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Panzer M, Meindl E, Schaefer B, Wagner S, Glodny B, Mayer G, Pircher A, Schwarz C, Beckmann F, Hejny C, Joachim-Mrosko B, Konzett J, Tilg H, Heidegger I, Wolf M, Weiskirchen R, Zoller H. Intravenous iron-induced hypophosphatemia and kidney stone disease. Bone Rep 2024; 21:101759. [PMID: 38590391 PMCID: PMC10999795 DOI: 10.1016/j.bonr.2024.101759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
Patients with Crohn's disease are at increased risk for symptomatic nephrolithiasis. Stones in these patients are most commonly composed of calcium oxalate monohydrate or mixed calcium-oxalate and calcium-phosphate. Precipitation of both minerals depends on urinary pH, calcium, phosphate and oxalate excretion. The present manuscript reports on two patients with Crohn's disease and bowel resection, in whom the onset of symptomatic urolithiasis occurred after repeated infusions of ferric carboxymaltose - a drug, which is known to cause hyperphosphaturia. The present study shows that ferric carboxymaltose-induced hyperphosphaturia can be associated with kidney stone formation and symptomatic urolithiasis, especially in patients treated with calcitriol. Calcitriol has been shown to mitigate ferric carboxymaltose-induced secondary hyperparathyroidism and hyperphosphaturia, but is known to increase urinary calcium excretion. Chemical analysis of recovered stones revealed that they were mixed calcium oxalate and phosphate stones. Ring-like deposition of iron detected by spatially resolved elemental analysis using laser ablation-inductively coupled plasma mass spectrometry, showed that the stones also contained iron. Based on our findings, we propose that patients with inflammatory bowel disease requiring intravenous iron therapy should be carefully monitored for the development of hypophosphatemia and urolithiasis. If hypophosphatemia occurs in such patients, calcitriol should be used with caution.
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Affiliation(s)
- Marlene Panzer
- Christian Doppler Laboratory for Iron and Phosphate Biology, Austria
- Department of Internal Medicine I, Austria
| | - Eva Meindl
- Christian Doppler Laboratory for Iron and Phosphate Biology, Austria
- Department of Internal Medicine I, Austria
| | | | - Sonja Wagner
- Christian Doppler Laboratory for Iron and Phosphate Biology, Austria
- Department of Internal Medicine I, Austria
| | | | | | - Andreas Pircher
- Department of Internal Medicine V, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Christoph Schwarz
- Department of Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierninger Str. 170, 4400 Steyr, Austria
| | - Felix Beckmann
- Institute of Materials Physics, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany
| | - Clivia Hejny
- Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Bastian Joachim-Mrosko
- Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Juergen Konzett
- Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine and Duke Clinical Research Institute, 40 Duke Medicine Cir Durham, NC 27710-4000, United States of America
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Heinz Zoller
- Christian Doppler Laboratory for Iron and Phosphate Biology, Austria
- Department of Internal Medicine I, Austria
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Kiener TA, Moré E, Franzen M, Cadamuro J, Schwarz C, Bergmann C, Salmhofer H. Nephrolithiasis Associated with Nephrocalcinosis Is Primarily Composed of Carbonate Apatite. Kidney Blood Press Res 2024; 49:239-244. [PMID: 38513628 DOI: 10.1159/000537699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/03/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION This study was designed to determine the mineral composition of calculi in nephrocalcinosis with nephrolithiasis, diagnose the underlying disease, and monitor the course of renal function in patients with nephrocalcinosis-nephrolithiasis. METHODS Renal calculi extruded in a series of 8 patients with nephrocalcinosis were analysed using Fourier transmission infrared spectrometry. In 4 patients, next-generation sequencing using a nephrocalcinosis-nephrolithiasis panel was performed to determine the nature of the underlying disease. In addition, longitudinal analysis of renal function was performed in all patients. RESULTS Seven patients revealed carbonate apatite as the sole constituent of renal calculi. One patient showed a mixed composition of dicalcium phosphate dihydrate/carbonate apatite at first analysis yet in subsequent episodes also had calculi composed of pure carbonate apatite. Further molecular analysis displayed distal renal tubular acidosis in 2 of 4 patients who consented to sequencing. No known genetic defect could be found in the other two cases. In line with prior reports, decline of renal function was dependent on underlying disease. Distal renal tubular acidosis revealed a progressive course of renal failure, whereas other causes showed stable renal function in long term analysis. CONCLUSION Nephrocalcinosis with nephrolithiasis is a rare condition with heterogeneous aetiology. Yet mineral composition of renal calculi predominantly consisted of pure carbonate apatite. This uniform finding is similar to subcutaneous calcifications of various origins and might propose a general principle of tissue calcification. Progressive decline of renal function was found in distal renal tubular acidosis, whereas other conditions remained stable over time.
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Affiliation(s)
- Teresa Antonia Kiener
- Nephrology Unit, Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Elena Moré
- Nephrology Unit, Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Michael Franzen
- Nephrology Unit, Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Schwarz
- Nephrology Unit, Department of Internal Medicine 1, Pyhrn-Eisenwurzen-Klinikum, Steyr, Austria
| | | | - Hermann Salmhofer
- Nephrology Unit, Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
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Simmonds NJ, Southern KW, De Wachter E, De Boeck K, Bodewes F, Mainz JG, Middleton PG, Schwarz C, Vloeberghs V, Wilschanski M, Bourrat E, Chalmers JD, Ooi CY, Debray D, Downey DG, Eschenhagen P, Girodon E, Hickman G, Koitschev A, Nazareth D, Nick JA, Peckham D, VanDevanter D, Raynal C, Scheers I, Waller MD, Sermet-Gaudelus I, Castellani C. ECFS standards of care on CFTR-related disorders: Identification and care of the disorders. J Cyst Fibros 2024:S1569-1993(24)00037-7. [PMID: 38508949 DOI: 10.1016/j.jcf.2024.03.008] [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: 11/21/2023] [Revised: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
This is the third paper in the series providing updated information and recommendations for people with cystic fibrosis transmembrane conductance regulator (CFTR)-related disorder (CFTR-RD). This paper covers the individual disorders, including the established conditions - congenital absence of the vas deferens (CAVD), diffuse bronchiectasis and chronic or acute recurrent pancreatitis - and also other conditions which might be considered a CFTR-RD, including allergic bronchopulmonary aspergillosis, chronic rhinosinusitis, primary sclerosing cholangitis and aquagenic wrinkling. The CFTR functional and genetic evidence in support of the condition being a CFTR-RD are discussed and guidance for reaching the diagnosis, including alternative conditions to consider and management recommendations, is provided. Gaps in our knowledge, particularly of the emerging conditions, and future areas of research, including the role of CFTR modulators, are highlighted.
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Affiliation(s)
- N J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - K W Southern
- Department of Women's and Children's Health, University of Liverpool, University of Liverpool, Alder Hey Children's Hospital, Liverpool, UK
| | - E De Wachter
- Cystic Fibrosis Center, Pediatric Pulmonology department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K De Boeck
- Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - F Bodewes
- Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Groningen Medical Center, Groningen, the Netherlands
| | - J G Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB), University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - P G Middleton
- Cystic Fibrosis and Bronchiectasis Service, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, News South Wales, Australia
| | - C Schwarz
- HMU-Health and Medical University Potsdam, CF Center Westbrandenburg, Campus Potsdam, Germany
| | - V Vloeberghs
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Wilschanski
- CF Center, Department of Pediatrics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - E Bourrat
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - J D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - C Y Ooi
- a) School of Clinical Medicine, Discipline of Paediatrics and Child Health, Medicine & Health, University of New South Wales, Level 8, Centre for Child Health Research & Innovation Bright Alliance Building Cnr Avoca & High Streets, Randwick, Sydney, NSW, Australia, 2031; b) Sydney Children's Hospital, Gastroenterology Department, High Street, Randwick, Sydney, NSW, Australia, 2031
| | - D Debray
- Pediatric Hepatology unit, Centre de Référence Maladies Rares (CRMR) de l'atrésie des voies biliaires et cholestases génétiques (AVB-CG), National network for rare liver diseases (Filfoie), ERN rare liver, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - D G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - E Girodon
- Service de Médecine Génomique des Maladies de Système et d'Organe, APHP.Centre - Université de Paris Cité, Hôpital Cochin, Paris, France
| | - G Hickman
- APHP, Service de Dermatologie, CRMR MAGEC Nord St Louis, Hôpital-Saint Louis, Paris, France
| | - A Koitschev
- Klinikum Stuttgart, Pediatric Otorhinolaryngology, Stuttgart, Germany
| | - D Nazareth
- a) Adult CF Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust, U.K; b) Clinical Infection, Microbiology and Immunology, University of Liverpool, UK
| | - J A Nick
- Department of Medicine, National Jewish Health, Denver, CO, 80206, USA, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - D Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - D VanDevanter
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - C Raynal
- Laboratory of molecular genetics, University Hospital of Montpellier and INSERM U1046 PHYMEDEXP, Montpellier, France
| | - I Scheers
- Department of Pediatrics, Pediatric Gastroenterology and Hepatology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M D Waller
- Adult Cystic Fibrosis and Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Honorary Senior Lecturer, King's College London, London, United Kingdom
| | - I Sermet-Gaudelus
- INSERM U1151, Institut Necker Enfants Malades, Paris, France; Université de Paris, Paris, France; Centre de référence Maladies Rares, Mucoviscidose et maladies apparentées, Hôpital Necker Enfants malades, Paris, France
| | - C Castellani
- IRCCS Istituto Giannina Gaslini, Cystic Fibrosis Center, Genoa, Italy
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Schütte L, Hausmann K, Schwarz C, Ersoy F, Berger RG. The Nitrogen Content in the Fruiting Body and Mycelium of Pleurotus Ostreatus and Its Utilization as a Medium Component in Thraustochytrid Fermentation. Bioengineering (Basel) 2024; 11:284. [PMID: 38534558 DOI: 10.3390/bioengineering11030284] [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: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Following the idea of a circular bioeconomy, the use of side streams as substitutes for cultivation media (components) in bioprocesses would mean an enormous economic and ecological advantage. Costly compounds in conventional media for the production of the triterpene squalene in thraustochytrids are the main carbon source and complex nitrogen sources. Among other side streams examined, extracts from the spent mycelium of the basidiomycete Pleurotus ostreatus were best-suited to acting as alternative nitrogen sources in cultivation media for thraustochytrids. The total nitrogen (3.76 ± 0.01 and 4.24 ± 0.04%, respectively) and protein (16.47 ± 0.06 and 18.57 ± 0.18%, respectively) contents of the fruiting body and mycelium were determined. The fungal cells were hydrolyzed and extracted to generate accessible nitrogen sources. Under preferred conditions, the extracts from the fruiting body and mycelium contained 73.63 ± 1.19 and 89.93 ± 7.54 mM of free amino groups, respectively. Cultivations of Schizochytrium sp. S31 on a medium using a mycelium extract as a complex nitrogen source showed decelerated growth but a similar squalene yield (123.79 ± 14.11 mg/L after 216 h) compared to a conventional medium (111.29 ± 19.96 mg/L, although improvable by additional complex nitrogen source).
