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Katlama C, Bisshop F, Bogner J, Pérez Elías MJ, Di Giambenedetto S, Clarke E, Hodder S, Nwokolo N, Ait-Khaled M, Oyee J, Grove R, Wynne B, Okoli C, Jones B, Kisare M. Efficacy and safety of dolutegravir/lamivudine in virologically suppressed female participants: week 48 data from the pooled TANGO and SALSA studies. HIV Med 2024. [PMID: 38760011 DOI: 10.1111/hiv.13643] [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: 12/12/2023] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women represent >50% of people with HIV globally but have historically been underrepresented in clinical trials. We evaluated the efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) vs continuing their current antiretroviral regimen (CAR) by sex assigned at birth (female and male) in virologically suppressed adults with HIV-1 without prior virological failure in a pooled analysis of two randomized controlled trials. METHODS This analysis included 48-week data from the phase 3 TANGO and SALSA studies. Primary and key secondary endpoints included proportions of participants with HIV-1 RNA ≥50 and <50 copies/mL at week 48, respectively. Safety was also assessed. RESULTS Of 1234 participants, 250 (DTG/3TC, n = 133; CAR, n = 117) were female at birth. Week 48 proportions of participants with Snapshot HIV-1 RNA ≥50 copies/mL were similar regardless of sex at birth (DTG/3TC vs CAR: female, <1% [1/133] vs 2% [2/117]; male, <1% [1/482] vs <1% [3/502]). Proportions with HIV-1 RNA <50 copies/mL were high across sexes and treatment groups (DTG/3TC vs CAR: female, 91% [121/133] vs 89% [104/117]; male, 94% [455/482] vs 94% [471/502]). Immunological response with DTG/3TC was slightly higher in female participants. Incidences of adverse events leading to withdrawal and serious adverse events were low and comparable between treatment groups and across sexes. Weight gain was higher with DTG/3TC than with CAR among female participants aged ≥50 years (treatment difference 2.08 kg [95% confidence interval 0.40-3.75]). CONCLUSIONS Results confirm the robustness of DTG/3TC as a switch option in virologically suppressed females with HIV-1, with outcomes similar to those in males.
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Affiliation(s)
- C Katlama
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, INSERM-Sorbonne Universités, Paris, France
| | - F Bisshop
- Holdsworth House Medical Brisbane, Fortitude Valley, Queensland, Australia
| | - J Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | | | | | | | | | - B Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | - C Okoli
- ViiV Healthcare, Brentford, UK
| | - B Jones
- ViiV Healthcare, Brentford, UK
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Nakase-Richardson R, Dismuke-Greer C, Jeanne H, Drashser-Phillips L, Schwartz D, Calero K, Bogner J, Whyte J, Almeida E, Ketchum J, Magalang U. 1177 Cost Effectiveness Of Diagnostic Approaches To Sleep Apnea Evaluation During Inpatient Rehabilitation For Moderate To Severe TBI. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent work has highlighted prevalent obstructive sleep apnea (OSA) after traumatic brain injury (TBI) when patients are vulnerable to disruption of neural repair. The recently completed clinical trial comparing screening and diagnostic tools for OSA during inpatient rehabilitation provided the opportunity to conduct economic modeling of phased approaches using actual trial findings to address one perspective (the payor) on the value of phased testing.
Methods
A cost-effectiveness analysis of four phased approaches to OSA diagnosis including initial utilization of portable sleep monitoring [HSAT] regardless of pre-test probability, determination of pre-test probability using two prediction models [STOPBANG, MAPI], and initial assessment using Level 1 polysomnography was conducted. The analyses were modeled assuming all participants were considered high risk thus a negative screen or portable diagnostic test would result in a participant being referred for Level 1 polysomnography. The cost aversion used in analyses were derived from a recent white paper on the economic modeling of untreated OSA. Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5).
Results
At AHI ≥15 (33.6%), the prediction models (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and effectiveness relative to the HSAT approach (-$5,210) and initial use of Level 1 PSG (-$5,011). Sensitivity analyses at AHI ≥5 (70.1%) revealed the initial use of HSAT (-$6,322.85) relative to the prediction models (MAPI [-$6,249.71], STOPBANG [-$6,237) and initial assessment with Level 1 PSG (-$5,977) resulted in greater savings and cost effectiveness.
Conclusion
The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-effective approach varying by incidence of OSA.
Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
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Affiliation(s)
| | | | - H Jeanne
- University of Washington, Seattle, WA
| | | | - D Schwartz
- James A. Haley Veterans Hospital, Tampa, FL
| | - K Calero
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - J Bogner
- Departrment of PMR, Ohio State University, Columbus, OH
| | - J Whyte
- Moss Rehabilitation Research Institute, Philadelphia, PA
| | - E Almeida
- Craig Hospital Department of Research, Denver, CO
| | - J Ketchum
- Craig Hospital Department of Research, Denver, CO
| | - U Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Richardson R, Schwartz D, Drasher-Phillips L, Ketchum J, Calero K, Dahdah M, Monden K, Bell K, Hoffman J, Magalang U, Bogner J, Whyte J, Zeitzer J. 0606 Comparative Effectiveness of Sleep Apnea Screening Tools During Inpatient Rehabilitation for Moderate to Severe TBI. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions.
Methods
This is a prospective diagnostic comparative effectiveness trial of sleep apnea screening tools (STOPBANG, Berlin, MAPI [Multi-Apnea Prediction Index]) relative Level 1 polysomnography at six TBI Model System Inpatient Rehabilitation Centers. Between 05/2017 and 02/2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The primary outcome was the Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).
Results
Participants were primarily young to middle age (AGE IQR 28,40,59), male (81%), white (74%), and had primarily severe TBI (IQR GCS 3,6,14). A subset (26%) had a history of military service. Results revealed that the Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROCAUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI>5. The pattern was similar across TBI severity subgroups except for delirium or post-traumatic amnesia status wherein the MAPI outperformed the Berlin and STOPBANG. Youden’s Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.
