MCT with, interestingly, lower change in peak V̇O2 with increasing intensity. In HIIT, mean % HRR was not significantly associated with the change in peak V̇O2. After adjusting for energy expenditure, the difference in change in peak V̇O2 between training modes diminished, suggesting that MCT and HIIT were similarly effective.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission, Framework Program 7
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Affiliation(s)
- S Mueller
- University Hospital Klinikum rechts der Isar, Technical University of Munich, Department of Prevention and Sports Medicine , Munich , Germany
| | - M Cervenka
- University Hospital Klinikum rechts der Isar, Technical University of Munich, Department of Prevention and Sports Medicine , Munich , Germany
| | - E B Winzer
- Heart Centre Dresden - Dresden Technical University Hospital, Department of Internal Medicine and Cardiology , Dresden , Germany
| | - A B Gevaert
- Antwerp University Hospital, Department of Cardiology , Edegem , Belgium
| | - I Fegers-Wustrow
- University Hospital Klinikum rechts der Isar, Technical University of Munich, Department of Prevention and Sports Medicine , Munich , Germany
| | - B Haller
- Technical University of Munich, Institute of Medical Informatics, Statistics and Epidemiology , Munich , Germany
| | - F Edelmann
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology , Berlin , Germany
| | - J W Christle
- Stanford University, Department of Medicine, Division of Cardiovascular Medicine , Stanford , United States of America
| | - M J Haykowsky
- University of Alberta, Faculty of Nursing , Edmonton , Canada
| | - A Linke
- Heart Centre Dresden - Dresden Technical University Hospital, Department of Internal Medicine and Cardiology , Dresden , Germany
| | - V Adams
- Heart Centre Dresden - Dresden Technical University Hospital, Department of Internal Medicine and Cardiology , Dresden , Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology , Berlin , Germany
| | | | - M Halle
- University Hospital Klinikum rechts der Isar, Technical University of Munich, Department of Prevention and Sports Medicine , Munich , Germany
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Bock M, Von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F, Lechner K. Trans fatty acid blood levels and HFpEF phenotype: from the Aldo-DHF RCT. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prognosis in HFpEF is determined by risk factor control and treatment of comorbidities. Industrially processed TFA (IP-TFA) from partially hydrogenated oils have been linked to altered lipoprotein metabolism, endothelial dysfunction, increased biomarkers of inflammation and increased NTproBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
Purpose
To evaluate associations of blood TFA with cardiovascular risk factors, aerobic capacity and cardiac function in patients with HFpEF.
Methods
This is a secondary analysis from the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e' 7.1±1.5; median NT-proBNP 158 ng/L (IQR 82–298). Multiple linear regression analyses, using sex and age as covariates, were used to describe associations of TFA with metabolic phenotype, functional capacity, echocardiographic markers for left ventricular diastolic function (LVDF), and neurohumoral activation at baseline and after 12-months-follow-up (12mFU). To account for randomization group, all analyses were repeated as sensitivity analysis with group as covariate. A significance level of α=5% was used for all tests. As all tests were hypothesis generating without confirmatory interpretation, no correction was applied to counteract the problem of multiple comparisons.
Results
Higher blood levels of the naturally occurring TFA C16:1n-7t were broadly associated with a more favorable lipid profile, lower body weight/central adiposity, lower white blood cell count and lower biochemical markers of non-alcoholic fatty liver disease at baseline/12mFU. Conversely, blood levels of the IP-TFA C18:1n9t were directly associated with lipid risk markers [triglycerides (β=19.7, p<0,001), non-HDL-C (β=7.9, p=0,001), and LDL-C (β=5.4, p=0,011)]. The two IP-TFA C18:2n6 isomers C18:2n6tt and C18:2n6ct were positively associated with HbA1c [(β=14.6, p=0,003) and (β=4.2, p=0,014) respectively]. The IP-TFA C18:2n6tt/-ct isomers were associated with lower submaximal aerobic capacity (distance covered in the 6MWT) at baseline/12mFU. No significant association was found between TFA blood levels and left ventricular filling pressures, left ventricular relaxation or neurohumoral activation. Significant effects of group allocation (spironolactone +/−) were found for the 12mFU outcomes systolic/diastolic blood pressure (all p<0.001), heart rate, E/e$'$ and HbA1c.