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Affiliation(s)
- Lina Schütte
- Institute of Food Chemistry, Gottfried Wilhelm Leibniz University Hannover, 30167 Hannover, Germany
| | - Katharina Hausmann
- Institute of Food Chemistry, Gottfried Wilhelm Leibniz University Hannover, 30167 Hannover, Germany
| | | | - Franziska Ersoy
- Institute of Food Chemistry, Gottfried Wilhelm Leibniz University Hannover, 30167 Hannover, Germany
| | - Ralf G Berger
- Institute of Food Chemistry, Gottfried Wilhelm Leibniz University Hannover, 30167 Hannover, Germany
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Schwarz C, Eschenhagen PN, Mainz JG, Schmidergall T, Schuette H, Romanowska E. Pulmonary Aspergillosis in People with Cystic Fibrosis. Semin Respir Crit Care Med 2024; 45:128-140. [PMID: 38286138 DOI: 10.1055/s-0043-1777267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with cystic fibrosis (CF), with a particular focus on infections caused by Aspergillus spp. The most common organisms from this genus detected from respiratory cultures are Aspergillus fumigatus and Aspergillus terreus, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus nidulans. These species have been identified to be both chronic colonizers and sources of active infection and may negatively impact lung function in people with CF. This review article discusses definitions of aspergillosis, challenges in clinical practice, and current literature available for laboratory findings, clinical diagnosis, and treatment options for pulmonary diseases caused by Aspergillus spp. in people with CF.
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Affiliation(s)
- C Schwarz
- HMU-Health and Medical University, Potsdam, Germany
- Division Cystic Fibrosis, Clinic Westbrandenburg, Potsdam, Germany
| | - P N Eschenhagen
- HMU-Health and Medical University, Potsdam, Germany
- Division Cystic Fibrosis, Clinic Westbrandenburg, Potsdam, Germany
| | - J G Mainz
- Department of Paediatric Pneumology, Allergology, Cystic Fibrosis Center, Klinikum Westbrandenburg, Brandenburg a. d. Havel, Germany
- University Hospital of the Brandenburg Medical School, Brandenburg a. d. Havel, Germany
| | - T Schmidergall
- HMU-Health and Medical University, Potsdam, Germany
- Division Cystic Fibrosis, Clinic Westbrandenburg, Potsdam, Germany
| | - H Schuette
- Pneumology and Respiratory Medicine, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - E Romanowska
- HMU-Health and Medical University, Potsdam, Germany
- Division Cystic Fibrosis, Clinic Westbrandenburg, Potsdam, Germany
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Schwarz C, Lindner G, Windpessl M, Knechtelsdorfer M, Saemann MD. [Consensus recommendations on the diagnosis and treatment of hyponatremia from the Austrian Society for Nephrology 2024]. Wien Klin Wochenschr 2024; 136:1-33. [PMID: 38421476 PMCID: PMC10904443 DOI: 10.1007/s00508-024-02325-5] [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] [Accepted: 01/03/2024] [Indexed: 03/02/2024]
Abstract
Hyponatremia is a disorder of water homeostasis. Water balance is maintained by the collaboration of renal function and cerebral structures, which regulate thirst mechanisms and secretion of the antidiuretic hormone. Measurement of serum-osmolality, urine osmolality and urine-sodium concentration help to diagnose the different reasons for hyponatremia. Hyponatremia induces cerebral edema and might lead to severe neurological symptoms, which need acute therapy. Also, mild forms of hyponatremia should be treated causally, or at least symptomatically. An inadequate fast increase of the serum sodium level should be avoided, because it raises the risk of cerebral osmotic demyelination. Basic pathophysiological knowledge is necessary to identify the different reasons for hyponatremia which need different therapeutic procedures.
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Affiliation(s)
- Christoph Schwarz
- Innere Medizin 1, Pyhrn-Eisenwurzenklinikum, Sierningerstr. 170, 4400, Steyr, Österreich.
| | - Gregor Lindner
- Zentrale Notaufnahme, Kepler Universitätsklinikum GmbH, Johannes-Kepler-Universität, Linz, Österreich
| | | | | | - Marcus D Saemann
- 6.Medizinische Abteilung mit Nephrologie und Dialyse, Klinik Ottakring, Wien, Österreich
- Medizinische Fakultät, Sigmund-Freud Universität, Wien, Österreich
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Schwarz C, Balean O, Dumitrescu R, Ciordas PD, Marian C, Georgescu M, Bolchis V, Sava-Rosianu R, Fratila AD, Alexa I, Jumanca D, Galuscan A. Total Antioxidant Capacity of Saliva and Its Correlation with pH Levels among Dental Students under Different Stressful Conditions. Diagnostics (Basel) 2023; 13:3648. [PMID: 38132232 PMCID: PMC10743087 DOI: 10.3390/diagnostics13243648] [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: 11/14/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: This cross-sectional study conducted at the Faculty of Dental Medicine, Timisoara, Romania, between December 2022 and February 2023 aims to assess salivary total antioxidant capacity and pH levels in dental students experiencing non-stressful and stressful situations and explore potential correlations between these factors. (2) Methods: Saliva samples were collected during two different periods: before an Oral Health course and before the Oral Health exam, under stressful conditions. Ethical principles were followed, and informed consent was obtained. Data on age, gender, health status, drug use, smoking habits, and anxiety levels were recorded. Saliva was collected using the draining method and pH was measured using indicator paper strips. Total antioxidant capacity (TAC) was determined using a commercial assay kit. Statistical analysis involved descriptive statistics, Student's t-test to compare pH and TAC between study groups, and Pearson's correlation coefficient to analyze the correlation between salivary pH and TAC within each group, with p < 0.05 indicating significance. (3) Results: This study involved 80 participants, comprising 26 males and 54 females, all enrolled in the 5th year of the Oral Health course, with ages ranging from 20 to 53 and a mean age of 23.62 (±4.19) years. Pearson's correlation results show a statistically significant negative relationship between the STAI test and TAC during the stress-free period (-0.02 **, N = 80, p < 0.01). (4) Conclusions: There are variations in saliva's antioxidant capacity in response to different stress conditions. Dental students experienced a higher level of stress before academic assessments compared to the non-stress period during the course.
