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Gearhart A, Esteso P, Sperotto F, Elia EG, Michelson KA, Lipsitz S, Sun M, Knoll C, Vanderpluym C. Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients. Pediatr Emerg Care 2023; 39:907-912. [PMID: 37246140 PMCID: PMC10981975 DOI: 10.1097/pec.0000000000002980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED). METHODS A single-center retrospective cohort study examining all ED encounters from patients aged younger than 19 years between January 2016 and March 2020, during which a complete blood count was obtained. Univariate analysis and multivariable logistic regression were used to test the presence of NRBCs as an independent predictor of patient-related outcomes. RESULTS The prevalence of NRBCs was 8.9% (4195/46,991 patient encounters). Patient with NRBCs were younger (median age 4.58 vs 8.23 years; P < 0.001). Those with NRBCs had higher rates of in-hospital mortality (30/2465 [1.22%] vs 65/21,741 [0.30%]; P < 0.001), sepsis (19% vs 12%; P < 0.001), shock (7% vs 4%; P < 0.001), and cardiopulmonary resuscitation (CPR) (0.62% vs 0.09%; P < 0.001). They were more likely to be admitted (59% vs 51%; P < 0.001), have longer median hospital length of stay {1.3 (interquartile range [IQR], 0.22-4.14) vs 0.8 days (IQR, 0.23-2.64); P < 0.001}, and median intensive care unit (ICU) length of stay (3.9 [IQR, 1.87-8.72] vs 2.6 days [IQR, 1.27-5.83]; P < 0.001). Multivariable regression revealed presence of NRBCs as an independent predictor for in-hospital mortality (adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.38-3.53; P < 0.001), ICU admission (aOR, 1.30; 95% CI, 1.11-1.51; P < 0.001), CPR (aOR, 3.83; 95% CI, 2.33-6.30; P < 0.001), and 30-day return to the ED (aOR, 1.15; 95% CI, 1.15-1.26; P < 0.001). CONCLUSIONS The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.
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Affiliation(s)
- Addison Gearhart
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul Esteso
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Francesca Sperotto
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Eleni G. Elia
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Kenneth A. Michelson
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Stu Lipsitz
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Mingwei Sun
- Clinical Research Informatics Team, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Christopher Knoll
- Department of Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, 85016, USA
| | - Christina Vanderpluym
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
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Mattia D, Matney C, Zangwill S, Wisotzkey B, Rhee E, Knoll C. Prinzmetal angina in a child with actin gene ACTC1 mutation. Cardiol Young 2023; 33:2440-2442. [PMID: 37489518 DOI: 10.1017/s1047951123002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Prinzmetal angina is a rare cause of intermittent chest pain in paediatrics. Here, we report the case of a 2-year-old female who presented with episodic chest pain, malaise, diaphoresis, fatigue, and poor perfusion on exam. During her hospitalisation, these episodes were associated with significant low cardiac output as evidenced by lactic acidosis and low mixed venous oxygen saturations. Her workup revealed an actin alpha cardiac muscle 1 (ACTC1) gene mutation and associated left ventricular non-compaction with decreased systolic function. She was started on oral heart failure medications as well as a calcium channel blocker but continued to have episodes which were found to promptly resolve with nitroglycerine. She was ultimately listed for cardiac transplant given her perceived risk of sudden death.