Conclusions
In HFpEF patients, higher blood levels of industrially processed TFA, but not of the TFA C16:1n-7t in full fat dairy and meat, were associated with a higher risk phenotype and lower aerobic capacity. Our findings support efforts to remove IP-TFA from the food supply for improving risk factor control in HFpEF patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Foundation of Heart Research
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Affiliation(s)
- M Bock
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - C Von Schacky
- University Hospital of Munich, Omegametrix, Martinsried, Germany , Munich , Germany
| | - J Scherr
- University Hospital Balgrist , Zurich , Switzerland
| | - E Lorenz
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - B Lechner
- Ludwig Maximilians University , Munich , Germany
| | - B Haller
- Technical University of Munich, Institute of AI and Informatics in Medicine , Munich , Germany
| | - A Krannich
- Charité - University Medicine Berlin , Berlin , Germany
| | - M Halle
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - R Wachter
- Leipzig University Hospital, Clinic and Policlinic for Cardiology , Leipzig , Germany
| | - A Duvinage
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - F Edelmann
- Charité - University Medicine Berlin, Department of Cardiology , Berlin , Germany
| | - K Lechner
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
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Lechner K, von Schacky C, Scherr J, Lorenz E, Bock M, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F. Saturated Fatty Acid Blood Levels and Cardiometabolic Phenotype in Patients with HFpEF: A Secondary Analysis of the Aldo-DHF Trial. Biomedicines 2022; 10:biomedicines10092296. [PMID: 36140396 PMCID: PMC9496272 DOI: 10.3390/biomedicines10092296] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Circulating long-chain (LCSFAs) and very long-chain saturated fatty acids (VLSFAs) have been differentially linked to risk of incident heart failure (HF). In patients with heart failure with preserved ejection fraction (HFpEF), associations of blood SFA levels with patient characteristics are unknown. Methods: From the Aldo-DHF-RCT, whole blood SFAs were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were 67 ± 8 years, 53% female, NYHA II/III (87%/13%), ejection fraction ≥50%, E/e’ 7.1 ± 1.5; and median NT-proBNP 158 ng/L (IQR 82–298). Spearman´s correlation coefficients and linear regression analyses, using sex and age as covariates, were used to describe associations of blood SFAs with metabolic phenotype, functional capacity, cardiac function, and neurohumoral activation at baseline and after 12-month follow-up (12 mFU). Results: In line with prior data supporting a potential role of de novo lipogenesis-related LCSFAs in the development of HF, we showed that baseline blood levels of C14:0 and C16:0 were associated with cardiovascular risk factors and/or lower exercise capacity in patients with HFpEF at baseline/12 mFU. Contrarily, the three major circulating VLSFAs, lignoceric acid (C24:0), behenic acid (C22:0), and arachidic acid (C20:0), as well as the LCSFA C18:0, were broadly associated with a lower risk phenotype, particularly a lower risk lipid profile. No associations were found between cardiac function and blood SFAs. Conclusions: Blood SFAs were differentially linked to biomarkers and anthropometric markers indicative of a higher-/lower-risk cardiometabolic phenotype in HFpEF patients. Blood SFA warrant further investigation as prognostic markers in HFpEF. One Sentence Summary: In patients with HFpEF, individual circulating blood SFAs were differentially associated with cardiometabolic phenotype and aerobic capacity.