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Affiliation(s)
- Christoph Schwarz
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
| | - Octavia Balean
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
- Clinic of Preventive, Community Dentistry and Oral Health, Department I, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. no 2, 300041 Timisoara, Romania
| | - Ramona Dumitrescu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
- Clinic of Preventive, Community Dentistry and Oral Health, Department I, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. no 2, 300041 Timisoara, Romania
| | - Paula Diana Ciordas
- Department of Biochemistry and Pharmacology, Victor Babeş University of Medicine and Pharmacy, Pta Eftimie Murgu Nr. 2, 300041 Timisoara, Romania; (P.D.C.); (C.M.)
| | - Catalin Marian
- Department of Biochemistry and Pharmacology, Victor Babeş University of Medicine and Pharmacy, Pta Eftimie Murgu Nr. 2, 300041 Timisoara, Romania; (P.D.C.); (C.M.)
| | - Marius Georgescu
- Functional Sciences Department, Physiology Discipline, Victor Babes University of Medicine and Pharmacy of Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Vanessa Bolchis
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
| | - Ruxandra Sava-Rosianu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
- Clinic of Preventive, Community Dentistry and Oral Health, Department I, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. no 2, 300041 Timisoara, Romania
| | - Aurora Doris Fratila
- Faculty of Dental Medicine, Ludwig-Maximilian-University Munich, Goethestraße 70, 80336 München, Germany;
| | - Iulia Alexa
- Department of Dentistry, Faculty of Dental Medicine, “Vasile Goldis” Western University of Arad, 310045 Arad, Romania;
| | - Daniela Jumanca
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
- Clinic of Preventive, Community Dentistry and Oral Health, Department I, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. no 2, 300041 Timisoara, Romania
| | - Atena Galuscan
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (O.B.); (R.D.); (V.B.); (D.J.); (A.G.)
- Clinic of Preventive, Community Dentistry and Oral Health, Department I, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. no 2, 300041 Timisoara, Romania
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Holz F, Can E, Grehn C, Klotsche J, Materne B, Kruppa J, Kallinich T, Schwarz C. Manifestation and staging of arthropathy in cystic fibrosis. Defining different stages of cystic fibrosis arthropathy using ultrasound imaging and clinical scoring. J Cyst Fibros 2023; 22:980-988. [PMID: 37150649 DOI: 10.1016/j.jcf.2023.04.011] [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: 11/13/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The true prevalence of cystic fibrosis arthropathy (CFA) remains unclear and may be significantly higher than previously reported. In recent studies, joint symptoms have been reported in up to 30% of adults with CF. This underlines the importance of CFA as a rising and clinically relevant co-morbidity. A clear definition of CFA is yet missing and its pathogenesis remains unclear. We investigated the clinical manifestation of CFA particularly via ultrasound (US) examination to define and implement a staging for clinical assessment. METHODS In a prospective cohort study between March 2018 and February 2020 a total of 98 consecutively recruited, adult cystic fibrosis (CF) patients underwent joint-US examination according to a newly developed ultrasound score (US-CFA). A clinical assessment including rheumatological scores (DAS28, HAQ) has been conducted as well as a specially designed questionnaire. Investigation on clinical and microbiological data, as well as a comprehensive laboratory analysis, were carried out. Cluster analysis has been performed to detect patterns defining different CFA stages based on disease activity. RESULTS US imaging has shown a considerable incidence of mild to moderate effusion as sign of joint inflammation/(teno-)synovitis. K-means clustering was used to distinguish 3 different stages of CFA based on the intensity of the detected effusion. These stages showed a significant association with disease activity (DAS28, p = 0.0004) as well as with patient-reported symptoms such as total weeks of CFA per year (p = 0.004), acute CFA (p = 0.015), chronic CFA (p = 0.016), disease burden (p = 0.04). Based on the US-CFA, 16% of patients suffered from severe CFA (II), 51% from intermediate CFA (I) and 33% did not present detectable arthritis. Positive serology for Chlamydophilia pneumoniae (IgA, IgG) and Chlamydia trachomatis (IgA, IgG) significantly correlated with the US-CFA. CONCLUSIONS The results of this study show that a definition and categorization for the clinical manifestation of CFA can be described through US examination, which is able to detect disease activity concordant with the DAS28 as a validated clinical score on arthritis. Defining these stages will lead to a better understanding of the clinical phenotype of the disease and will optimize diagnosis, therapy and research on CFA in the future.
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Affiliation(s)
- F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany.
| | - E Can
- Department of Radiology including Pediatric Radiology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany
| | - J Klotsche
- German Rheumatism Research Centre, Berlin, Germany
| | - B Materne
- Department of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - J Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Germany
| | - T Kallinich
- German Rheumatism Research Centre, Berlin, Germany; Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Rheumatology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Schwarz
- Division Cystic Fibrosis, CF Center Westbrandenburg, Clinic Westbrandenburg, Potsdam, Germany; HMU Health and Medical University, Potsdam, Germany
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9
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Kampf S, Sponder M, Fitschek F, Laxar D, Bodingbauer M, Binder C, Stremitzer S, Kaczirek K, Schwarz C. Obesity and its influence on liver dysfunction, morbidity and mortality after liver resection. Hepatobiliary Surg Nutr 2023; 12:704-714. [PMID: 37886202 PMCID: PMC10598315 DOI: 10.21037/hbsn-22-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/15/2022] [Indexed: 10/28/2023]
Abstract
Background Obesity and associated steatosis is an increasing health problem worldwide. Its influence on post-hepatectomy liver failure (PHLF) and after liver resection (LR) is still unclear. Methods Patients who underwent LR were investigated and divided into three groups [normal weight: body mass index (BMI) 18.5-24.9 kg/m2, overweight: BMI 25.0-29.9 kg/m2, obese: BMI ≥30 kg/m2] in this retrospective study. Primary aim of this study was to assess the influence of BMI and nonalcoholic steatohepatitis (NASH) on PHLF and morbidity. Results Of 888 included patients, 361 (40.7%) had normal weight, 360 (40.5%) were overweight, 167 (18.8%) were obese. Median age was 62.5 years (IQR, 54-69 years). The primary indication for LR was colorectal liver metastases (CLM) (n=366, 41.2%). NASH was present in 58 (16.1%) of normal weight, 84 (23.3%) of overweight and 69 (41.3%) of obese patients (P<0.001). PHLF occurred in 16.3% in normal weight, 15.3% in overweight and 11.4% in obese patients (P=0.32). NASH was not associated with PHLF. There was no association between patients' weight and the occurrence of postoperative complications (P=0.45). At multivariable analysis, solely major LR [odds ratio (OR): 2.7, 95% confidence interval (CI): 1.83-4.04; P<0.001] remained a significant predictor for PHLF. Conclusions Postoperative complications and PHLF are comparable in normal weight, overweight and obese patients and LRs using modern techniques can be safely performed in these patients.
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Affiliation(s)
- Stephanie Kampf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Sponder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Fabian Fitschek
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Laxar
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Carina Binder
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Stremitzer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Schwarz
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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10
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Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D’Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, Stättner S. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg 2023; 110:1331-1347. [PMID: 37572099 PMCID: PMC10480040 DOI: 10.1093/bjs/znad233] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian E Oberkofler
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bobby V M Dasari
- Department of Hepatobiliary–pancreatic and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK
| | - Jan Heil
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rafael Diaz-Nieto
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Adam E Frampton
- Hepatopancreatobiliary Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dominik Geisel
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amelia J Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mickaël Lesurtel
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Damian Mole
- Hepatopancreatobiliary Surgery Unit, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Robert Öllinger
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Stockmann
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille University, Lille, France
- CANTHER Laboratory ‘Cancer Heterogeneity, Plasticity and Resistance to Therapies’ UMR-S1277, Team ‘Mucins, Cancer and Drug Resistance’, Lille, France
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Kortrijk, Belgium
| | - Michelle L DeOliveira
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, the Netherlands
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris Centre Hopital Cochin, Paris, France
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Hassan Malik
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuh N Rahbari
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Georg Göbel
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
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11
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Schwarz C, Hajdu AI, Dumitrescu R, Sava-Rosianu R, Bolchis V, Anusca D, Hanghicel A, Fratila AD, Oancea R, Jumanca D, Galuscan A, Leretter M. Link between Oral Health, Periodontal Disease, Smoking, and Systemic Diseases in Romanian Patients. Healthcare (Basel) 2023; 11:2354. [PMID: 37628551 PMCID: PMC10454691 DOI: 10.3390/healthcare11162354] [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: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: The link between oral and systemic health is becoming increasingly obvious. Oral diseases, particularly periodontitis, have been linked to various diseases including diabetes and cardiovascular disease, among others. This survey aimed to assess the oral health condition of individuals, considering both their overall health and periodontal status, by performing oral examinations and collecting data using questionnaires. (2) Methods: After obtaining approval from the University's Ethics Committee, the study was carried out from 2021 to 2022 at the Department of Oral Health, located in the Emergency Municipal Hospital in Timisoara, Timis County, Romania. Bivariate correlations were performed using nonparametric Spearman's Rho using SPPS software version 23. To assess the importance of smoking frequency related to the severity of periodontitis diagnosis, the ANOVA Simple test (one-way) and Hochberg GT2 post hoc analysis were utilized. The chi-squared test was employed for nominal variables. A significance level of 0.05 (alpha = 0.05) was adopted for all statistical tests. (3) Results: There is a significant positive association between the frequency of systemic disease and the severity of the periodontitis diagnosis taken as a total, Rho (242) = 0.151, p < 0.05, and taken as a stage, Rho (242) = 0.199, p < 0.01, thus as the severity of the diagnosis increases, the patient presents comorbidities. Hochberg GT2 post hoc analysis indicates that the non-smoking group has statistically significantly lower diagnostic severity (Mdif = -0.81, p = 0.01), with a strong effect size (Cohen's d = 0.73). (4) Conclusions: The findings are increasingly indicating a potential association between oral diseases and a range of systemic diseases. The impact of periodontal disease on the quality of life is significant, especially in individuals with associated systemic conditions and present risk factors.