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Affiliation(s)
- Donald Mattia
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
| | - Chelsea Matney
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
| | | | | | - Edward Rhee
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
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3
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Gearhart A, Esteso P, Sperotto F, Elia E, Sun M, Knoll C, Michelson K, VanderPluym C. 275 Association of Nucleated Red Blood Cells With Outcomes for Children in the Emergency Department. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O'Connor MJ, Lorts A, Kwiatkowski D, Butts R, Barnes A, Jeewa A, Knoll C, Fenton M, McQueen M, Cousino MK, Shugh S, Rosenthal DN. Learning networks in pediatric heart failure and transplantation. Pediatr Transplant 2021; 25:e14073. [PMID: 34138489 DOI: 10.1111/petr.14073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Learning networks have emerged in medicine as a novel organizational structure that contains elements of quality improvement, education, and research with the goal of effecting rapid improvements in clinical care. In this article, the concept of a learning network is defined and highlighted in the field of pediatric heart failure and transplantation. METHODS Learning networks are defined, with particular attention paid to the recent creation of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) for children with heart failure and those being supported with ventricular assist devices (VAD). RESULTS The mission, goals, and organizational structure of ACTION are described, and recent initiatives promoted by ACTION are highlighted, such as stroke reduction initiatives, practice harmonization protocols, and use of ACTION data to support the recent US Food and Drug Administration approval of newer VAD for pediatric patients. CONCLUSIONS The learning network, exemplified by ACTION, is distinguished from traditional clinical research collaboratives by contributions in research, quality improvement, patient-reported outcomes, and education, and serves as an effective vehicle to drive clinical improvement in the care of children with advanced heart failure.
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Affiliation(s)
- Matthew J O'Connor
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Ryan Butts
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Medical Center of Dallas, Dallas, TX, USA
| | | | - Aamir Jeewa
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher Knoll
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | | | | | - Svetlana Shugh
- Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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5
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Wang Y, Makadia R, Knoll C, Hardin J, Voss EA, Fife D, Davis K, Sloan S. Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration. BMC Gastroenterol 2021; 21:121. [PMID: 33731009 PMCID: PMC7967955 DOI: 10.1186/s12876-021-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn's disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent. METHODS UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients' treatment, disease progression and overall health care utilization prior to initiating biologic agents. RESULTS Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased. CONCLUSIONS Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.
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Affiliation(s)
- Yiting Wang
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Rupa Makadia
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Christopher Knoll
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Jill Hardin
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Erica A Voss
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Daniel Fife
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Kourtney Davis
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Sheldon Sloan
- Janssen Global Services, LLC, Raritan, 08869, NJ, USA
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Knoll C, Kaufman B, Chen S, Murray J, Cohen H, Sourkes BM, Rosenthal DN, Hollander SA. Palliative Care Engagement for Pediatric Ventricular Assist Device Patients: A Single-Center Experience. ASAIO J 2020; 66:929-932. [PMID: 32740354 DOI: 10.1097/mat.0000000000001092] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Outcomes in pediatric patients with ventricular assist devices (VADs) for advanced heart failure (HF) are improving, but the risk of associated morbidity and mortality remains substantial. Few data exist on the involvement of pediatric palliative care (PPC) in this high-risk patient population. We aimed to characterize the extent of palliative care involvement in the care of patients requiring VAD placement at our institution. Single-center retrospective chart review analyzing all VAD patients at a large pediatric center over a 4 year period. Timing and extent of palliative care subspecialty involvement were analyzed. Between January 2014 and December 2017, 55 HF patients underwent VAD implantation at our institution. Pediatric palliative care utilization steadily increased over consecutive years (2014: <10% of patients, 2015: 20% of patients, 2016: 50% of patients, and 2017: 65% of patients) and occurred in 42% (n = 23) of all patients. Of these, 57% (n = 13) occurred before VAD placement while 43% (n = 10) occurred after implantation. Patients who died during their VAD implant hospitalization (24%, n = 13) were nearly twice as likely to have PPC involvement (62%) as those who reached transplant (38%). Of those who died, patients who had PPC involved in their care were more likely to limit resuscitation efforts before their death. Four patients had advanced directives in place before VAD implant, of which three had PPC consultation before device placement. Three families (5%) refused PPC involvement when offered. Pediatric palliative care utilization is increasing in VAD patients at our institution. Early PPC involvement occurred in the majority of patients and appears to lead to more frequent discussion of goals-of-care and advanced directives.