Conclusion
This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for moderate to severe TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
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Affiliation(s)
| | - D Schwartz
- Medicine Service, James A. Haley Veterans’ Hospital, Tampa, FL
| | | | - J Ketchum
- Research Department, Craig Hospital, Denver, CO
| | - K Calero
- Medicine Service, James A. Haley Veterans’ Hospital, Tampa, FL
| | - M Dahdah
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX; Baylor Scott & White Medical Center, Dallas, TX
| | | | - K Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - J Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - U Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Bogner
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - J Whyte
- Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Philadelphia, PA
| | - J Zeitzer
- Psychiatry and Behavioral Service, Stanford University, Palo Alto, CA
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Santos JR, Cozzi-Lepri A, Phillips A, De Wit S, Pedersen C, Reiss P, Blaxhult A, Lazzarin A, Sluzhynska M, Orkin C, Duvivier C, Bogner J, Gargalianos-Kakolyris P, Schmid P, Hassoun G, Khromova I, Beniowski M, Hadziosmanovic V, Sedlacek D, Paredes R, Lundgren JD. Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe. HIV Med 2018; 19:324-338. [PMID: 29388732 DOI: 10.1111/hiv.12581] [Citation(s) in RCA: 4] [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] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens. METHODS Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches. RESULTS The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART. CONCLUSIONS Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.
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Affiliation(s)
- J R Santos
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - A Phillips
- Royal Free and University College, London, UK
| | - S De Wit
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - C Pedersen
- Odense University Hospital, Odense, Denmark
| | - P Reiss
- Academic Medical Center, Amsterdam, the Netherlands
| | - A Blaxhult
- Karolinska Institute, Venhälsan, Stockholm, Sweden
| | - A Lazzarin
- San Raffaele Scientific Institute, Milan, Italy
| | - M Sluzhynska
- Lviv Regional HIV/AIDS Prevention and Control Centre, Kiev, Ukraine
| | - C Orkin
- Royal London Hospital, London, UK
| | - C Duvivier
- Hôpital Necker-Enfants Malades, Paris, France
| | - J Bogner
- Medizinische Poliklinik, Munchen, Germany
| | | | - P Schmid
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - G Hassoun
- Rambam Health Care Campus, Haifa, Israel
| | - I Khromova
- Centre for HIV/AIDS and Infectious Diseases, Moscow, Russia
| | | | - V Hadziosmanovic
- Klinicki Centar Univerziteta Sarajevo (KCUS), Sarajevo, Bosnia & Herzegovina
| | - D Sedlacek
- Charles University Hospital, Plzen, Czech Republic
| | - R Paredes
- Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Barcelona, Spain.,Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - J D Lundgren
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Kuhlmann A, Mittendorf T, Hower M, Heiken H, Gerschmann S, Klauke S, Lutz T, Bogner J, Degen O, van Lunzen J, Bachmann C, Stellbrink HJ, Schmidt W, Leistner I, Mahlich J, Ranneberg B, Stoll M. [Cost of Illness of HIV Patients under Anteretroviral Therapy in Germany - Results of the 48-Week Interim Analysis of the Prospective Multicentre Observational Study 'CORSAR']. Gesundheitswesen 2014; 77:e133-42. [PMID: 25247761 DOI: 10.1055/s-0034-1381993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND With the introduction of highly active combined antiretroviral therapy (c-ART) mortality and morbidity of HIV patients declined substantially. Earlier studies reported that c-ART was able to save health-care costs due to a reduction of other direct medical costs, particularly for inpatient treatments and concomitant medication. To date, analyses of costs and health-related quality of life (HRQOL) of patients under c-ART are lacking in Germany. Hence, this study aims to estimate the current cost of illness and HRQOL of HIV-patients under c-ART in different treatment lines. METHODS A multicenter, prospective observational study was carried out in 12 specialised German centres for infectious diseases: 8 private practices/outpatient centres and 4 specialised hospitals offering both inpatient and outpatient services. Demographic, clinical and medication data were derived from patient records. Resource utilisation, information on productivity, out of pocket costs and HRQOL (EQ-5D) were collected every 12 weeks via a patient questionnaire. All costs were calculated based on price information from publicly accessible databases. RESULTS N=1,154 patients were included in the analysis. Mean direct disease-related costs of -patients under c-ART amounted to 22,563 Euro/year. Patients beyond the 3(rd) line of treatment -incurred considerably higher costs 24,654 Euro/year. In the 1(st) treatment line, c-ART accounted for 83.2% of the total direct costs, in the 2(nd)/3(rd) line for 80.8% and in >3(rd) line for 83.4%, respectively. Indirect costs due to impaired productivity were higher in the 2(nd)/3(rd) treatment line (2,843 Euro) compared to the 1(st) (1,604 Euro) and >3(rd) (1,752 Euro) treatment lines, respectively. The average HRQOL (EQ-5D) varied between 0.77 (self-assessment via visual analogue scale) and 0.91 (utility score based on the German time trade-off tariff). CONCLUSIONS Over the last decade, cost of illness of HIV patients under c-ART decreased slightly with average costs per year still being substantial. Main cost driver of overall costs is c-ART. There have been, however, noticeable shifts between different cost domains.