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Affiliation(s)
- Christoph Schwarz
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
| | - Adrian Ioan Hajdu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
| | - Ramona Dumitrescu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
- Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Ruxandra Sava-Rosianu
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
- Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Vanessa Bolchis
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
| | - Diana Anusca
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
| | - Andreea Hanghicel
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
| | - Aurora Doris Fratila
- Faculty of Dental Medicine, Ludwig-Maximilian-University Munich, Goethestraße 70, 80336 München, Germany;
| | - Roxana Oancea
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
- Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Daniela Jumanca
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
- Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Atena Galuscan
- Translational and Experimental Clinical Research Centre in Oral Health, Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania; (C.S.); (A.I.H.); (R.S.-R.); (V.B.); (D.A.); (A.H.); (R.O.); (D.J.); (A.G.)
- Department of Preventive, Community Dentistry and Oral Health, University of Medicine and Pharmacy “Victor Babes”, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Marius Leretter
- Department of Prosthodontics, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, University of Medicine and Pharmacy Timisoara “Victor Babes”, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
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Schwarz M, Schwarz C, Schütz A, Schwanke C, Krabb E, Schubert R, Liebich ST, Bauer D, Burghart L, Brinkmann L, Gutic E, Reiberger T, Haltmayer H, Gschwantler M. Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to antiviral therapy. J Virus Erad 2023; 9:100319. [PMID: 36970063 PMCID: PMC10036924 DOI: 10.1016/j.jve.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/17/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Background & aims Despite effective direct-acting antivirals (DAAs), hepatitis C virus (HCV) prevalence is high among people who inject drugs (PWIDs) and non-adherence to therapy remains a major obstacle towards HCV elimination in this subpopulation. To overcome this issue, we have combined ongoing opioid agonist therapy (OAT) with DAAs in a directly-observed therapy (DOT) setting. Method From September 2014 until January 2021 PWIDs at high risk of non-adherence to DAA therapy, who were also on OAT, were included into this microelimination project. Individuals received their OAT and DAAs under supervision of healthcare workers as DOT in a pharmacy or low-threshold facility. Results In total, 504 HCV RNA-positive PWIDs on OAT (387 men, 76.8%; median age: 38 years [IQR 33-45], HIV: 4.6%; hepatitis B: 1.4%) were included into this study. Two thirds reported ongoing intravenous drug use (IDU) and half of them had no permanent housing. Only 41 (8.1%) were lost to follow-up and two (0.4%) died of reasons unrelated to DAA toxicity. Overall, 90.7% of PWIDs achieved sustained virological response 12 weeks after treatment (SVR12) (95% CI: 88.1-93.2%). By excluding those lost to follow-up and hose who had died of causes unrelated to DAAs, the SVR12 rate was 99.1% (95% CI: 98.3-100.0%; modified intention-to-treat analysis). Four PWIDs (0.9%) experienced treatment failure. Over a median follow-up of 24 weeks (IQR 12-39), 27 reinfections (5.9%) were observed in individuals with the highest IDU rates (81.2%). Importantly, even though some were lost to follow-up, all completed their DAA treatment. By using DOT, adherence to DAAs was excellent with only a total of 86 missed doses (0.3% of 25,224 doses). Conclusions In this difficult-to-treat population of PWIDs with high rates of IDU , coupling DAA treatment to OAT in a DOT setting resulted in high SVR12 rates equivalent to conventional treatment settings in non-PWID populations.
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13
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Schwarz C, Muckenhuber M, Wekerle T. Optimizing Costimulation Blockade-Based Immunosuppression. Kidney360 2022; 3:2005-2007. [PMID: 36591358 PMCID: PMC9802563 DOI: 10.34067/kid.0005652022] [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] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Christoph Schwarz
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Moritz Muckenhuber
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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14
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Unger LW, Muckenhuber M, Mahr B, Schwarz C, Pilat N, Granofszky N, Regele H, Wekerle T. Chronic CD40L blockade is required for long-term cardiac allograft survival with a clinically relevant CTLA4-Ig dosing regimen. Front Immunol 2022; 13:1060576. [PMID: 36569922 PMCID: PMC9773869 DOI: 10.3389/fimmu.2022.1060576] [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: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction In de-novo kidney transplantation, the CTLA4-Ig fusion protein belatacept is associated with improved graft function but also an increased risk of acute rejection compared to calcineurin inhibitor therapy. The combination with a second costimulation blocker could potentially improve outcome while avoiding calcineurin inhibitor toxicity. The aim of this study was to define the conditions under which the combination of CTLA4-Ig and CD40L blockade leads to rejection-free permanent graft survival in a stringent murine heart transplantation model. Methods Naïve wild-type or CD40L (CD154) knock-out mice received a fully mismatched BALB/c cardiac allograft. Selected induction and maintenance protocols for CTLA4-Ig and blocking αCD40L monoclonal antibodies (mAB) were investigated. Graft survival, rejection severity and donor-specific antibody (DSA) formation were assessed during a 100-day follow-up period. Results and Discussion Administering αCD40L mAb as monotherapy at the time of transplantation significantly prolonged heart allograft survival but did not further improve the outcome when given in addition to chronic CTLA4-Ig therapy (which prolongs graft survival to a median of 22 days). Likewise, chronic αCD40L mAb therapy (0.5mg) combined with perioperative CTLA4-Ig led to rejection in a proportion of mice and extensive histological damage, despite abrogating DSA formation. Only the permanent interruption of CD40-CD40L signaling by using CD40L-/- recipient mice or by chronic αCD40L administration synergized with chronic CTLA4-Ig to achieve long-term allograft survival with preserved histological graft integrity in all recipients without DSA formation. The combination of α-CD40L and CTLA4-Ig works most effectively when both therapeutics are administered chronically.
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Affiliation(s)
- Lukas W. Unger
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria,Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Moritz Muckenhuber
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Benedikt Mahr
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Christoph Schwarz
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria,Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Nina Pilat
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Nicolas Granofszky
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria,*Correspondence: Thomas Wekerle,
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [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] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Abstract
Regulatory T cells (Tregs) play a critical role in maintaining self-tolerance and in containing allo-immune responses in the context of transplantation. Recent advances yielded the approval of the first pharmaceutical costimulation blockers (abatacept and belatacept), with more of them in the pipeline. These costimulation blockers inhibit effector cells with high clinical efficacy to control disease activity, but might inadvertently also affect Tregs. Treg homeostasis is controlled by a complex network of costimulatory and coinhibitory signals, including CD28, the main target of abatacept/belatacept, and CTLA4, PD-1 and ICOS. This review shall give an overview on what effects the therapeutic manipulation of costimulation has on Treg function in transplantation.
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Affiliation(s)
- Moritz Muckenhuber
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Thomas Wekerle, ; Christoph Schwarz,
| | - Christoph Schwarz
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Thomas Wekerle, ; Christoph Schwarz,
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Mainz J, Zagoya C, Polte L, Naehrlich L, Sasse L, Eickmeier O, Smaczny C, Barucha A, Bechinger L, Duckstein F, Eschenhagen P, Kurzidim L, Caley L, Peckham D, Schwarz C. WS02.01 Abdominal symptoms significantly decline after 24 weeks of elexacaftor/tezacaftor/ivacaftor treatment: first results obtained with the cystic fibrosis-specific CFAbd-Score in Germany and the UK. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Barth K, Sedivy M, Lindner G, Schwarz C. Successful treatment with denosumab for two cases with hypercalcemia due to vitamin D intoxication and associated acute kidney injury. CEN Case Rep 2022; 11:141-145. [PMID: 34515963 PMCID: PMC8810995 DOI: 10.1007/s13730-021-00643-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
Hypervitaminosis D is a rare reason for hypercalcemia and associated with acute kidney injury. We report on two cases of hypercalcemia and acute kidney injury because of vitamin D intoxication successfully treated with denosumab. Case 1 is an 83-year-old woman, who was initially treated for 2 weeks with intravenous hydration, steroids and thereafter with furosemide without any effect on serum calcium levels and renal function. Because acute renal failure discouraged us to use intravenous bisphosphonate therapy, we applicated 60 mg denusomab subcutaneously. This led to a prompt reduction in serum calcium levels and improvement of renal function within 1 week. Case 2 is a 45-year-old athletic woman, who refused the standard therapy of steroids and forced diuresis for vitamin D intoxication. After 1 day of rehydration therapy, she received 60 mg denusomab. Similar to case 1 serum calcium declined and renal function improved within 7 days.