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Affiliation(s)
- Katharina Lechner
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | | | - Johannes Scherr
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Elke Lorenz
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | - Matthias Bock
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, 80336 Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | | | - Martin Halle
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, 37077 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, 37075 Göttingen, Germany
| | - André Duvinage
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité, Universitätsmedizin Berlin, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: ; Tel.: +49-(0)30-450-553731; Fax: +49-(0)30-450-7-553731
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Lorenzen S, Quante M, Rauscher I, Slotta-Huspenina J, Weichert W, Feith M, Friess H, Combs SE, Weber WA, Haller B, Angele M, Albertsmeier M, Blankenstein C, Kasper S, Schmid RM, Bassermann F, Schwaiger M, Liffers ST, Siveke JT. PET-directed combined modality therapy for gastroesophageal junction cancer: Results of the multicentre prospective MEMORI trial of the German Cancer Consortium (DKTK). Eur J Cancer 2022; 175:99-106. [PMID: 36099671 DOI: 10.1016/j.ejca.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Positron emission tomography (PET) may differentiate responding and non-responding tumours early in the treatment of locally advanced gastroesophageal junction adenocarcinomas. Early PET non-responders (P-NR) after induction CTX might benefit from changing to chemoradiation (CRT). METHODS Patients underwent baseline 18F-FDG PET followed by 1 cycle of CTX. PET was repeated at day 14-21 and responders (P-R), defined as ≥35% decrease in SUVmean from baseline, continued with CTX. P-NR switched to CRT (CROSS). Patients underwent surgery 4-6 weeks post-CTX/CRT. The primary objective was an improvement in R0 resection rates in P-NR above a proportion of 70%. RESULTS In total, 160 patients with resectable gastroesophageal junction adenocarcinomas were prospectively investigated by PET scanning. Eighty-five patients (53%) were excluded. Seventy-five eligible patients were enrolled in the study. Based on PET criteria, 50 (67.6%)/24 (32.4%) were P-R and P-NR, respectively. Resection was performed on 46 responders, including one patient who withdrew the ICF, and 22 non-responders (per-protocol population). R0 resection rates were 95.6% (43/45) for P-R and 86.4% (19/22) for P-NR. No treatment related deaths occurred. With a median follow-up time of 24.5 months, estimated 18 months DFS was 75.4%/64.2% for P-R/P-NR, respectively. The estimated 18 months OS was 95.5% for P-R and 68.2% for P-NR. CONCLUSION The primary endpoint of the study to increase the R0 resection rate in metabolic NR was not met. PET response after induction CTX is prognostic for outcome with a prolonged OS and DFS in PET responders. TRIAL REGISTRATION NCT00002014-000860-16.
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Affiliation(s)
- Sylvie Lorenzen
- Technical University of Munich, Klinikum rechts der Isar, III. Medizinische Klinik und Poliklinik, Munich, Germany
| | - Michael Quante
- Technical University Munich, Klinikum rechts der Isar, II. Medizinische Klinik und Poliklinik, Munich, Germany; Department of Internal Medicine II, University of Freiburg, Germany
| | - Isabel Rauscher
- Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany
| | | | - Wilko Weichert
- Technical University Munich, Institute of Pathology, Munich, Germany
| | - Marcus Feith
- Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany
| | - Helmut Friess
- Technical University Munich, Klinikum rechts der Isar, Surgical Clinic and Policlinic, Munich, Germany
| | - Stefanie E Combs
- Technical University Munich, Klinikum rechts der Isar, Department of Radiation Oncology, Munich, Germany
| | - Wolfgang A Weber
- Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany
| | - Bernhard Haller
- Technical University Munich, Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Munich, Germany
| | - Martin Angele
- Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Markus Albertsmeier
- Ludwig-Maximilians-Universität (LMU) Munich, LMU University Hospital, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | | | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Roland M Schmid
- Technical University Munich, Klinikum rechts der Isar, II. Medizinische Klinik und Poliklinik, Munich, Germany; Department of Internal Medicine II, University of Freiburg, Germany
| | - Florian Bassermann
- Technical University of Munich, Klinikum rechts der Isar, III. Medizinische Klinik und Poliklinik, Munich, Germany
| | - Markus Schwaiger
- Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany
| | - Sven-Thorsten Liffers
- German Cancer Consortium (DKTK), Partner Site Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Jens T Siveke
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany.