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Affiliation(s)
- A Kuhlmann
- Center for Health Economics Research Hannover (CHERH), Leibniz -Universität Hannover, Hannover
| | - T Mittendorf
- Health Economic Research & Consulting, Herescon GmbH, Hannover
| | - M Hower
- ID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund
| | - H Heiken
- Innere Medizin, Praxis Georgstraße, Hannover
| | - S Gerschmann
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover
| | - S Klauke
- Infektiologie, Infektiologikum, Frankfurt
| | - T Lutz
- Infektiologie, Infektiologikum, Frankfurt
| | - J Bogner
- Infektionskrankheiten und klinische Immunologie, Ludwig-Maximilians-Universität München, München
| | - O Degen
- Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - J van Lunzen
- Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Bachmann
- ID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund
| | - H J Stellbrink
- ICH Grindel, Infektionsmedizinisches Centrum Hamburg, Hamburg
| | - W Schmidt
- Innere Medizin, Ärzteforum Seestraße, Berlin
| | - I Leistner
- Innere Medizin, Ärzteforum Seestraße, Berlin
| | - J Mahlich
- Health Economics & Pricing, Janssen-Cilag GmbH, Neuss
| | - B Ranneberg
- Health Economics & Pricing, Janssen-Cilag GmbH, Neuss
| | - M Stoll
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover
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Abstract
Agitation, while considered an important factor influencing outcome following traumatic brain injury (TBI), has been a poorly defined construct. As a result, the literature on agitation has been confusing and incomplete in regard to incidence rates, causes and correlates, intervention methods, and long-term outcomes. In this article, we review previous research on incidence rates, concluding that differences in definition have greatly limited current knowledge. We then review how agitation has been operationalized in previous clinical and research efforts, and we recommend a definition that we believe will allow future studies to proceed in a more systematic manner.
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Affiliation(s)
- J Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - J D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
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Bartmeyer B, Schmidt D, Kollan C, Fätkenheuer G, Stellbrink H, Bogner J, Jensen BO, Stoll M, Kücherer C, Hamouda O. O19.3 Estimate of the Prevalence of Transmitted Drug Resistance (TDR) and Acquired Drug Resistance (ADR) in a HIV Resistance Study of the German ClinSurv-HIV Cohort. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0193] [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: 11/03/2022]
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Whiteneck G, Cuthbert J, Corrigan J, Bogner J. The lifetime history of traumatic Brain injury and associated outcomes: a state-wide population-based survey. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.67] [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: 11/03/2022]
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Bogner J. Dear readers of INFECTION. Infection 2012; 40:237-8. [DOI: 10.1007/s15010-012-0271-4] [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: 10/28/2022]
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Affiliation(s)
- Maximilian Münchhoff
- Infektionsambulanz, Campus Innenstadt der Ludwigs-Maximilians-Universität München.
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Spokas K, Bogner J, Chanton J. A process-based inventory model for landfill CH4emissions inclusive of seasonal soil microclimate and CH4oxidation. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2011jg001741] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Hentrich M, Schiel X, Niedermeier A, Lutz L, Rupec R, Stief C, Bogner J, Karthaus M, Gerl A. Successful salvage high-dose chemotherapy and autologous stem-cell transplantation in HIV-related germ-cell tumor. Ann Oncol 2009; 20:1900-1. [PMID: 19748902 DOI: 10.1093/annonc/mdp448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Magasi S, Hammel J, Heinemann A, Whiteneck G, Bogner J. Participation: A comperative analysis of multiple rehabilitation stakeholders’ perspectives. J Rehabil Med 2009; 41:936-44. [DOI: 10.2340/16501977-0450] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Scheutz C, Bogner J, Chanton JP, Blake D, Morcet M, Aran C, Kjeldsen P. Atmospheric emissions and attenuation of non-methane organic compounds in cover soils at a French landfill. Waste Manag 2007; 28:1892-1908. [PMID: 18032020 DOI: 10.1016/j.wasman.2007.09.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 08/27/2007] [Accepted: 09/07/2007] [Indexed: 05/25/2023]
Abstract
In addition to methane (CH(4)) and carbon dioxide (CO(2)), landfill gas may contain more than 200 non-methane organic compounds (NMOCs) including C(2+)-alkanes, aromatics, and halogenated hydrocarbons. Although the trace components make up less than 1% v/v of typical landfill gas, they may exert a disproportionate environmental burden. The objective of this work was to study the dynamics of CH(4) and NMOCs in the landfill cover soils overlying two types of gas collection systems: a conventional gas collection system with vertical wells and an innovative horizontal gas collection layer consisting of permeable gravel with a geomembrane above it. The 47 NMOCs quantified in the landfill gas samples included primarily alkanes (C(2)-C(10)), alkenes (C(2)-C(4)), halogenated hydrocarbons (including (hydro)chlorofluorocarbons ((H)CFCs)), and aromatic hydrocarbons (BTEXs). In general, both CH(4) and NMOC fluxes were all very small with positive and negative fluxes. The highest percentages of positive fluxes in this study (considering all quantified species) were observed at the hotspots, located mainly along cell perimeters of the conventional cell. The capacity of the cover soil for NMOC oxidation was investigated in microcosms incubated with CH(4) and oxygen (O(2)). The cover soil showed a relatively high capacity for CH(4) oxidation and simultaneous co-oxidation of the halogenated aliphatic compounds, especially at the conventional cell. Fully substituted carbons (TeCM, PCE, CFC-11, CFC-12, CFC-113, HFC-134a, and HCFC-141b) were not degraded in the presence of CH(4) and O(2). Benzene and toluene were also degraded with relative high rates. This study demonstrates that landfill soil covers show a significant potential for CH(4) oxidation and co-oxidation of NMOCs.
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Affiliation(s)
- C Scheutz
- Institute of Environment and Resources, Technical University of Denmark, Bygningstorvet-Building 115, DK-2800 Lyngby, Denmark.