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Affiliation(s)
- Katharina Barth
- Department of Internal Medicine 2, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Michal Sedivy
- Department of Internal Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierningerstraße 170, 4400, Steyr, Austria
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierningerstraße 170, 4400, Steyr, Austria.
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Stift J, Graf A, Neudert B, Herac M, Woeran K, Tamandl D, Laengle J, Schwarz C, Wrba F, Kaczirek K, Stremitzer S. Immune checkpoints and liver resection after neoadjuvant chemotherapy including bevacizumab in patients with microsatellite-stable colorectal liver metastases. HPB (Oxford) 2022; 24:40-46. [PMID: 34158230 DOI: 10.1016/j.hpb.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical value of immune checkpoint expression as prognostic biomarker in bevacizumab-pretreated patients with resected microsatellite-stable (MMS) colorectal liver metastases is unclear and was retrospectively investigated in this study. METHODS Expression analyses of IDO-1, PD-L1, and CTLA-4 were performed by immunohistochemistry in resected bevacizumab-pretreated colorectal liver metastases. Association of immune checkpoint expression in tumor cells and immune cells with response and clinical outcome was investigated. Expression profiles were compared with those of patients with anti-EGFR-targeted therapy and lung metastases, respectively. RESULTS One hundred thirty-six patients with MMS disease were investigated (79 (58.1%) male/57 (41.9%) female, median age 62.9 years (range 31.0-80.4)). High expression of IDO-1 in immune cells was associated with longer OS (not reached versus 44.8 months, HR 0.23 (95% CI 0.09, 0.55), P = 0.001). Low expression of CTLA-4 in tumor cells was associated with better histological response (26 major, 19 partial, 18 none versus 14 major, 23 partial, 30 none, P = 0.032). Expression profiles differed compared to patients with anti-EGFR-targeted therapy and patients with lung metastases. CONCLUSION Immune checkpoint expression was associated with response and survival. IDO-1 may serve as a novel prognostic and/or predictive biomarker in patients with MMS colorectal liver metastases.
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Affiliation(s)
- Judith Stift
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexandra Graf
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Barbara Neudert
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Merima Herac
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Woeran
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Laengle
- Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Schwarz
- Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Friedrich Wrba
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klaus Kaczirek
- Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Stremitzer
- Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Schwarz C, Mahr B, Muckenhuber M, Weijler AM, Unger LW, Pilat N, Latus M, Regele H, Wekerle T. In vivo Treg expansion under costimulation blockade targets early rejection and improves long-term outcome. Am J Transplant 2021; 21:3765-3774. [PMID: 34152692 PMCID: PMC9292010 DOI: 10.1111/ajt.16724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/13/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Abstract
CTLA4Ig has been shown to improve kidney allograft function, but an increased frequency of early rejection episodes poses a major obstacle for more widespread clinical use. The deleterious effect of CTLA4Ig on Treg numbers provides a possible explanation for graft injury. Therefore, we aimed at improving CTLA4Ig's efficacy by therapeutically increasing the number of Tregs. Murine cardiac allograft transplantation (BALB/c to B6) was performed under CTLA4Ig therapy modeled after the clinically approved dosing regimen and Tregs were transferred early or late after transplant. Neither early nor late Treg transfer prolonged allograft survival. Transferred Tregs were traceable in various lymphoid compartments but only modestly increased overall Treg numbers. Next, we augmented Treg numbers in vivo by means of IL2 complexes. A short course of IL2/anti-IL2-complexes administered before transplantation reversed the CTLA4Ig-mediated decline in Tregs. Of note, the addition of IL2/anti-IL2-complexes to CTLA4Ig therapy substantially prolonged heart allograft survival and significantly improved graft histology on day 100. The depletion of Tregs abrogated this effect and resulted in a significantly diminished allograft survival. The increase in Treg numbers upon IL2 treatment was associated with a decreased expression of B7 on dendritic cells. These results demonstrate that therapy with IL2 complexes improves the efficacy of CTLA4Ig by counterbalancing its unfavorable effect on Tregs.
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Affiliation(s)
- Christoph Schwarz
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria,Division of Visceral SurgeryDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Benedikt Mahr
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Moritz Muckenhuber
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Anna Marianne Weijler
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Lukas Walter Unger
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria,Division of Visceral SurgeryDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Nina Pilat
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Michaela Latus
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
| | - Heinz Regele
- Clinical Institute of PathologyMedical University ViennaViennaAustria
| | - Thomas Wekerle
- Section of Transplantation ImmunologyDivision of TransplantationDepartment of General SurgeryMedical University ViennaViennaAustria
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Franzen-Castle L, Schwarz C, Brison C, Larvick C, Aufdenkamp B, Frecks N, Jones G, Urbanec N, Wells C. Home Food Preservation Virtual Learning Series Increases Knowledge, Understanding, and Confidence for Preserving Food. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Windpessl M, Wallner M, Schwarz C. 'Bowel Prep Hyponatremia' Unmasking Underlying Adrenal Insufficiency. Am J Med 2021; 134:e378-e379. [PMID: 33434561 DOI: 10.1016/j.amjmed.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Martin Windpessl
- Nephrology Section, Fourth Department of Medicine, Klinikum Wels-Grieskirchen, Wels, Austria.
| | - Manfred Wallner
- Nephrology Section, Fourth Department of Medicine, Klinikum Wels-Grieskirchen, Wels, Austria
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Grehn C, Dittrich AM, Wosniok J, Holz F, Hafkemeyer S, Naehrlich L, Schwarz C. Risk factors for cystic fibrosis arthropathy: Data from the German cystic fibrosis registry. J Cyst Fibros 2021; 20:e87-e92. [PMID: 34034985 DOI: 10.1016/j.jcf.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiology and potential risk factors for cystic fibrosis arthropathy (CFA) were studied in a relevant cystic fibrosis (CF) patient cohort. METHODS Cohort study of patients included in the German CF registry in 2016-2017. Descriptive analysis, exploratory tests and multivariable logistic regression were used to assess prevalence of CFA and associated potential risk factors for adult patients with/without chronic Pseudomonas aeruginosa infection. RESULTS 6069 CF patients aged from 0 to 78 years were analysed. CFA was observed in 4.9% of the patients. Prevalence was significantly higher in adult patients (8.4%) compared to patients <18 years (0.7%; p<0.0001). Logistic regression analyses in adult patients (n=3319) showed that CFA was significantly associated with increasing age (OR=1.04; 95% CI: 1.02-1.05; p<0.0001), female gender (OR=2.10; 95%CI:1.52-2.90; p<0.0001), number of hospitalizations (OR=1.24; 95%CI:1.12-1.36; p<0.0001), chronic P. aeruginosa infection (OR=1.83; 95%CI:1.28-2.61; p=0.0009), CF-related diabetes (OR=1.69; 95%CI:1.23-2.33; p=0.0013), pancreatic insufficiency (OR=2.39; 95%CI:1.28-4.46; p=0.0060) and sinusitis/polyps (OR=1.91; 95%CI:1.39-2.62; p<0.0001). In a subgroup analysis of adults without chronic P. aeruginosa infection (n=1550) CFA was also significantly associated with increasing age, female gender, increasing number of hospitalizations, pancreatic insufficiency as well as sinusitis/polyps; antimycotic treatment associated only in this subgroup while association with CF-related diabetes was not significant. CONCLUSION CFA is a frequent and clinically relevant co-morbidity particularly in adult CF patients. CFA is significantly more common in patients with chronic P. aeruginosa colonization but associations with other indicators for a more severe disease course were identified regardless of P. aeruginosa colonization status.
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Affiliation(s)
- Claudia Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany.
| | - A-M Dittrich
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - J Wosniok
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
| | - F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - S Hafkemeyer
- Mukoviszidose Institut gGmbH (MI), Bonn, Germany
| | - L Naehrlich
- Department of Pediatrics, Justus-Liebig-University, Giessen, Germany
| | - C Schwarz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
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Schwarz C, Morel A, Rondeau E, Marie M, Dahan K, LUQUE Y. POS-768 Hepatitis B reactivation in kidney transplant recipients treated with belatacept. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Schwarz C, Fitschek F, Mittlböck M, Saukel V, Bota S, Ferlitsch M, Ferlitsch A, Bodingbauer M, Kaczirek K. von Willebrand Factor Antigen Predicts Outcomes in Patients after Liver Resection of Hepatocellular Carcinoma. Gut Liver 2021; 14:218-224. [PMID: 30428508 PMCID: PMC7096232 DOI: 10.5009/gnl17115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 10/26/2017] [Accepted: 11/25/2017] [Indexed: 12/12/2022] Open
Abstract
Background/Aims von Willebrand factor antigen (vWF-Ag) is a noninvasive predictor of portal hypertension that serves as a negative prognostic marker in various malignancies. Increased portal hypertension is associated with higher postoperative morbidity and decreased survival after hepatectomy. The purpose of this study was to determine the correlation between vWF-Ag, postoperative morbidity and oncological outcome. Methods This analysis includes 55 patients who underwent liver resection for hepatocellular carcinoma (HCC) between 2008 and 2015 with available preoperative vWF-Ag levels. The primary endpoints were postoperative complications and long-term outcome, including overall and disease-free survival. Results The median plasma level of vWF-Ag was 191% (range, 162.5% to 277%). There was a significant correlation between vWF-Ag levels and tumor size in the resected specimens (p=0.010, r=0.350). Patients who developed any grade of postoperative complication had significantly higher preoperative vWF-Ag levels (216% [range, 178% to 283.25%] vs 176% [range, 148% to 246%], p=0.041). Median overall survival was 39.8 months in patients with high vWF-Ag levels (≥191%) compared with 73.4 months in patients with low levels (<191%, p=0.007). Of note, there was a remarkable disparity in the number of patients who died of HCC with low versus high vWF-Ag levels (14.8% vs 28.6%, p=0.011). Conclusions vWF-Ag may serve as a prognostic marker for the outcome of patients undergoing liver resection for HCC that is closely connected to tumor size, postoperative complication rate and long-term outcome.