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Widmann M, Haller B, Gaidai R, Reinsberger C, Nieß A. Covid-19 In Elite Sports - A Multi-center Cohort Study (CoSmo-s). Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876872.19742.2f] [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: 11/21/2022]
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Schaller N, Krusemark H, Mende E, Weiß M, Spanier B, Zelger O, Bischof J, Haller B, Halle M, Siegrist M. Bestform-F - Best Function of Range of Motion: A Feasibility Study of a Multimodal Exercise Training Program for Older Adults in Retirement Homes. Clin Interv Aging 2022; 17:1069-1080. [PMID: 35846178 PMCID: PMC9286070 DOI: 10.2147/cia.s367858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Mobility is a crucial factor for independence and quality of life in old age. Nevertheless, many old people in retirement homes do not meet the physical activity recommendations. The aim of the Bestform-F – Best Function of Range of Motion feasibility study (bestform-F) was to evaluate the feasibility of implementing a machine-based multimodal exercise training program in older residents in retirement homes. Materials and Methods The participants (n = 77) were recruited from two retirement homes and took part in a six-month multimodal exercise training program (2x/week, 45 minutes) on pneumatic strength training machines, a balance platform and bicycle ergometers. Feasibility criteria were recruitment number ≥ 35 participants within six months, dropout rate < 40% of participants within six months of exercise, and training adherence ≥ 50% of participants taking part in at least 50% of offered training sessions. Additionally, physical performance, fear of falling, cognitive function, and quality of life were assessed at baseline and after six months. Results For the bestform-F study, 77 (85.6 ± 6.6 years; 78% women) out of 215 eligible residents from two senior residences were recruited. The dropout rate over six months was 10% (8/77 participants). The training adherence rate for the finishing participants was 77% (53/69 participants). In addition to the achieved feasibility criteria, significant improvements were recorded in the Chair Stand Test, Six-Minute Walk Test, and fear of falling after six months. Conclusion All feasibility criteria have been fulfilled. The high number of recruited participants, the low dropout rate, and high adherence to the training program confirm the feasibility of a multimodal machine-based exercise training program offered to residents in retirement homes. The results provide a basis for a cluster-randomized controlled trial aimed at further investigating the efficacy of the bestform-F program.
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Affiliation(s)
- Nina Schaller
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Helge Krusemark
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Esther Mende
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Michael Weiß
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Bianca Spanier
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Otto Zelger
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Jan Bischof
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
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45
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Mueller S, Haller B, Feuerstein A, Winzer EB, Beckers P, Haykowsky MJ, Gevaert AB, Hommel J, Azevedo LF, Duvinage A, Esefeld K, Fegers-Wustrow I, Christle JW, Pieske-Kraigher E, Belyavskiy E, Morris DA, Kropf M, Aravind-Kumar R, Edelmann F, Linke A, Adams V, Van Craenenbroeck EM, Pieske B, Halle M. Peak O 2 -pulse predicts exercise training-induced changes in peak V̇O 2 in heart failure with preserved ejection fraction. ESC Heart Fail 2022; 9:3393-3406. [PMID: 35840541 DOI: 10.1002/ehf2.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Exercise training (ET) has been consistently shown to increase peak oxygen consumption (V̇O2 ) in patients with heart failure with preserved ejection fraction (HFpEF); however, inter-individual responses vary significantly. Because it is unlikely that ET-induced improvements in peak V̇O2 are significantly mediated by an increase in peak heart rate (HR), we aimed to investigate whether baseline peak O2 -pulse (V̇O2 × HR-1 , reflecting the product of stroke volume and arteriovenous oxygen difference), not baseline peak V̇O2 , is inversely associated with the change in peak V̇O2 (adjusted by body weight) following ET versus guideline control (CON) in patients with HFpEF. METHODS AND RESULTS This was a secondary analysis of the OptimEx-Clin (Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure, NCT02078947) trial, including all 158 patients with complete baseline and 3 month cardiopulmonary exercise testing measurements (106 ET, 52 CON). Change in peak V̇O2 (%) was analysed as a function of baseline peak V̇O2 and its determinants (absolute peak V̇O2 , peak O2 -pulse, peak HR, weight, haemoglobin) using