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Spokas K, Bogner J, Chanton JP, Morcet M, Aran C, Graff C, Golvan YML, Hebe I. Methane mass balance at three landfill sites: what is the efficiency of capture by gas collection systems? Waste Manag 2006; 26:516-25. [PMID: 16198554 DOI: 10.1016/j.wasman.2005.07.021] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 06/01/2005] [Accepted: 07/29/2005] [Indexed: 05/04/2023]
Abstract
Many developed countries have targeted landfill methane recovery among greenhouse gas mitigation strategies, since methane is the second most important greenhouse gas after carbon dioxide. Major questions remain with respect to actual methane production rates in field settings and the relative mass of methane that is recovered, emitted, oxidized by methanotrophic bacteria, laterally migrated, or temporarily stored within the landfill volume. This paper presents the results of extensive field campaigns at three landfill sites to elucidate the total methane balance and provide field measurements to quantify these pathways. We assessed the overall methane mass balance in field cells with a variety of designs, cover materials, and gas management strategies. Sites included different cell configurations, including temporary clay cover, final clay cover, geosynthetic clay liners, and geomembrane composite covers, and cells with and without gas collection systems. Methane emission rates ranged from -2.2 to >10,000 mg CH(4) m(-2) d(-1). Total methane oxidation rates ranged from 4% to 50% of the methane flux through the cover at sites with positive emissions. Oxidation of atmospheric methane was occurring in vegetated soils above a geomembrane. The results of these studies were used as the basis for guidelines by the French environment agency (ADEME) for default values for percent recovery: 35% for an operating cell with an active landfill gas (LFG) recovery system, 65% for a temporary covered cell with an active LFG recovery system, 85% for a cell with clay final cover and active LFG recovery, and 90% for a cell with a geomembrane final cover and active LFG recovery.
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Affiliation(s)
- K Spokas
- University of Minnesota, Department of Soil, Water, and Climate, St. Paul, USA.
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Stock M, Nagyova K, Dieckmann K, Bogner J, Poetter R, Georg D. A Non-Invasive Approach for Precise Gated DIBH: Impact of a Feedback System on SBRT. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.851] [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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21
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Dieckmann K, Georg D, Bogner J, Zehetmayer M, Petersch B, Weitmann H, Chorvat M, Poetter R. Optimizing Linac Based Stereotactic Radiotherapy of Uveal Melanomas: Seven Years Clinical Experience. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Mock U, Bogner J, Georg D, Auberger T, Pötter R. 466 A treatment planning comparison of conventional, 3D conformal, intensity modulated photon — and proton irradiation therapy in the treatment of paranasal sinus carcinoma. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90498-8] [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: 10/26/2022] Open
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23
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Schiemann U, Walli R, Schmidt F, Bogner J, Gross M. Thyroid hypoechogenicity in patients with chronic hepatitis receiving interferon-alpha therapy: evaluation by standardized grey scale ultrasonography. Eur J Med Res 2002; 7:271-7. [PMID: 12117662] [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: 02/25/2023] Open
Abstract
BACKGROUND Recombinant human interferon-a therapy of chronic hepatitis B and C is associated with the induction of thyroid dysfunction in up to 15%. Little is known about morphological changes of the thyroid gland, especially about its tissue echogenicity under this immunomodulative drug treatment. METHODS 116 patients with chronic hepatitis B or C were consecutively investigated. 53 patients qualified for treatment with interferon-a alone or in combination with ribavirin. Patients with normal serum aminotransferase levels, advanced liver cirrhosis, hepatocellular carcinoma, active intravenous drug or alcohol abusus and with focal thyroid lesions (nodes, cysts, calcifications) were excluded. Thyroid function was determined by measurements of FT4, TSH and thyroidal autoantibodies. Ultrasonography was performed before, during and after interferon-a therapy including volumetry and standardized grey scale analysis. The data were compared with values of 100 euthyroid volunteers as control group. RESULTS After six months of therapy patients differed from controls by significant TSH elevation (12.8 +/- 9.34 vs. 2.8 +/- 1.1 microU/ml, p<0.02). Six patients (11%) developed overt hypothyroidism with detectable thyroidal autoantibodies. Thyroid volume in patients was similar (13.0 +/- 4.1 ml) to that in the control group (12.6 +/- 4.7 ml). However, thyroid echogenicity of the patients was significantly lower after 6 months of therapy (21.9 +/- 2.5 grey scales) compared to the status before (25.6 +/- 2.3 grey scales) and compared to the values of controls (25.4 +/- 2.1 grey scales, p <0.002). CONCLUSION Beside of functional disorders interferon-alpha leads to thyroid hypoechogenicity suggesting relevant morphological changes of the organ.
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Affiliation(s)
- U Schiemann
- Medizinische Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Pettenkoferstr. 8a, D-80336 München, Germany. uwe.schiemann @ pk-i.med.uni- muenchen.de
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24
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Dieckmann K, Bogner J, Georg D, Zehetmayer M, Georgopoulos M, Poetter R. Fractionated stereotactic radiotherapy of uveal melanoma at a 6 MV LINAC. preliminary results. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02446-4] [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: 10/18/2022]
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25
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Bogner J, Dieckmann K, Petersch B, Zehetmayer M, Georg D, Poetter R. A non-invasive eye fixation and computer aided eye monitoring system for LINAC based stereotactic radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE To describe a stereotactic irradiation technique for uveal melanomas performed at a linac, based on a non-invasive eye fixation and eye monitoring system. METHODS For eye immobilization a light source system is integrated in a standard stereotactic mask system in front of the healthy eye: During treatment preparation (computed tomography/magnetic resonance imaging) as well as for treatment delivery, patients are instructed to gaze at the fixation light source. A mini-video camera monitors the pupil center position of the diseased eye. For treatment planning and beam delivery standard stereotactic radiotherapy equipment is used. If the pupil center deviation from a predefined 'zero-position' exceeds 1 mm (for more than 2 s), treatment delivery is interrupted. Between 1996 and 1999 60 patients with uveal melanomas, where (i) tumor height exceeded 7 mm, or (ii) tumor height was more than 3 mm, and the central tumor distance to the optic disc and/or the macula was less than 3 mm, have been treated. A total dose of 60 or 70 Gy has been given in 5 fractions within 10 days. RESULTS The repositioning accuracy in the mask system is 0.47+/-0.36 mm in rostral-occipital direction, 0.75+/-0.52 mm laterally, and 1.12+/-0.96 mm in vertical direction. An eye movement analysis performed for 23 patients shows a pupil center deviation from the 'zero' position<1 mm in 91% of all cases investigated. In a theoretical analysis, pupil center deviations are correlated with GTV 'movements'. For a pupil center deviation of 1 mm (rotation of the globe of 5 degrees ) the GTV is still encompassed by the 80% isodose in 94%. CONCLUSION For treatments of uveal melanomas, linac-based stereotactic radiotherapy combined with a non-invasive eye immobilization and monitoring system represents a feasible, accurate and reproducible method. Besides considerable technical requirements, the complexity of the treatment technique demands an interdisciplinary team continuously dedicated to this task.