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Affiliation(s)
- Christopher Knoll
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Beth Kaufman
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Sharon Chen
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Jenna Murray
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Harvey Cohen
- Division of Hematology/Oncology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Barbara M Sourkes
- Division of Pediatric Critical Care, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - David N Rosenthal
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Seth A Hollander
- From the Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
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Wilcox MA, Villasis-Keever A, Sena AG, Knoll C, Fife D. Evaluation of disability in patients exposed to fluoroquinolones. BMC Pharmacol Toxicol 2020; 21:40. [PMID: 32493505 PMCID: PMC7268406 DOI: 10.1186/s40360-020-00415-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fluoroquinolones are used for conditions including sinusitis, bronchitis, and urinary tract infections. It has been suggested that exposure to fluoroquinolones for these conditions is associated with disability resulting from adverse events in 2 or more organ systems. The objectives were to: describe: 1) fluoroquinolone, azithromycin, and sulfamethoxazole / trimethoprim utilization for these infections; 2) the rate of disability associated with exposure to each of these antibiotic classes and adverse events in 2 or more system organ classes, and 3) compare outcome rates for each of the antibiotic classes. METHODS This study was conducted using administrative data to mitigate the limitations of spontaneous reports. The sampling frame was a U.S. population with both medical and disability insurance, including patients with the above uncomplicated infections who were prescribed the antibiotics of interest. The primary outcome was an incident short-term disability claim associated with adverse events in 2 different organ systems within 120 days of exposure. A matched analysis was used to compare the outcome for patients receiving each of the drug classes. RESULTS After propensity score matching, there were 119,653 individuals in each of the exposure groups. There were 264 fluoroquinolone associated disability events and 243 azithromycin/ sulfamethoxazole associated disability events (relative risk =1.09 (95% CI: 0.92-1.30; calibrated p = 0.84)). The results were not significantly different from the null hypothesis of no difference between groups. CONCLUSION Comparative assessments are difficult to conduct in spontaneous reports. This examination of disability associated with adverse events in different system organ classes showed no difference between fluoroquinolones and azithromycin or sulfamethoxazole in administrative data.
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Affiliation(s)
- Marsha A Wilcox
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA.
| | | | - Anthony G Sena
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Christopher Knoll
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
| | - Daniel Fife
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Road, Titusville, NJ, 08560, USA
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8
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Hawkins B, Ventresco C, Hellinger A, VanderPluym C, Knoll C. Safety and Feasibility of Home INR Monitoring for Outpatient Ventricular Assist Device Support in Children. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.079] [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] Open
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9
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Knoll C, Geiger J. [Where have all the condoms gone?]. MMW Fortschr Med 2019; 161:25-26. [PMID: 31175594 DOI: 10.1007/s15006-019-0574-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher Knoll
- Münchner Aids-Hilfe e.V., Lindwurmstraße 71, D-80337, München, Deutschland.
| | - Jan Geiger
- Fachstelle Sexuelle Gesundheit des Sub e.V., München, Deutschland
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10
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Knoll C, Chen S, Murray JM, Dykes JC, Yarlagadda VV, Rosenthal DN, Almond CS, Maeda K, Shin AY. A Quality Bundle to Support High-Risk Pediatric Ventricular Assist Device Implantation. Pediatr Cardiol 2019; 40:1159-1164. [PMID: 31087144 DOI: 10.1007/s00246-019-02123-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/03/2019] [Indexed: 11/27/2022]
Abstract
Pediatric ventricular assist device (VAD) implantation outcomes are increasingly promising for children with dilated cardiomyopathy and advanced decompensated heart failure (ADHF). VAD placement in patients with clinical features such as complex congenital cardiac anatomy, small body size, or major comorbidities remains problematic. These comorbidities have been traditionally prohibitive for VAD consideration leaving these children as a treatment-orphaned population. Here we describe the quality bundle surrounding these patients with ADHF considered high risk for VAD implantation at our institution. Over a 7-year period, a quality bundle aimed at the peri-operative care for children with high-risk features undergoing VAD implantation was incrementally implemented at a tertiary children's hospital. Patients were considered high risk if they were neonates (< 30 days), had single-ventricle physiology, non-dilated cardiomyopathy, biventricular dysfunction, or significant comorbidities. The quality improvement bundle evolved to include (1) structured team-based peri-operative evaluation, (2) weekly VAD rounds addressing post-operative device performance, (3) standardized anticoagulation strategies, and (4) a multidisciplinary system for management challenges. These measures aimed to improve communication, standardize management, allow for ongoing process improvement, and incorporate principles of a high-reliability organization. Between January 2010 and December 2017, 98 patients underwent VAD implantation, 48 (49%) of which had high-risk comorbidities and a resultant cohort survival-to-transplant rate of 65%. We report on the evolution of a quality improvement program to expand the scope of VAD implantation to patients with high-risk clinical profiles. This quality bundle can serve as a template for future large-scale collaborations to improve outcomes in these treatment-orphaned subgroups.