robust linear regression analyses. Mediating effects on change in peak V̇O2 through changes in peak O2 -pulse, peak HR and weight were analysed by a causal mediation analysis with multiple correlated mediators. Change in submaximal exercise tolerance (V̇O2 at the ventilatory threshold, VT1) was analysed as a secondary endpoint. Among 158 patients with HFpEF (66% female; mean age, 70 ± 8 years), changes in peak O2 -pulse explained approximately 72% of the difference in changes in peak V̇O2 between ET and CON [10.0% (95% CI, 4.1 to 15.9), P = 0.001]. There was a significant interaction between the groups for the influence of baseline peak O2 -pulse on change in peak V̇O2 (interaction P = 0.04). In the ET group, every 1 mL/beat higher baseline peak O2 -pulse was associated with a decreased mean change in peak V̇O2 of -1.45% (95% CI, -2.30 to -0.60, P = 0.001) compared with a mean change of -0.08% (95% CI, -1.11 to 0.96, P = 0.88) following CON. None of the other factors showed significant interactions with study groups for the change in peak V̇O2 (P > 0.05). Change in V̇O2 at VT1 was not associated with any of the investigated factors (P > 0.05). CONCLUSIONS In patients with HFpEF, the easily measurable peak O2 -pulse seems to be a good indicator of the potential for improving peak V̇O2 through exercise training. While changes in submaximal exercise tolerance were independent of baseline peak O2 -pulse, patients with high O2 -pulse may need to use additional therapies to significantly increase peak V̇O2 .
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Affiliation(s)
- Stephan Mueller
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Anna Feuerstein
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ephraim B Winzer
- Heart Centre Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Paul Beckers
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Jennifer Hommel
- Heart Centre Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Luciene F Azevedo
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Heart Institute (InCor), Clinical Hospital, Medical School of University of São Paulo, São Paulo, Brazil
| | - André Duvinage
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Katrin Esefeld
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Isabel Fegers-Wustrow
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jeffrey W Christle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martin Kropf
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Radhakrishnan Aravind-Kumar
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Axel Linke
- Heart Centre Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Volker Adams
- Heart Centre Dresden - University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Burkert Pieske
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Karge A, Lobmaier SM, Haller B, Kuschel B, Ortiz JU. Value of Cerebroplacental Ratio and Uterine Artery Doppler as Predictors of Adverse Perinatal Outcome in Very Small for Gestational Age at Term Fetuses. J Clin Med 2022; 11:jcm11133852. [PMID: 35807137 PMCID: PMC9267630 DOI: 10.3390/jcm11133852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the association between cerebroplacental ratio (CPR), mean uterine artery (mUtA) Doppler and adverse perinatal outcome (APO) and their predictive performance in fetuses with birth weight (BW) <3rd centile (very small for gestational age, VSGA) in comparison with fetuses with BW 3rd−10th centile (small for gestational age, SGA). This was a retrospective cohort study including singleton pregnancies delivered at term (37 + 0−41 + 6) in a single tertiary referral center over a six-year period. APO was defined as a composite of cesarean section for intrapartum fetal compromise (IFC), umbilical artery pH < 7.20, and admission to the neonatal intensive care unit for >24 h. The characteristics of the study population according to BW (VSGA and SGA) as well as the presence of composite APO were assessed. The prognostic performance of CPR and mUtA-PI was evaluated using receiver operating characteristic (ROC) analysis. In total, 203 pregnancies were included. Of these, 55 (27%) had CPR <10th centile, 25 (12%) mUtA-PI >95th centile, 65 (32%) VSGA fetuses, and 93 (46%) composite APO. VSGA showed a non-significantly higher rate of composite APO in comparison to SGA (52% vs. 43%; p = 0.202). The composite APO rate was significantly higher in SGA with CPR <10th centile (36% vs. 13%; p = 0.001), while in VSGA with CPR <10th centile was not (38% vs. 35%; p = 0.818). The composite APO rate was non-significantly higher both in VSGA (26% vs. 10%; p = 0.081) and SGA (14% vs. 6%; p = 0.742) with mUtA-PI >95th centile. The ROC analysis showed a significantly predictive value of CPR for composite APO in SGA only (AUC 0.612; p = 0.025). A low CPR was associated with composite APO in SGA fetuses. VSGA fetuses were more frequently affected by composite APO regardless of Doppler values. The predictive performance of CPR and uterine artery Doppler was poor.