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Affiliation(s)
- Christoph Schwarz
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martina Mittlböck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University Vienna, Vienna, Austria
| | - Veronika Saukel
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Monika Ferlitsch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University Vienna, Vienna, Austria
| | - Arnulf Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Medical University Vienna, Vienna, Austria
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Ravioli S, Pluess E, Funk GC, Walter P, Schwarz C, Exadaktylos AK, Woitok BK, Lindner G. Dyskalemias in patients with acute kidney injury presenting to the emergency department are common and independent predictors of adverse outcome. Int J Clin Pract 2021; 75:e13653. [PMID: 32770846 DOI: 10.1111/ijcp.13653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No data concerning the prevalence and risk factors of dyskalemia in acute kidney injury (AKI) exist. We investigated (a) prevalence rates, (b) risk factors and (c) outcome of hypo- and hyperkalemia in emergency patients. METHODS In this cross-sectional analysis, all patients admitted to the emergency department of a large public hospital in Switzerland between January 1st 2017 and December 31st 2018 with measurements of creatinine and potassium were included. Baseline characteristics, medication and laboratory data were extracted. Chart reviews were performed to identify patients with a diagnosis of chronic kidney disease (CKD) and to extract their baseline creatinine. For all other patients, the ADQI backformula was used in order to calculate baseline creatinine. AKI was graduated using creatinine criteria of the acute kidney injury network. Binary logistic regression analysis was used to identify risk factors for appearance of hyperkalemia and outcome. RESULTS AKI was found in 8% of patients. Hyperkalemia was present in 13% and hypokalemia in 11% of patients with AKI. AKI stage, potassium-sparing diuretics, ACE inhibitors and underlying CKD were the strongest risk factors for hyperkalemia. Hyperkalemia as well as profound hypokalemia were independently associated with prolonged length of stay and in-hospital mortality. The study is limited by its dependency on chart review data in order to identify patients with chronic kidney disease and by limitations of the ADQI backformula to calculate baseline creatinine. CONCLUSIONS Dyskalemias are common in emergency patients with AKI and are independent risk factors for adverse outcomes. Potassium-sparing diuretics, ACE-inhibitors, AKIN stage and CKD are predictors of hyperkalemia in AKI.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Emanuel Pluess
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Philipp Walter
- Department of Laboratory Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine 1, Landeskrankenhaus Steyr, Steyr, Austria
| | | | - Bertram K Woitok
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Woitok BK, Funk GC, Walter P, Schwarz C, Ravioli S, Lindner G. Dysnatremias in emergency patients with acute kidney injury: A cross-sectional analysis. Am J Emerg Med 2020; 38:2602-2606. [DOI: 10.1016/j.ajem.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/25/2019] [Accepted: 01/04/2020] [Indexed: 01/24/2023] Open
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Abstract
BACKGROUND Acid base and electrolyte disorders are frequently reported in the early period after renal transplantation. No comprehensive data exist on the prevalence and patterns of, and contributing factors to, electrolyte disturbances in patients with stable long-term allograft function. METHODS We analysed 576 renal transplant recipients (serum creatinine level <2.0 mg/dl) in a cross-sectional study to evaluate the prevalence of electrolyte disorders and the risk factors associated with their occurrence. RESULTS A total of 369 patients (64%) of all allograft recipients (n = 576) showed at least one electrolyte and acid base disorder. The most abundant disorder was hypomagnesaemia (25%, n = 143), followed by hyperkalaemia (12.8%, n = 74), hypercalcaemia (12%, n = 69), hypophosphataemia (11.6%, n = 67), metabolic acidosis (11.1%, n = 61) and hyponatraemia (9%, n = 52). All other electrolyte disorders were rare (<6%). In most cases the electrolyte disorders could be classified as mild. Forty percent of the cases had a combined disorder, but without a preferential pattern of combinations. In a multivariate logistic regression analysis, the most important factors contributing significantly to the occurrence of electrolyte disorders were renal function and concomitant medications. CONCLUSION Acid base and electrolyte disorders are frequently observed in stable renal allograft recipients, but are usually mild. A combination of two or more electrolyte abnormalities often occurs, although no predominant pattern of a unique combination of electrolyte disorder is recognizable.  .
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Affiliation(s)
- Georg Beilhack
- Department of Nephrology and Dialysis, Medical University Vienna, Austria
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Christoph Schwarz
- Department of Internal Medicine I, Pyhrn-Eisenwurzenklinikum, Steyr, Austria
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Stremitzer S, Stift J, Laengle J, Schwarz C, Kaczirek K, Jones RP, Quinn LM, Fenwick SW, Diaz-Nieto R, Poston GJ, Malik HZ. Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma. Ann Surg Oncol 2020; 28:1493-1498. [PMID: 32914390 DOI: 10.1245/s10434-020-09105-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Resection margin status is a known prognosticator in patients who undergo resection for hilar cholangiocarcinoma. However, the influence of an isolated positive circumferential margin on clinical outcome is unclear. METHODS Patients with resected de novo hilar cholangiocarcinoma from two European hepatobiliary centres (Medical University of Vienna and Aintree University Hospital, 2006-2016) were classified according to resection margin status (negative, surgically positive, isolated circumferentially positive) and investigated with respect to overall survival (OS), recurrence-free survival (RFS) and recurrence pattern. RESULTS Eighty-three (48 male/35 female) patients were enrolled. The median age was 64 years (range 33-80). The median follow-up was 21.7 months (range 0.3-92.4). Forty (48%) patients had negative resection margins, 25 (30%) had an isolated positive circumferential margin and 18 (22%) had a positive surgical margin. The 5-year OS rates in patients with negative, isolated positive circumferential and positive surgical resection margins were 47%, 33% and 0%, respectively. Median OS was 45.6, 32.7 and 14.5 months, respectively (log rank, P = 0.011). Upon multivariable Cox regression analysis, resection margin status and lymph node status remained statistically significant (P < 0.05). No difference with respect to RFS and recurrence pattern was found between the groups (P > 0.05). CONCLUSION Our data show that these three resection margin types were associated with different clinical outcomes. Circumferential margin status may therefore serve as a novel prognostic biomarker.
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Affiliation(s)
- Stefan Stremitzer
- Department of General Surgery, Medical University Vienna, Vienna, Austria.
| | - Judith Stift
- Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - Johannes Laengle
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Christoph Schwarz
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - Robert P Jones
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - Leonard M Quinn
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - Stephen W Fenwick
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - Rafael Diaz-Nieto
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - Graeme J Poston
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - Hassan Z Malik
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
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Schwarz C, Fitschek F, Primavesi F, Stättner S, Margonis GA, Weiss MA, Stavrou GA, Oldhafer KJ, Kornprat P, Wundsam H, Fischer I, Längle F, Függer R, Hauer A, Klug R, Kieler M, Prager G, Schindl M, Stremitzer S, Bodingbauer M, Sahora K, Kaczirek K. Metachronous hepatic resection for liver only pancreatic metastases. Surg Oncol 2020; 35:169-173. [PMID: 32889249 DOI: 10.1016/j.suronc.2020.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The value of liver resection (LR) for metachronous pancreatic ductal adenocarcinoma (PDAC) metastases remains controversial. However, in light of increasing safety of liver resections, surgery might be a valuable option for metastasized PDAC in selected patients. METHODS We performed a retrospective, multicenter study including patients undergoing hepatectomy for metachronous PDAC liver metastases between 2004 and 2015 to analyze postoperative outcome and overall survival. All patients were operated with curative intent. Patients with oligometastatic metachronous liver metastasis with definitive chemotherapy (n = 8) served as controls. RESULTS Overall 25 patients in seven centers were included in this study. The median age at the time of LR was 63.8 years (56.9-69.9) and the median number of metastases in the liver was 1 (IQR 1-2). There were eight non-anatomical resections (32%), 15 anatomical minor (60%) and 2 major LR (8%). Postoperative complications occurred in eleven patients (eight Clavien-Dindo grade I complications (32%) and three grade IIIa complications (12%), respectively). The 30-day mortality was 0%. The median length of stay was 8.6 days (IQR 5-11). Median overall survival following LR was 36.8 months compared to 9.2 months in patients with metachronous liver metastasis with chemotherapy (p = 0007). DISCUSSION Liver resection for metachronous PDAC metastasis is safe and feasible in selected patients. To address general applicability and to find factors for patient selection, larger trials are urgently warranted.