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Affiliation(s)
- Christopher Knoll
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Jenna M Murray
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - John C Dykes
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Vamsi V Yarlagadda
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - David N Rosenthal
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Christopher S Almond
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Katsuhide Maeda
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Andrew Y Shin
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
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Sharma R, Dunn A, Aschman D, Cheng D, Wheeler A, Soni A, McGuinn C, Knoll C, Stein DT, Young G, French J, Sanders J, Davis JA, Tarantino M, Lim M, Gruppo R, Sidonio R, Ahuja S, Carpenter S, Pipe S, Shapiro A. Radionuclide synovectomy/synoviorthesis (RS) in persons with bleeding disorders: A review of impact of national guidance on frequency of RS using the ATHNdataset. Haemophilia 2017; 23:e385-e388. [DOI: 10.1111/hae.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- R. Sharma
- BloodCenter of Wisconsin; Milwaukee WI USA
| | - A. Dunn
- Nationwide Children's Hospital; Columbus OH USA
| | - D. Aschman
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - D. Cheng
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - A. Wheeler
- Vanderbilt University Medical Center; Nashville TN USA
| | - A. Soni
- Center for Comprehensive Care and Diagnosis of Inherited Blood Disorders; Orange CA USA
| | | | - C. Knoll
- Arizona Hemophilia and Thrombosis Center; University of Arizona Health Sciences Center; Tucson AZ USA
| | - D. T. Stein
- Northwest Ohio Hemophilia Treatment Center; Toledo OH USA
| | - G. Young
- Childrens Hospital Los Angeles; Los Angeles CA USA
| | - J. French
- Palmetto Health Richland; Columbia SC USA
| | - J. Sanders
- Cook Children's Hospital; Fort Worth Bleeding Disorders Program; Fort Worth TX USA
| | - J. A. Davis
- University of Miami Comprehensive Pediatric Hemophilia Treatment Center; Miami FL USA
| | - M. Tarantino
- Bleeding and Clotting Disorders Institute; University of Illinois College of Medicine-Peoria; Peoria IL USA
| | - M. Lim
- UNC Comprehensive Hemophilia Diagnostic and Treatment Center; Chapel Hill NC USA
| | - R. Gruppo
- Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - R. Sidonio
- Emory/Children's Healthcare of Atlanta Comprehensive Hemophilia Program; Atlanta GA USA
| | - S. Ahuja
- Rainbow Babies & Children's Hospital; University Hospitals Case Medical Center; Cleveland OH USA
| | | | - S. Pipe
- Department of Pediatrics and Pathology; University of Michigan; Ann Arbor MI USA
| | - A. Shapiro
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
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Stroh C, Köckerling F, Lange V, Wolff S, Knoll C, Bruns C, Manger T. Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB—Data Analysis of German Bariatric Surgery Registry. Obes Surg 2016; 27:445-453. [DOI: 10.1007/s11695-016-2340-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Stroh C, Weiner R, Wolff S, Knoll C, Manger T. [Revisional surgery and reoperations in obesity and metabolic surgery : Data analysis of the German bariatric surgery registry 2005-2012]. Chirurg 2016; 86:346-54. [PMID: 24824002 DOI: 10.1007/s00104-014-2762-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Increasing numbers of interventions for obesity and metabolic surgery have led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures. Evidence-based guidelines for indications and choice of procedure for revisional surgery do not currently exist. AIM The spectrum of various revisional and redo operations following standard operative procedures for obesity and metabolic surgery is presented based on current data from the German bariatric surgery registry (GBSR, German nationwide survey on quality assurance in bariatric surgery) and a literature search. MATERIAL AND METHODS Since 1 January 2005, the current situation of bariatric surgery has been examined using the GBSR. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Since 2005 a total of 24,070 primary bariatric procedures, 2070 revisional procedures and 1124 redo operations were analyzed. The study evaluated 1021 revisional and 491 redo operations after gastric banding (GB), 443 redo operations after sleeve gastrectomy (SG) and 306 revisional procedures and 10 redo operations after a Roux-en-Y gastric bypass (RYGBP). RESULTS Reoperations of GB to SG were performed in 240 cases. The complication rate for GB removal and SG showed a significantly higher leakage rate for one step operations than for two step procedures of 3.3% vs. 0.0%. Conversion of GB to RYGBP was performed in 402 operations without any significant differences between one and two step approaches (1.9% vs. 2.2%). The specific complication rate in the 443 interventions in patients for conversion from SG to RYGBP was 10.8% which is higher than for primary SG (4.9%) and RYGBP (5.3%). CONCLUSION Compared with the primary surgical procedures redo operations and revisional procedures have significantly higher complication rates. The data evaluated show that strong and differentiated indications are necessary for revisional and redo operations particularly in cases of therapy or metabolic failure.