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Affiliation(s)
- Anne Karge
- Division of Obstetrics and Perinatal Medicine, Department of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.K.); (S.M.L.); (B.K.)
| | - Silvia M. Lobmaier
- Division of Obstetrics and Perinatal Medicine, Department of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.K.); (S.M.L.); (B.K.)
| | - Bernhard Haller
- Institute of AI Medical Informatics in Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Bettina Kuschel
- Division of Obstetrics and Perinatal Medicine, Department of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.K.); (S.M.L.); (B.K.)
| | - Javier U. Ortiz
- Division of Obstetrics and Perinatal Medicine, Department of Obstetrics and Gynecology, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.K.); (S.M.L.); (B.K.)
- Correspondence: ; Tel.: +49-89-4140-2430; Fax: +49-89-4140-2447
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Angermann S, Günthner R, Hanssen H, Lorenz G, Braunisch MC, Steubl D, Matschkal J, Kemmner S, Hausinger R, Block Z, Haller B, Heemann U, Kotliar K, Grimmer T, Schmaderer C. Cognitive impairment and microvascular function in end-stage renal disease. Int J Methods Psychiatr Res 2022; 31:e1909. [PMID: 35290686 PMCID: PMC9159686 DOI: 10.1002/mpr.1909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hemodialysis patients show an approximately threefold higher prevalence of cognitive impairment compared to the age-matched general population. Impaired microcirculatory function is one of the assumed causes. Dynamic retinal vessel analysis is a quantitative method for measuring neurovascular coupling and microvascular endothelial function. We hypothesize that cognitive impairment is associated with altered microcirculation of retinal vessels. METHODS 152 chronic hemodialysis patients underwent cognitive testing using the Montreal Cognitive Assessment. Retinal microcirculation was assessed by Dynamic Retinal Vessel Analysis, which carries out an examination recording retinal vessels' reaction to a flicker light stimulus under standardized conditions. RESULTS In unadjusted as well as in adjusted linear regression analyses a significant association between the visuospatial executive function domain score of the Montreal Cognitive Assessment and the maximum arteriolar dilation as response of retinal arterioles to the flicker light stimulation was obtained. CONCLUSION This is the first study determining retinal microvascular function as surrogate for cerebral microvascular function and cognition in hemodialysis patients. The relationship between impairment in executive function and reduced arteriolar reaction to flicker light stimulation supports the involvement of cerebral small vessel disease as contributing factor for the development of cognitive impairment in this patient population and might be a target for noninvasive disease monitoring and therapeutic intervention.
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Affiliation(s)
- Susanne Angermann
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Roman Günthner
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Georg Lorenz
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Matthias C Braunisch
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Dominik Steubl
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Julia Matschkal
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Stephan Kemmner
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany.,Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Renate Hausinger
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Zenonas Block
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
| | - Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Campus Jülich, Jülich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munchen, Germany
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Martini E, Kantenwein V, Haller B, Telishevska M, Bourier F, Reents T, Kottmaier M, Popa M, Risse E, Lengauer S, Lennerz C, Hessling G, Deisenhofer I, Kolb C. Long term outcome after ablation of persistent atrial fibrillation in patients with postprocedurally unmasked sinus node disease. Europace 2022. [DOI: 10.1093/europace/euac053.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
About three percent of patients with persistent atrial fibrillation [AF] additionally suffer from a concealed sinus node disease [SND]. We sought to determine the ablation success one year after ablation of persistent AF in patients with postprocedurally unmasked SND.