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Affiliation(s)
- C Schwarz
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
| | - F Fitschek
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
| | - F Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria
| | - S Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria
| | - G A Margonis
- Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - M A Weiss
- Department of Surgery, Northwell Health Cancer Institute, New York, USA
| | - G A Stavrou
- Department of Surgery, Division of HPB Surgery, Asklepios Campus Barmbek, Hamburg, Germany; Semmelweis University Budapest, Asklepios Campus Hamburg, Germany
| | - K J Oldhafer
- Department of Surgery, Division of HPB Surgery, Asklepios Campus Barmbek, Hamburg, Germany; Semmelweis University Budapest, Asklepios Campus Hamburg, Germany
| | - P Kornprat
- Department of Surgery, Medical University Graz, Graz, Austria
| | - H Wundsam
- Department of Surgery, Hospital Sisters of Mercy Linz, Linz, Austria
| | - I Fischer
- Department of Surgery, Hospital Sisters of Mercy Linz, Linz, Austria
| | - F Längle
- Department of Surgery, LK Wiener Neustadt, Wiener Neustadt, Austria
| | - R Függer
- Department of Surgery, Hospital Sisters of Mercy Linz, Linz, Austria
| | - A Hauer
- Department of Surgery, KH Horn, Austria
| | - R Klug
- Department of Surgery, KH Horn, Austria
| | - M Kieler
- Department of Internal Medicine/Division of Oncology, Medical University Vienna, Austria
| | - G Prager
- Department of Internal Medicine/Division of Oncology, Medical University Vienna, Austria
| | - M Schindl
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
| | - S Stremitzer
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
| | - M Bodingbauer
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
| | - K Sahora
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria.
| | - K Kaczirek
- Department of Surgery/Division of General Surgery, Medical University Vienna, Austria
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Eschenhagen P, Grehn C, Bacher P, Scheffold A, Schwarz C. WS12.2 Antigen-specific T cell response in Aspergillus fumigatus conditions in cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hong G, Moss R, Marshall B, Quon B, Eschenhagen P, Schwarz C. P107 ECFS/CFF global survey on diagnosis and treatment of Aspergillus fumigatus-related conditions. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holz F, Can E, Kallinich T, Schwarz C. ePS2.09 Defining different stages of cystic fibrosis arthropathy using ultrasound imaging and clinical scoring. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Strehlow AL, Bremer W, Fronia N, Goldbeck A, Ellemunter H, Schwarz C, Smaczny C, Stähle B, Schlangen M. ePS5.06 Assessment of patient satisfaction as a means of quality development and patient participation in German cystic fibrosis centres. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30325-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grehn C, Eschenhagen P, Temming S, Düesberg U, Neumann K, Schwarz C. P051 Urban life as risk factor for aspergillosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Anthony H, Tabak R, Morshed AB, Schwarz C, Phad A, Haire-Joshu D. Awareness and accuracy of height and weight among mothers and their preschool-aged children. Public Health 2020; 182:151-154. [PMID: 32320905 PMCID: PMC7265393 DOI: 10.1016/j.puhe.2020.02.005] [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: 07/08/2019] [Revised: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A constant challenge in addressing the issue of obesity is the validity and reliability of self-reported measurements to calculate body mass index, that assesses the prevalence of obesity in a population. The objective of this study is to analyze both awareness and accuracy of mothers who are overweight or obese, in reporting their own and their child's height and weight measurements. STUDY DESIGN cross-sectional study. METHODS In this study, mothers were asked over phone to self-report height and weight for them and their child. This was followed by objective measurement of maternal and child height and weight by study staff in a clinical setting. The descriptive and statistical analysis of the data obtained were carried out using SAS software. RESULTS 1) The mean weight of mothers who inaccurately self-reported their weight was 9.5 kg greater than the mean weight of those who reported accurately (P < 0.001). (2) Despite being aware of, and reporting their own measurements, 50% (n = 116) of mothers reported not knowing their child's height and 23% (n = 54) of them reported not knowing their child's weight. CONCLUSION Strategies to tackle both maternal awareness and accuracy of child's measurements can help with early identification of child's obesity risk and prevention of long-term consequences.
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Affiliation(s)
- H Anthony
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Gastroenterology, Internal Medicine, Washington University in St. Louis, USA.
| | - R Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - C Schwarz
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - A Phad
- Center for Diabetes Translation and Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63110, USA
| | - D Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Internal Medicine, Washington University School of Medicine, Washington University in St. Louis, USA
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Carvalho D, St. Louis E, Lowe V, Schwarz C, Boeve B, Przybelski S, Reddy A, Mielke M, Knopman D, Petersen R, Jack C, Prashanthi V. tau-PET signal elevation in selective basal forebrain nuclei is associated with excessive daytime sleepiness in cognitively unimpaired middle aged and older adults. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kampf S, Sponder M, Bergler-Klein J, Sandurkov C, Fitschek F, Bodingbauer M, Stremitzer S, Kaczirek K, Schwarz C. Physical recovery after laparoscopic vs. open liver resection – A prospective cohort study. Int J Surg 2019; 72:224-229. [DOI: 10.1016/j.ijsu.2019.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
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Schwarz C, Wirth M, Gerischer L, Grittner U, Witte AV, Köbe T, Flöel A. Effects of Omega-3 Fatty Acids on Resting Cerebral Perfusion in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial. J Prev Alzheimers Dis 2019; 5:26-30. [PMID: 29405229 DOI: 10.14283/jpad.2017.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Alteration of cerebral perfusion can be considered as a possible therapeutic target in mild cognitive impairment. This randomized, placebo-controlled, double-blind proof-of-concept study assessed effects of omega-3 fatty acids on cerebral perfusion in patients with mild cognitive impairment. In thirteen patients (omega:n=5; placebo:n=8) cerebral perfusion was measured before and after 26-weeks intervention within posterior cortical regions using magnetic resonance imaging. There was a medium effect of intervention on cerebral blood flow (η2=0.122) and blood volume (η2=0.098). The omega group showed an increase in blood flow (mean difference: 0.02 [corresponds to 26.1%], 95% confidence interval:0.00-0.05) and blood volume (mean difference: 0.08 [corresponds to 18.5%], 95% confidence interval:0.01-0.15), which was not observed in the placebo group. These preliminary findings suggest that omega-3 fatty acids supplementation may improve perfusion in cerebral regions typically affected in mild cognitive impairment.Regulation of perfusion may help to maintain brain structure and function and potentially delay conversion to dementia.
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Affiliation(s)
- C Schwarz
- Claudia Schwarz, MSc, Charité - Universitätsmedizin Berlin, NeuroCure Clinical Research Center NCRC, Charitéplatz 1, D-10117 Berlin, E-mail: , Phone: + 49-30-450-660395, Fax: + 49-30-450-7560280
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Schwarz C, Plass I, Fitschek F, Punzengruber A, Mittlböck M, Kampf S, Asenbaum U, Starlinger P, Stremitzer S, Bodingbauer M, Kaczirek K. The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection. Sci Rep 2019; 9:8421. [PMID: 31182746 PMCID: PMC6557886 DOI: 10.1038/s41598-019-44815-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022] Open
Abstract
Postoperative liver dysfunction remains a major concern following hepatic resection. In order to identify patients who are at risk of developing liver dysfunction, indocyanine green (ICG) clearance has been proposed to predict postoperative liver function. All patients who underwent liver resection at the Medical University Vienna, Austria between 2006 and 2015 with preoperative ICG clearance testing (PDR, R15) were analyzed in this study. Postoperative liver dysfunction was analyzed as defined by the International Study Group of Liver Surgery. Overall, 698 patients (male: 394 (56.4%); female: 304 (43.6%)) with a mean age of 61.3 years (SD: 12.9) were included in this study, including 313 minor liver resections (44.8%) and 385 major liver resections (55.2%). One hundred and seven patients developed postoperative liver dysfunction after liver resection (15.3%). Factors associated with liver dysfunction were: male sex (p = 0.043), major liver resection (p < 0.0001), and preoperative ICG clearance (PDR (p = 0.002) and R15 (p < 0.0001)). Notably ICG clearance was significantly associated with liver dysfunction in minor and major liver resections respectively and remained a predictor upon multivariable analysis. An optimal cut-off for preoperative ICG clearance to accurately predict liver dysfunction was PDR < 19.5%/min and R15 > 5.6%. To the best of our knowledge, this is the largest study analyzing the predictive value of preoperative ICG clearance assessment in patients undergoing liver resection. ICG clearance is useful to identify patients at risk of postoperative liver dysfunction.