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Affiliation(s)
- K Dieckmann
- Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Ascherl G, Sgadari C, Bugarini R, Bogner J, Schatz O, Ensoli B, Stürzl M. Serum concentrations of fibroblast growth factor 2 are increased in HIV type 1-infected patients and inversely related to survival probability. AIDS Res Hum Retroviruses 2001; 17:1035-9. [PMID: 11485620 DOI: 10.1089/088922201300343717] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/13/2022] Open
Abstract
HIV-1-infected patients develop a generalized vasculopathy that is clinically most evident as Kaposi's sarcoma (KS), a multifocally appearing endothelial cell-derived tumor. Fibroblast growth factor 2 (FGF-2) is a potent autocrine and paracrine mitogen of endothelial cells and has been implicated in the cell proliferation and angiogenesis observed in KS. Here we determined by ELISA the FGF-2 serum concentrations in different clinical groups of HIV-1-infected patients. AIDS-KS patients (n = 53) and HIV-1-infected patients without KS (n = 39) revealed significantly increased FGF-2 serum concentrations (median, 4.5 and 4.6 pg/ml, respectively), as compared with the healthy control group (n = 22; median, 2.2 pg/ml; p < 0.01). FGF-2 concentrations were highest in untreated HIV-1-infected patients (median, 8.6 pg/ml) and were significantly decreased in patients undergoing antiretroviral therapy (AZT-median, 4.5 pg/ml; HAART-median, 2.5 pg/ml; p < 0.01). In addition, FGF-2 serum concentrations above 5.2 pg/ml were associated with a statistically significant higher risk of death in HIV-1-infected patients. Multivariate analysis showed that this effect is independent of CD4 levels, localization of KS (cutaneous or visceral), AIDS-defining opportunistic diseases, and therapy. Circulating FGF-2 may contribute to AIDS-associated vasculopathy and may be a sensitive and easily accessible surrogate marker to determine the survival time of HIV-1-infected patients and the efficacy of antiretroviral therapy.
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Affiliation(s)
- G Ascherl
- Institute of Molecular Virology, GSF-National Research Center for Environment and Health GmbH, 85764 Neuherberg, Germany
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Schmitz M, Michl GM, Walli R, Bogner J, Bedynek A, Seidel D, Goebel FD, Demant T. Alterations of apolipoprotein B metabolism in HIV-infected patients with antiretroviral combination therapy. J Acquir Immune Defic Syndr 2001; 26:225-35. [PMID: 11242195 DOI: 10.1097/00042560-200103010-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
BACKGROUND Dyslipidemia (predominantly hypertriglyceridemia) is frequently seen in patients receiving antiretroviral combination therapy (ART). However, the underlying mechanisms and long-term risks (e.g., cardiovascular events) are still unclear. OBJECTIVES/METHODS In 5 patients with ART-associated dyslipidemia, stable isotope labeled amino acid tracer (d3-Leu) kinetic analysis over 12 days was used to investigate the metabolism of apolipoprotein B-containing lipoproteins (very low density lipoproteins [VLDL]1, VLDL2, intermediate density lipoproteins [IDL] and low density lipoproteins [LDL]). Data were compared with those in 6 healthy normolipidemic controls. RESULTS The patients under ART showed significantly increased fasting triglycerides (359 vs. 77 mg/dl) and VLDL (54 vs. 15 mg/dl), compared with controls. They had significantly higher total cholesterol (213 vs. 157 mg/dl) and there was a nonsignificant trend toward higher LDL (136 vs. 93 mg/dl), and toward lower HDL (26 vs. 46 mg/dl). The ratio of large, buoyant LDL1 over small, dense LDL2 was markedly reduced in patients under ART (0.80 vs. 2.00). Total apo B synthesis was significantly increased (25.5 vs. 14.5 mg/kg/d) and shifted toward triglyceride rich VLDL1 (18.5 vs. 8.7 mg/kg/d) in patients receiving ART. There was also a significantly reduced rate of apo B lipoprotein transfer from VLDL1 to VLDL2 (3.7 vs. 20.7 pools/d). In addition, all patients revealed insulin resistance. CONCLUSIONS These data indicate that increased triglycerides in HIV-infected patients with ART are primary due to reduced rates of VLDL transfer into denser lipoproteins implying a lower rate of lipoprotein lipase-mediated delipidation. In addition, total apo B synthesis was increased and shifted toward triglyceride-rich VLDL1. Overall, this lipoprotein profile in patients with ART-associated dyslipidemia implies an increased risk for cardiovascular events.
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Affiliation(s)
- M Schmitz
- Institut für Klinische Chemie and Medizinische Poliklinik, Dresden, Germany
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Mannstadt M, Sing A, Leitritz L, Brenner-Maucher K, Bogner J. Conservative management of biliary obstruction due to Fasciola hepatica. Clin Infect Dis 2000; 31:1301-3. [PMID: 11073771 DOI: 10.1086/317472] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/03/2022] Open
Abstract
We report a case of temporary biliary obstruction due to fascioliasis. This case report shows that in Central Europe, fascioliasis is one of the differential diagnoses of abdominal pain, especially if it is associated with eosinophilia. Successful medical treatment is possible even with obstruction of the bile duct.