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Affiliation(s)
- C Stroh
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548, Gera, Deutschland,
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14
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Antun A, Monahan PE, Manco-Johnson MJ, Callaghan MU, Kanin M, Knoll C, Carpenter SL, Davis JA, Guerrera MF, Kruse-Jarres R, Ragni MV, Witmer C, McCracken CE, Kempton CL. Inhibitor recurrence after immune tolerance induction: a multicenter retrospective cohort study. J Thromb Haemost 2015; 13:1980-8. [PMID: 26382916 PMCID: PMC4639409 DOI: 10.1111/jth.13143] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 04/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immune tolerance induction (ITI) in patients with congenital hemophilia A is successful in up to 70%. Although there is growing understanding of predictors of response to ITI, the probability and predictors of inhibitor recurrence after successful ITI are not well understood. OBJECTIVES To determine the association of clinical characteristics, particularly adherence to factor VIII (FVIII) prophylaxis after ITI, with inhibitor recurrence in patients with hemophilia A who were considered tolerant after ITI. METHODS In this multicenter retrospective cohort study, 64 subjects with FVIII level < 2% who were considered successfully tolerant after ITI were analyzed to estimate the cumulative probability of inhibitor recurrence using the Kaplan-Meier method. The association of clinical characteristics with inhibitor recurrence was assessed using logistic regression. RESULTS A recurrent inhibitor titer ≥ 0.6 BU mL(-1) occurred at least once in 19 (29.7%) and more than once in 12 (18.8%). The probability of any recurrent inhibitor at 1 and 5 years was 12.8% and 32.5%, respectively. Having a recurrent inhibitor was associated with having received immune modulation during ITI (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2-22.4) and FVIII recovery of < 85% at the end of ITI (OR 2.6, 95% CI 1.3-5.9) but was not associated with adherence to post-ITI prophylactic FVIII infusion (OR 0.5, 95% CI 0.06-4.3). CONCLUSIONS The use of immune modulation therapy during ITI and lower FVIII recovery at the end of ITI appear to be associated with an increased risk of inhibitor recurrence after successful ITI. Adherence to post-ITI prophylactic FVIII infusions is not a major determinant of recurrence.