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Affiliation(s)
- Christoph Schwarz
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Immanuel Plass
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Antonia Punzengruber
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martina Mittlböck
- Section for Medical Statistics, Medical University Vienna, Vienna, Austria
| | - Stephanie Kampf
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Ulrika Asenbaum
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Patrick Starlinger
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Stefan Stremitzer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria.
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Eschenhagen P, Bacher P, Kaufmann S, Rickerts V, Seidel K, Holz F, Scheffold A, Mall M, Schwarz C. P169 Longitudinal observation of azol-resistance Aspergillus fumigatus in patients with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Holz F, Kallinich T, Röhmel J, Eschenhagen P, Mehl A, Staab D, Kaufmann S, Gräber S, Mall M, Schwarz C. WS17-1 Prospective evaluation of arthropathy in patients with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Downey D, Flume P, Jain M, Fajac I, Schwarz C, Pressler T, Van Koningsbruggen-Rietschel S, Taylor-Cousar J, Horsley A, Sutharsan S, Miller J, Poirier G, Jiang J, Inoue T, Wilson S, Lee PS, Gilmartin G. WS06-1 Initial results evaluating combinations of the novel CFTR corrector PTI-801, potentiator PTI-808, and amplifier PTI-428 in cystic fibrosis subjects. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eschenhagen P, Bacher P, Kaufmann S, Rickerts V, Seidel K, Röhmel J, Mehl A, Staab D, Gräber S, Holz F, Scheffold A, Mall M, Schwarz C. P165 Prospective evaluation of Aspergillus fumigatus-specific IgG in patients with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eder M, Schwarz C, Kammer M, Jacobsen N, Stavroula ML, Cowan MJ, Chongkrairatanakul T, Gaston R, Ravanan R, Ishida H, Bachmann A, Alvarez S, Koch M, Garrouste C, Duffner UA, Cullis B, Schaap N, Medinger M, Sørensen SS, Dauber E, Böhmig G, Regele H, Berlakovich GA, Wekerle T, Oberbauer R. Allograft and patient survival after sequential HSCT and kidney transplantation from the same donor-A multicenter analysis. Am J Transplant 2019; 19:475-487. [PMID: 29900661 PMCID: PMC6585795 DOI: 10.1111/ajt.14970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 01/25/2023]
Abstract
Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 μmol/l (interquartile range [IQR] 72-99) in the tolerant cohort and 118 μmol/l (IQR 99-143) in the control group. Mixed linear-model showed around 29% lower average creatinine levels throughout follow-up in the tolerant group (P < .01). Our data clearly show stable renal graft function without long-term immunosuppression for many years, suggesting permanent donor-specific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.
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Affiliation(s)
- Michael Eder
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
| | - Christoph Schwarz
- Department of SurgeryDivision of TransplantationMedical University ViennaViennaAustria
| | - Michael Kammer
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria,Center for Medical StatisticsInformatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Niels Jacobsen
- Department of HaematologyFinsen CentreNational University Hospital, RigshospitaletCopenhagenDenmark
| | | | - Morton J. Cowan
- Pediatric Allergy Immunology and Blood and Marrow Transplant DivisionUniversity of California San FranciscoBenioff Children's HospitalSan FranciscoCAUSA
| | | | - Robert Gaston
- Department of MedicineDivision of NephrologyUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Hideki Ishida
- Department of UrologyTokyo Woman′s Medical UniversityTokyoJapan
| | - Anette Bachmann
- Department of Internal Medicine, Neurology and DermatologyDivision of NephrologyUniversity Hospital LeipzigLeipzigGermany
| | | | - Martina Koch
- Department of Hepatobiliary and Transplantation SurgeryUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Cyril Garrouste
- Department of NephrologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Ulrich A. Duffner
- Helen DeVos Children's HospitalBlood and Bone Marrow Transplant ProgramGrand RapidsMIUSA
| | - Brett Cullis
- Renal UnitGreys HospitalPietermaritzburgSouth Africa
| | - Nicolaas Schaap
- Department of HematologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Michael Medinger
- Division of Hematology and Internal MedicineDepartment of MedicineUniversity Hospital BaselBaselSwitzerland
| | | | - Eva‐Maria Dauber
- Department of Blood Group Serology and Transfusion MedicineMedical University of ViennaViennaAustria
| | - Georg Böhmig
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
| | - Heinz Regele
- Clinical Institute of PathologyMedical University of ViennaViennaAustria
| | | | - Thomas Wekerle
- Section of Transplantation ImmunologyDepartment of SurgeryMedical University of ViennaViennaAustria
| | - Rainer Oberbauer
- Department of Internal Medicine IIIDivision of Nephrology and DialysisMedical University of ViennaViennaAustria
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Farkas AM, Baranyi U, Böhmig GA, Unger L, Hopf S, Wahrmann M, Regele H, Mahr B, Schwarz C, Hock K, Pilat N, Kristo I, Mraz J, Lupinek C, Thalhamer J, Bond G, Kuessel L, Wlodek E, Martin J, Clatworthy M, Pettigrew G, Valenta R, Wekerle T. Allograft rejection is associated with development of functional IgE specific for donor MHC antigens. J Allergy Clin Immunol 2019; 143:335-345.e12. [PMID: 30009843 DOI: 10.1016/j.jaci.2018.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Donor-specific antibodies of the IgG isotype are measured routinely for diagnostic purposes in renal transplant recipients and are associated with antibody-mediated rejection and long-term graft loss. OBJECTIVE This study aimed to investigate whether MHC-specific antibodies of the IgE isotype are induced during allograft rejection. METHODS Anti-MHC/HLA IgE levels were measured in sera of mice grafted with skin or heart transplants from various donor strains and in sera of kidney transplant patients with high levels of HLA IgG. Mediator release was triggered in vitro by stimulating basophils that were coated with murine or human IgE-positive serum, respectively, with specific recombinant MHC/HLA antigens. Kidney tissue samples obtained from organ donors were analyzed by using flow cytometry for cells expressing the high-affinity receptor for IgE (FcεRI). RESULTS Donor MHC class I- and MHC class II-specific IgE was found on acute rejection of skin and heart grafts in several murine strain combinations, as well as during chronic antibody-mediated heart graft rejection. Anti-HLA IgE, including donor HLA class I and II specificities, was identified in a group of sensitized transplant recipients. Murine and human anti-MHC/HLA IgE triggered mediator release in coated basophils on stimulation with specific MHC/HLA antigens. HLA-specific IgE was not linked to atopy, and allergen-specific IgE present in allergic patients did not cross-react with HLA antigens. FcεRI+ cells were found in the human renal cortex and medulla and provide targets for HLA-specific IgE. CONCLUSION These results demonstrate that MHC/HLA-specific IgE develops during an alloresponse and is functional in mediating effector mechanisms.
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Affiliation(s)
- Andreas M Farkas
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ulrike Baranyi
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria; Cardiac Surgery Laboratory, Medical University of Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lukas Unger
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Hopf
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Wahrmann
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Heinz Regele
- Institute of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Mahr
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Schwarz
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Karin Hock
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Nina Pilat
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Kristo
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Jasmin Mraz
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Physiology and Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Josef Thalhamer
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Gregor Bond
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kuessel
- Department for Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Wlodek
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Jack Martin
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Menna Clatworthy
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gavin Pettigrew
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Physiology and Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Stremitzer S, Graf A, Neudert B, Herac M, Beer A, Schwarz C, Wrba F, Kaczirek K, Stift J. Immune checkpoints and liver resection after neoadjuvant chemotherapy including bevacizumab in patients with colorectal liver metastases. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Cystic fibrosis (CF) is an inherited incurable multi-organ disease. Improvement in treatment approaches over the last 20 years have led to an increased life expectancy where the number of adult patients has doubled and will continue to increase exponentially. Due to the use of new substances which modulate the basic defect, a substantial improvement in the prognosis can be assumed but the existing healthcare structures in Germany do not meet these rising needs. With more than 50% of patients being adults, there are only very few internal medicine centers available. Only approximately one third of the patients are treated in adult health centers. Adolescence in particular is a very vulnerable phase of the disease, the risk of comorbidities is increased and adherence to the very laborious treatment recommendations is as a rule low. While in many other countries transition programs have been evaluated and implemented for more than 20 years, in Germany there have only been rudimentary approaches to transition. Meanwhile investigations are available on the perceptions of adolescents with respect to coping with the disease and their treatment needs, including the perception of the time when the transition process should begin. Successful transition seems to be performed best in combined pediatric and adult centers, with the back-up of an experienced multidisciplinary team of healthcare providers.
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Affiliation(s)
- D Staab
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - C Schwarz
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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50
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Schwarz C, Wirth M, Benson G, Köbe T, Stekovic S, Madeo F, Flöel A. P57. Safety and tolerability of spermidine supplementation: A translational study in mice and older adults with subjective cognitive decline. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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