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Affiliation(s)
- M Mannstadt
- Medizinische Poliklinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, München, Germany.
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Strobach D, Vetter-Kerkhoff C, Bogner J, Breugst W, Schlöndorff D. [Patient medication counseling--patient counseling about discharge medication]. Med Klin (Munich) 2000; 95:548-51. [PMID: 11092167 DOI: 10.1007/pl00002061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND With discharge from hospital, the correct use of his drugs is the responsibility of the patient. The patient's compliance mainly affects the success of therapy. An essential requirement for good compliance is informing the patient properly about the purpose and correct use of his drugs. In the first pilot study in Germany on this subject, we investigated how the additional patient medication counseling by a clinical pharmacist prior to discharge improves the patient's knowledge of his drugs. STUDY DESIGN During a 10-week period, 37 patients were randomly assigned to either an intervention group or a control group. Patients of the intervention group were verbally and in writing informed about the purpose and correct use of their drugs. The effect of the additional counseling was determined in both groups by a questionnaire at the time of discharge and a telephone interview 2 weeks later. CONCLUSION Patient medication counseling by a clinical pharmacist prior to discharge improves the patient's knowledge of his drugs as an essential requirement of good compliance. Taking into consideration the economical consequences of noncompliance and the financial problems of the public health system it is advisable to establish this service in German hospitals.
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Affiliation(s)
- D Strobach
- Apotheke, Klinikum Innenstadt der Ludwig-Maximilians-Universität München.
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Abstract
The relationship between emotional distress and differing perceptions of the extent of deficits was investigated with fifty individuals with brain injury and their significant others. Participants completed questionnaires assessing their perceptions of the individual's deficits in various areas (Patient Competency Rating Scale, PCRS). Difference scores were used as markers for awareness of deficits. Emotional distress of the individuals with brain injury and their significant others was assessed with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Forty per cent of persons with brain injury and 34% of significant others reported symptoms suggestive of mild or greater depression, while 54% of persons with brain injury and 39% of significant others reported symptoms suggestive of experiencing mild or greater anxiety. Significant relationships were not found between the emotional distress of significant others and difference scores. Moderate-to-weak relationships were found between difference scores and the emotional distress of individuals with brain injury. The relationship between chronicity and awareness of deficits was in the opposite direction than predicted. The adjustment of significant others appears to be a function of the extent to which they perceive a resolution of deficits, time since injury, and other factors. Implications for rehabilitation and future research are discussed.
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Affiliation(s)
- C A Wallace
- Bancroft NeuroHealth, Haddonfield, New Jersey, USA
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Mandernack KW, Kinney CA, Coleman D, Huang YS, Freeman KH, Bogner J. The biogeochemical controls of N2O production and emission in landfill cover soils: the role of methanotrophs in the nitrogen cycle. Environ Microbiol 2000; 2:298-309. [PMID: 11200431 DOI: 10.1046/j.1462-2920.2000.00106.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [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: 11/20/2022]
Abstract
Emissions of N2O from cover soils of both abandoned (> 30 years) and active landfills greatly exceed the maximum fluxes previously reported for tropical soils, suggesting high microbial activities for N2O production. Low soil matrix potentials (<-0.7 MPa) indicate that nitrification was the most likely mechanism of N2O formation during most of the time of sampling. Soil moisture had a strong influence on N2O emissions. The production of N2O was stimulated by as much as 20 times during laboratory incubations, when moisture was increased from -2.0 MPa to -0.6 MPa. Additional evidence from incubation experiments and delta13C analyses of fatty acids (18:1) diagnostic of methanotrophs suggests that N2O is formed in these soils by nitrification via methanotrophic bacteria. In a NH3(g)-amended landfill soil, the rate of N2O production was significantly increased when incubated with 100 ppmv methane compared with 1.8 ppmv (atmospheric) methane. Preincubation of a landfill soil with 1% CH4 for 2 weeks resulted in higher rates of N2O production when subsequently amended with NH3(g) relative to a control soil preincubated without CH4. At one location, at the soil depth (9-16 cm) of maximum methane consumption and N2O production, we observe elevated concentrations of organic carbon and nitrogen and distinct minima in delta15N (+1.0%) and delta13C (-33.8%) values for organic nitrogen and organic carbon respectively. A delta13C value of -39.3% was measured for 18:1 carbon fatty acids in this soil, diagnostic of type II methanotrophs. The low delta15N value for organic nitrogen is consistent with N2 fixation by type II methanotrophs. These observations all point to a methanotrophic origin for the organic matter at this depth. The results of this study corroborate previous reports of methanotrophic nitrification and N2O formation in aqueous and soil environments and suggest a predominance of type II rather than type I or type X methanotrophs in this landfill soil.
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Affiliation(s)
- K W Mandernack
- Department of Earth System Science, University of California, Irvine 92717, USA.