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Affiliation(s)
- A Antun
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - P E Monahan
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - M J Manco-Johnson
- Hemophilia and Thrombosis Center and Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - M Kanin
- Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - C Knoll
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | - J A Davis
- Department of Pediatrics, University of Miami, Miami, FL, USA
| | - M F Guerrera
- Children's National Medical Center, Washington, DC, USA
| | - R Kruse-Jarres
- Department of Medicine, Tulane University, New Orleans, LA, USA
| | - M V Ragni
- Department of Medicine, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA
| | - C Witmer
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C E McCracken
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - C L Kempton
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
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Stroh C, Weiner R, Wolff S, Knoll C, de Zwaan M, Manger T, Adipositas K. [Comment on Gender-Specific Aspects in Obesity and Metabolic Surgery--Analysis of Data from the German Bariatric Surgery Registry]. Zentralbl Chir 2015; 140:285-93. [PMID: 25906018 DOI: 10.1055/s-0034-1396294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The current situation in obesity and metabolic surgery since January 2005 has been investigated with the help of the quality assurance study on surgical therapy for obesity = German Bariatric Surgery Registry (GBSR). The data were acquired and analysed in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University. METHODS Data acquisition was done with the help of an online database. On a voluntary basis, all obesity and metabolic surgical interventions since 2005 have been recorded. In addition to the surgical data, the findings of the yearly follow-up investigations were recorded. RESULTS Since 2005 there have been 1,263 gastric balloon procedures, 11,840 sleeve gastrectomies, 13,722 Roux-en-Y gastric bypasses and 3999 gastric banding operations. The average age of the male patients in all interventions was significantly higher. The average BMI of female patients who received a gastric banding or a gastric balloon procedure was significantly lower than that of the male patients. Men exhibited a higher incidence of comorbidities than women. CONCLUSION The number of obesity and metabolic surgical interventions in Germany is continuously increasing. The results of the study on surgical therapy for obesity (GBSR) reveal significant differences in the gender-specific incidence of preoperative comorbidities. postoperative complications and mortality. Further studies on gender-specific aspects are necessary in order to optimise patient selection and reduce the incidence of postoperative complications.
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Affiliation(s)
- C Stroh
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH Deutschland
| | - R Weiner
- Chirurgie, KH Sachsenhausen, Frankfurt am Main, Deutschland
| | - S Wolff
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - C Knoll
- StatConsult Magdeburg, Deutschland
| | - M de Zwaan
- Psychosomatik, Medizinische Hochschule Hannover, Deutschland
| | - T Manger
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH Deutschland
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Stroh C, Weiner R, Wolff S, Lerche C, Knoll C, Keller T, Bruns C, Manger T. One Versus Two-Step Roux-en-Y Gastric Bypass After Gastric Banding—Data Analysis of the German Bariatric Surgery Registry. Obes Surg 2014; 25:755-62. [DOI: 10.1007/s11695-014-1527-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Stroh C, Benedix D, Weiner R, Benedix F, Wolff S, Knoll C, Manger T. Is a one-step sleeve gastrectomy indicated as a revision procedure after gastric banding? Data analysis from a quality assurance study of the surgical treatment of obesity in Germany. Obes Surg 2014; 24:9-14. [PMID: 23999964 DOI: 10.1007/s11695-013-1068-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 1 January 2005, the outcomes of bariatric surgeries have been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. METHODS Data are collected in an online data bank. Data collection began in 2005 for the results of gastric banding (GB) and in 2006 for sleeve gastrectomies (SGs). In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany. RESULTS SGs are a popular redo operation after failed gastric banding. Using the German Bariatric Surgery Registry, we analyzed data from 137 SGs that were used in a one-step approach after GB and 37 SGs that were used in a two-step approach. Leakage rates for primary SGs dropped to 1.9 %. The incidence of leakage after a one-step SG after GB is significantly higher (4.4 %) than for a two-step approach (0 %). CONCLUSION SGs are popular procedures after failed GB in Germany, but the complication rates for one-step band removal are higher than for a two-step approach. After examining the data, we suggest performing band removal and SG as a two-step procedure. Further analysis is necessary to evaluate the optimal time period between band removal and SG. Follow-up investigations must be performed to determine if SG is an effective and safe option after GB.