Methods and Results
In total 2239 patients with an ablation of persistent AF at our center were screened for a postprocedurally unmasked SND, which made cardiac pacing necessary within one week after ablation. In a propensity score matched case control study, the longterm ablation success of 51 patients (mean age 73±8years, 58% male) with postprocedurally unmasked SND after ablation of persistent AF was compared to that of 102 patients without SND after ablation of persistent AF. Controls were matched to cases based on the propensity score considering age, body mass index, left ventricular ejection fraction, gender, blood pressure, diabetes mellitus, atrial low voltage, previous number of ablations and method of ablation.
One year after ablation of persistent AF, 20 (39%) patients with postprocedurally unmasked SND and 61 (60%) patients without postprocedurally unmasked SND were in sinus rhythm (p=0.025). The number of repeat ablation procedures within the follow up year did not differ significantly between cases and controls (0.60±0.68 vs 0.53±0.80, p=0.574).
Conclusion
In patients with a postprocedurally unmasked SND after ablation of persistent AF, longterm ablation success seems to be worse compared to patients without postprocedurally unmasked SND.
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Affiliation(s)
- E Martini
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - V Kantenwein
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - B Haller
- Hospital Rechts der Isar of the TU Munich, Institute of Medical Statistics and Epidemiology, Munich, Germany
| | - M Telishevska
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - F Bourier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - T Reents
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Kottmaier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Popa
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - E Risse
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - S Lengauer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Lennerz
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - G Hessling
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - I Deisenhofer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Kolb
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
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49
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Knoll K, Oconnor M, Chouchane A, Haller B, Schaarschmidt C, Bock M, Foerschner L, Froehlich R, Kottmaier M, Bourier F, Reents T, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Procalcitonin as a biomarker of cardiac implantable electronic device pocket infection: a prospective validation study. Europace 2022. [DOI: 10.1093/europace/euac053.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The implantation of cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators is increasing along with the complexitly of these devices. CIED infection is an uncommon, but severe complication associated with the presence of a device and is associated with a high mortality and morbidity. Lead-related infections and frank endocarditis are associated with a systemic inflammatory response and, in general, are readily identified. Isolated pocket infections do not produce such a systemic response and are thus more complex to diagnose. There is a reliance on clinical accumen and examination of local signs of infection. There is thus a need for a reliable biomaker to help identify cases of pocket infection.
Aim
Our group have previously shown procalcitonin (PCT) to be a potentially useful biomaker in the clinial situation of possible pocket infection. We aim to prospectively validate the proposed cut-off value of 0.05ng/ml for the procalcitonin (PCT) biomaker in an independent cohort, which we have previously identified as showing promise in this clinical situation.
Methods
In this prospective case-control validation study the PCT levels of 81 patients with confirmed pocket infections were compared to 81 controls, matched for age and renal function, presenting for elective generator replacement or lead revision unrelated to infection. Exclusion criteria included: concomitant infectious or inflammatory diseases, end-stage renal failure, active malignancy or receiving immunosuppressive therapy.
Results
A PCT over 0.05 ng/ml was found in 68% (n= 55) of pocket infections and 24% (n= 19) of controls. Using the predefined cut-off value of 0.05 ng/ml PCT had a sensitivity of 68% and a specificity of 77% for diagnosing pocket infections. ROC analysis revealed area under the curve of 0.752 (standard error 0.039, p <0.001 ) for PCT. In patients presenting with minimal infective signs the sensivity remained high (67% vs 70% with extensive inflammation) and similarly remained high in thus who had received anti-biotic therapy prior to PCT sampling (65% vs 69%).