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Ascherl G, Hohenadl C, Schatz O, Shumay E, Bogner J, Eckhart L, Tschachler E, Monini P, Ensoli B, Stürzl M. Infection with human immunodeficiency virus-1 increases expression of vascular endothelial cell growth factor in T cells: implications for acquired immunodeficiency syndrome-associated vasculopathy. Blood 1999; 93:4232-41. [PMID: 10361120] [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: 02/12/2023] Open
Abstract
Alterations in the vascular system and the onset of angioproliferative lesions such as Kaposi's sarcoma (KS) are common traits of human immunodeficiency virus-1 (HIV-1)-infected patients. To investigate possible factors involved in acquired immunodeficiency syndrome (AIDS)-associated vasculopathy and vascular malfunction, expression of vascular endothelial cell growth factor-A (VEGF-A) was analyzed in HUT 78 T lymphocytes upon infection with HIV-1. VEGF-A was found to be increased in supernatants from infected cells as compared with uninfected cells. In addition, VEGF-A mRNA expression and protein secretion were significantly increased in HUT 78 cells incubated with conditioned medium (CM) derived from HIV-1 chronically infected HUT 78 cells (HIV-TCM) as compared with CM from uninfected cells (TCM). Increase of VEGF-A production in T cells was promoted by inflammatory cytokines (IC) present in HIV-TCM, including tumor necrosis factor alpha (TNFalpha), interferon gamma (IFNgamma), interleukin-1beta (IL-1beta), and IL-6. These IC that have been shown to be increased in sera of HIV-1-infected patients and to be increased by HIV-1 infection or cell activation in these individuals as well as HIV-TCM also increased VEGF-A expression in primary T lymphocytes. Consistent with this, VEGF-A concentrations were found to be higher in sera of HIV-1-infected patients with (mean, 357.1 +/- 197.9 pg/mL) and without KS (mean, 256.7 +/- 137.5 pg/mL) as compared with uninfected individuals (mean, 188.6 +/- 91.7 pg/mL). These data suggest that increased secretion of VEGF-A by T lymphocytes of HIV-1-infected individuals may induce vascular leakage and stimulate proliferation of vascular endothelial cells, which are hallmarks of AIDS-associated vasculopathy and especially of KS development.
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Affiliation(s)
- G Ascherl
- Department of Virology, Max Planck Institute for Biochemistry, Martinsried, Germany
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Stoehr A, Arasteh K, Staszewski S, Brockmeyer N, Albrecht H, Mertenskötter T, Jablonowski H, Emminger C, Rockstroh JK, Baumgarten R, Bogner J, Loch T, Plettenberg A. Pneumocystis carinii pneumonia in the Federal Republic of Germany in the era of changing antiretroviral therapy - IDKF 13 -. German AIDS Study Group (GASG/IdKF). Eur J Med Res 1999; 4:131-4. [PMID: 10205287] [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: 02/11/2023] Open
Abstract
BACKGROUND Pneumocystis carinii pneumonia (PCP) is one of the most common AIDS defining diagnoses. METHODS In a prospective observational trial all cases of Pneumocystis carinii pneumonia (PCP) were evaluated. Patients with and without PCP-prophylaxis were compared for symptoms, efficacy, side effects and mortality at week 4 and 26. RESULTS 293 patients developed a PCP episode. Patients with no prophylaxis had a significant lower CD4 cell count and a more severe clinical status at time of diagnosis. This was pronounced in the group with first positive HIV test at time of diagnosis. There was no difference in the rate of successful treatment between both groups. At week four a tendency to a better survival in the group with prophylaxis was observed, however this changed to a trend to a better survival at week 26 for the group without prophylaxis. CONCLUSION Even in the era of highly active antiretroviral treatment many patients present with PCP. Nearly 60% of patients presented without antiretroviral treatment or PCP-prophylaxis. Nearly 25% of all patients had their first HIV-test at time of PCP diagnosis.
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Affiliation(s)
- A Stoehr
- Infektionsambulanz und Tagesklinik, AK. St. Georg, Lohmühlenstr. 5, D-20099 Hamburg, Germany.
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Bennett CL, Golub RM, Stinson TJ, Aboulafia DM, von Roenn J, Bogner J, Goebel FD, Stewart S. Cost-effectiveness analysis comparing liposomal anthracyclines in the treatment of AIDS-related Kaposi's sarcoma. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 18:460-5. [PMID: 9715842 DOI: 10.1097/00042560-199808150-00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Liposomal formulations have been shown to alter the efficacy and toxicity profiles of anthracylines for patients with HIV-related advanced Kaposi's sarcoma (KS). Using decision-analysis models, the costs and cost-effectiveness of the two U.S. Food and Drug Administration (FDA)-approved liposomal formulations of these agents were estimated. Estimates of costs, effectiveness, and cost-effectiveness were derived from clinical trial data of separate, randomized phase III trials of pegylated liposomal doxorubicin (20 mg/m2 every 3 weeks) and liposomal daunorubicin (40 mg/m2 every 2 weeks). Clinical response rates were 59% for pegylated liposomal doxorubicin and 25% for liposomal daunorubicin. Despite higher acquisition costs for pegylated liposomal doxorubicin, total estimated costs of treatment for KS and chemotherapy-related hematologic toxicities were similar ($7,066 U.S. compared with $6,621 U.S. for liposomal daunorubicin). Cost-effectiveness profiles, defined as average costs per responder, favored pegylated liposomal doxorubicin ($11,976 U.S./responder versus $26,483 U.S./responder for liposomal daunorubicin), reflecting the higher reported response rate in the phase III trial. Sensitivity analyses suggested that the costs and cost-effectiveness results would not differ markedly when evaluated over a range of assumptions, including response rate, neutropenia rate, and dosage variations.
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Affiliation(s)
- C L Bennett
- Division of Hematology/Oncology, Northwestern University, and VA Chicago Health Care System, Illinois, USA
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Abstract
Sleep disorders are a relatively common occurrence after brain injury. Sleep disturbances often result in a poor daytime performance and a poor individual sense of well-being. Unfortunately, there has been minimal attention paid to this common and often disabling sequela of brain injury. This study attempts to define and to correlate the incidence and type of sleep disturbances that occur after brain injury. Consecutive admissions to a rehabilitation unit were used to create a longitudinal database designed to predict long-term outcomes for individuals who suffered a brain injury. Fifty percent of subjects had difficulty sleeping. Sixty-four percent described waking up too early, 25% described sleeping more than usual, and 45% described problems falling asleep. Eighty percent of subjects reporting sleep problems also reported problems with fatigue. Logistic regression analysis revealed the following: the more severe the brain injury the less likely the subject would be to have a sleep disturbance; subjects who had sleep disturbances were more likely to have problems with fatigue; females were more likely to have trouble with sleep. This study demonstrates the substantial prevalence of sleep disturbances after brain injury. It underscores the relationship between sleep disorders and perception of fatigue. It also underscores the need for clinicians to strive for interventional studies to look at the treatment of sleep and fatigue problems after brain injury.