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Stroh C, Weiner R, Benedix F, Horbach T, Birk D, Luderer D, Ludwig K, Meyer G, Wilhelm B, Wolff S, Knoll C, Manger T. [Bariatric and metabolic surgery in Germany 2012 - results of the quality assurance study on surgery for obesity (data of the German Bariatric Surgery Registry)]. Zentralbl Chir 2014; 139:e1-5. [PMID: 24777601 DOI: 10.1055/s-0033-1360227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C Stroh
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland
| | - R Weiner
- Chirurgie, KH Sachsenhausen, Frankfurt am Main, Deutschland
| | - F Benedix
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - T Horbach
- Chirurgie, Krankenhaus Schwabach, Deutschland
| | - D Birk
- Chirurgie, Klinikum Zweibrücken, Deutschland
| | - D Luderer
- Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera, Deutschland
| | - K Ludwig
- Klinikum Rostock, Südstadt, Deutschland
| | - G Meyer
- Chirurgie, Wolfahrtklinik, München, Deutschland
| | - B Wilhelm
- Chirurgie, Klinikum Nordhausen, Deutschland
| | - S Wolff
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - C Knoll
- StatConsult Magdeburg, Deutschland
| | - T Manger
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland
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Stroh C, Wilhelm B, Weiner R, Ludwig K, Benedix F, Knoll C, Lippert H, Manger T, Adipositas K. [Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany]. Zentralbl Chir 2013; 141:45-52. [PMID: 24338802 DOI: 10.1055/s-0033-1350792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. METHODS Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. RESULTS Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. CONCLUSION Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities.
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Affiliation(s)
- C Stroh
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland
| | - B Wilhelm
- Abteilung für Allgemeinchirurgie, Hufeland Klinikum Mühlhausen, Deutschland
| | - R Weiner
- Chirurgie, KH Sachsenhausen, Frankfurt am Main, Deutschland
| | - K Ludwig
- Klinik für Chirurgie, Klinikum Südstadt, Rostock, Deutschland
| | - F Benedix
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - C Knoll
- Statconsult Magdeburg, Deutschland
| | - H Lippert
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - T Manger
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland
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Scheel SK, Beiter K, Hiendelmeyer E, Brabletz T, Hlubek F, Haynl A, Knoll C, Kirchner T, Jung A. β-Catenin reguliert die Expression von Tenascin-C in humanen kolorektalen Tumoren. Z Gastroenterol 2007. [DOI: 10.1055/s-2007-992761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Harris C, Flinchum A, Knoll C, Cooley S, McCormick M. Rapid Response: Real Time Capturing of Significant Organisms by a Simple Computer Based Tracking System. Am J Infect Control 2006. [DOI: 10.1016/j.ajic.2006.05.268] [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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Jung A, Schrauder M, Oswald U, Knoll C, Sellberg P, Palmqvist R, Niedobitek G, Brabletz T, Kirchner T. The invasion front of human colorectal adenocarcinomas shows co-localization of nuclear beta-catenin, cyclin D1, and p16INK4A and is a region of low proliferation. The American Journal of Pathology 2001; 159:1613-7. [PMID: 11696421 PMCID: PMC1867079 DOI: 10.1016/s0002-9440(10)63007-6] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
At the invasion front of well-differentiated colorectal adenocarcinomas, the oncogene beta-catenin is found in the nuclear compartment of tumor cells. Under these conditions, beta-catenin can function as a transcription factor and thus activate target genes. One of these target genes, cyclin D1, is known to induce proliferation. However, invasion front of well-differentiated colorectal adenocarcinomas are known to be zones of low proliferation and express the cell cycle inhibitor p16INK4A. Therefore, we investigated the expression profiles of nuclear beta-catenin, cyclin D1, p16INK4A, and the Ki-67 antigen, a marker for proliferation, in serial sections of well-differentiated colorectal adenocarcinomas. Invasion fronts with nuclear beta-catenin were compared with areas from central parts of the tumors without nuclear beta-catenin, for the expression of cyclin D1, p16INK4A, and Ki-67. It was observed that expression of nuclear beta-catenin, cyclin D1, and p16INK4A at the invasion front are significantly correlated. Such areas exhibit low Ki-67 expression indicating a low rate of proliferation. Thus, in colorectal carcinogenesis the function of beta-catenin and its target gene cyclin D1 does not appear to be the induction of tumor cell proliferation. In particular, the function of cyclin D1 should be reconsidered in view of these observations.
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Affiliation(s)
- A Jung
- Department of Molekulare Pathologie, Pathologisches Institut, Universität Erlangen-Nürnberg, Erlangen, Germany.
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Abstract
A system for automatic detection of cephalometric landmarks is presented. Landmark detection is carried out in two steps: a line detection module searches for significant, well-contrasted lines of the image, such as the jaw line or the nasal spine. The landmark detection module uses the lines located in the first module to determine the search areas and then applies a pattern detection algorithm, based on mathematical morphology techniques. Relations between landmarks and lines are determined by means of a training process. The system has been tested for the detection of 17 landmarks on 20 images: more than 90% of the landmarks are accurately identified.