Conclusion
PCT is a potentially useful biomarker to aid the diagnosis of a pocket infection when used with the prospecitvely validated cut-off value of 0.05ng/ml. The sensitivity of the PCT positive result remained high even in patients pre-treated with antibiotics or with minimal clinical signs of inflammation.
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Affiliation(s)
- K Knoll
- German Heart Centre Munich, Munich, Germany
| | - M Oconnor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | | | - B Haller
- Clinic rechts der Isar of the University of Technology, Institut für KI und Informatik in der Medizin, Munich, Germany
| | | | - M Bock
- German Heart Centre Munich, Munich, Germany
| | | | | | | | - F Bourier
- German Heart Centre Munich, Munich, Germany
| | - T Reents
- German Heart Centre Munich, Munich, Germany
| | - G Hessling
- German Heart Centre Munich, Munich, Germany
| | | | - C Kolb
- German Heart Centre Munich, Munich, Germany
| | - C Lennerz
- German Heart Centre Munich, Munich, Germany
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50
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Kram H, Prokop G, Haller B, Gempt J, Wu Y, Schmidt-Graf F, Schlegel J, Conrad M, Liesche-Starnecker F. Glioblastoma Relapses Show Increased Markers of Vulnerability to Ferroptosis. Front Oncol 2022; 12:841418. [PMID: 35530303 PMCID: PMC9071304 DOI: 10.3389/fonc.2022.841418] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/22/2022] [Indexed: 01/08/2023] Open
Abstract
Background Despite the availability of various therapy options and being a widely focused research area, the prognosis of glioblastoma (GBM) still remains very poor due to therapy resistance, genetic heterogeneity and a diffuse infiltration pattern. The recently described non-apoptotic form of cell death ferroptosis may, however, offer novel opportunities for targeted therapies. Hence, the aim of this study was to investigate the potential role of ferroptosis in GBM, including the impact of treatment on the expression of the two ferroptosis-associated players glutathione-peroxidase 4 (GPX4) and acyl-CoA-synthetase long-chain family number 4 (ACSL4). Furthermore, the change in expression of the recently identified ferroptosis suppressor protein 1 (FSP1) and aldehyde dehydrogenase (ALDH) 1A3 was investigated. Methods Immunohistochemistry was performed on sample pairs of primary and relapse GBM of 24 patients who had received standard adjuvant treatment with radiochemotherapy. To identify cell types generally prone to undergo ferroptosis, co-stainings of ferroptosis susceptibility genes in combination with cell-type specific markers including glial fibrillary acidic protein (GFAP) for tumor cells and astrocytes, as well as the ionized calcium-binding adapter molecule 1 (Iba1) for microglial cells were performed, supplemented by double stains combining GPX4 and ACSL4. Results While the expression of GPX4 decreased significantly during tumor relapse, ACSL4 showed a significant increase. These results were confirmed by analyses of data sets of the Cancer Genome Atlas. These profound changes indicate an increased susceptibility of relapsed tumors towards oxidative stress and associated ferroptosis, a cell death modality characterized by unrestrained lipid peroxidation. Moreover, ALDH1A3 and FSP1 expression also increased in the relapses with significant results for ALDH1A3, whereas for FSP1, statistical significance was not reached. Results obtained from double staining imply that ferroptosis occurs more likely in GBM tumor cells than in microglial cells. Conclusion Our study implies that ferroptosis takes place in GBM tumor cells. Moreover, we show that recurrent tumors have a higher vulnerability to ferroptosis. These results affirm that utilizing ferroptosis processes might be a possible novel therapy option, especially in the situation of recurrent GBM.
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Affiliation(s)
- Helena Kram
- Department of Neuropathology, Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Prokop
- Department of Neuropathology, Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yang Wu
- Department of Neuropathology, Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen Schlegel
- Department of Neuropathology, Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus Conrad
- Institute of Metabolism and Cell Death, Helmholtz Zentrum München, Neuherberg, Germany.,Laboratory of Experimental Oncology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Friederike Liesche-Starnecker
- Department of Neuropathology, Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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