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Affiliation(s)
- V Grau
- MedICLab, Departamento de Ingeniería Electrónica, Universidad Politécnica de Valencia, Camino de Vera, s/n, 46022 Valencia, Spain.
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Grau V, Alcañiz M, Knoll C, Juan MC, Monserrat C. Multiresolution segmentation of three-dimensional medical images using mathematical morphology techniques. Stud Health Technol Inform 2000; 70:110-2. [PMID: 10977522] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
A semi-automatic method for three-dimensional segmentation of medical images is proposed. A multiresolution representation is achieved through the application of morphological filters, which assures causality for image extrema. This allows for a compact scale space representation, in which each extremum is assigned a scale value. Interactive selection of the interesting extrema of the image is carried out, aided by this scale information and other relevant features. Extrema selected are then used as markers in three-dimensional watersheds calculation. The system has been developed and tested under low cost platforms, and can be the base for totally automatic, knowledge based segmentation systems.
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Affiliation(s)
- V Grau
- DIE, Universidad Politécnica de Valencia.
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Monserrat Aranda C, Juan Lizandra MC, Alcañiz Raya M, Grau Colomer V, Knoll C. Deformation simulation algorithms of elastic tissues in "real-time" based in elasticity theory. Stud Health Technol Inform 1999; 62:21-2. [PMID: 10538358] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In this paper, a new deformable model based in Boundary Elements Method (BEM) is presented. This model is characterised by its robustness and high deformation calculation speed. Experiments developed show that this model could calculate elastic deformations of elastic objects composed by 150 nodes with a 15 Hz. refresh rate (minim refresh rate acceptable in real time interactive systems).
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Affiliation(s)
- C Monserrat Aranda
- Design and Image Development Research Group, Universidad Politécnica de Valencia, Spain
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Abstract
Periodontal diseases are the major cause of tooth loss. The study of the evolution of these diseases is crucial to achieve adequate planning and treatment. Depth probing is essential to know the periodontal disease stage. In this paper we present a new system for Computer-Aided Periodontal Disease Diagnosis using computer vision. The system automates the depth probing and incorporates a colour camera fitted together with a plastic probe that automatically and exactly obtains the depth probing measure. The system has been tested by several periodontists and with 125 teeth of different patients. The differences between the values taken by the system and two periodontists have not been significant.
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Affiliation(s)
- M C Juan
- Departamento de Sistemas Informáticos y Computación, Universidad Politécnica de Valencia, Spain.
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Hübner I, Knoll C, Obst U. [Experiences with the detection of E. coli and coliform bacteria with reference to the drinking water regulation of 1986]. Zentralbl Bakteriol Mikrobiol Hyg B Umwelthyg Krankenhaushyg Arbeitshyg Prav Med 1989; 187:209-5. [PMID: 2494815] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
After the introduction of a limiting value for coliform bacteria in the German Drinking Water Regulation from May 22, 1986 the detection of coliform bacteria has become as important as that of E. coli to indicate pathogenic Enterobacteriaceae and fecal contamination. 130 water samples from different steps of drinking water treatment and distribution have been investigated for Enterobacteriaceae, even when typical indicating marks for such as acid- and gas-formation in the enrichment media were absent. We found the total of 46 isolates of Enterobacteriaceae, among which E. coli was the most frequent one. Whereas in 7 samples with acid- and gas-formation in the enrichment media Enterobacteriaceae could not be isolated, coliform bacteria and other enterobacteriaceae were found in 6 samples without these characteristics. As our experiences have show, those 'false positive' results can be avoided by a careful identification procedure of isolated microorganisms. The hygienically much more important 'false negative' results would not be recognized in routine control of drinking water following the prescribed methods.
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Lueken W, Knoll C. Difference in interphase nucleus organization within the genus Xiphophorus (Pisces, Poeciliidae). Experientia 1968; 24:595-6. [PMID: 4880491 DOI: 10.1007/bf02153795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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