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Affiliation(s)
- D M Clinchot
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus 43210, USA
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Wallace CA, Bogner J, Corrigan JD, Clinchot D, Mysiw WJ, Fugate LP. Primary caregivers of persons with brain injury: life change 1 year after injury. Brain Inj 1998; 12:483-93. [PMID: 9638325] [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: 02/07/2023]
Abstract
The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.
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Affiliation(s)
- C A Wallace
- Department of Psychology, Ohio State University, Columbus, USA
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Malo A, Rommel F, Bogner J, Gruber R, Schramm W, Goebel FD, Riethmüller G, Wank R. Lack of protection from HIV infection by the mutant HIV coreceptor CCR5 in intravenously HIV infected hemophilia patients. Immunobiology 1998; 198:485-8. [PMID: 9562872 DOI: 10.1016/s0171-2985(98)80055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 02/07/2023]
Abstract
The CCR5 chemokine receptor is an important coreceptor for macrophage-tropic HIV strains. Homozygous carriers of the mutated CCR5 receptor with a 32 bp deletion (delta 32-CCR5) are highly protected against HIV infection. A protective effect has also been described for heterozygous individuals carrying both mutated and wildtype CCR5 receptors. We compared the frequency of the mutated delta 32-CCR5 HIV coreceptor in HIV positive patients infected by sexual contact (N = 160) with intravenously HIV infected hemophilic patients (N = 84) and HIV negative individuals (N = 421). We found no protective effect of delta 32-CCR5 HIV coreceptor in hemophilic patients (p = 0.0134). If proteins of plasma concentrates would be responsible for facilitating the entry of HIV macrophages by upregulation of the CCR5 wildtype receptor it would be of therapeutical interest to identify the responsible plasma proteins.
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Affiliation(s)
- A Malo
- Institut für Immunologie, Universität München, Germany
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Abstract
The life span of HIV-infected patients has increased because of anti-retroviral therapy and improved means for treating opportunistic infections. However, HIV infection and subsequent immunosuppression result in an increased risk of high-grade B-cell lymphomas. The purpose of this study was to determine the incidence, localization, clinical features, therapy and survival time of patients with HIV-related lymphomas of the head and neck. Between 1988 and 1995, 280 HIV-infected patients presented with otolaryngologic symptoms. Seventy-two (25.7%) were found to have a neoplastic disease. Fifty-six of these patients (20%) were diagnosed as having Kaposi's sarcoma and 12 (4.3%) had lymphomas. According to the Kiel classification, lymphomas were subdivided into Hodgkin's disease (2 cases) and B-cell lymphomas of high-grade malignancy (10 cases). These latter cases were centroblastic (n = 4), Burkitt's type (n = 4), anaplastic large cell (n = 1) and not classifiable (n = 1). All patients with HIV-related non-Hodgkin's lymphomas (NHL) were men and 8 were homosexuals. The mean age was 36.1 years. In addition to 7 nodal locations, high-grade B-cell lymphomas were found in the oropharynx (n = 2) and palate (n = 1). Four patients underwent chemotherapy, 1 patient underwent radiation therapy and 2 were treated with both methods. Two patients did not receive any treatment and 1 patient underwent laser therapy. The survival time depended on the previous diagnosis of AIDS, the patients' immune status and the karnofsky index. In 2 patients the lymphoma led to the diagnosis of HIV infection. Our findings show that any solitary or enlarging tumors or ulcerating lesions in the head and neck region of HIV patients must be examined histologically to exclude HIV-NHL. We also recommend that young patients with high-grade B-cell lymphomas should undergo HIV screening.
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Affiliation(s)
- A Riederer
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke, Ludwig-Maximilians-Universität München
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Rolinski B, Sadri I, Bogner J, Goebel FD. Determination of endothelin-1 immunoreactivity in plasma, cerebrospinal fluid and urine. Res Exp Med (Berl) 1994; 194:9-24. [PMID: 8202641 DOI: 10.1007/bf02576362] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Endothelin-1 (ET-1) is a potent vasoconstrictor peptide apparently involved in a number of vascular diseases in man. Nonetheless, its determination in biological samples is difficult, and data on plasma or urine concentrations are controversial. We investigated different sample preparation procedures as well as different radioimmunoassays for their influence on ET-1 measurement. Recovery of ET-1 depended on the extraction procedure, the type and size of the extraction columns and on the biological matrix itself. Incomplete removal of matrix components by the extraction leads to the formation of particulate matter in the evaporated eluate. When dissolved in assay buffer, ET-1 was found to be absorbed to and only partly released from these particulates, so that it was not accessible for measurement in a radioimmunoassay. This was the case for all extraction procedures investigated except for that involving acetic acid. HPLC analysis of spiked samples revealed that ET-1 is in part degraded during extraction, most probably to Meth-sulphoxide ET-1. Dilution curves of synthetic pure ET-1 standards from different suppliers, prepared either in plasma with subsequent extraction or in assay buffer of the respective radioimmunoassay, resulted in considerable differences in the measured values for ET-1-immunoreactivity. Every radioimmunoassay tested had a specific pattern of recognizing different synthetic ET-1 standards. In conclusion, the measurement of ET-1-immunoreactivity is strongly influenced by the experimental conditions of sample preparation as well as by the radioimmunoassay employed.
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Affiliation(s)
- B Rolinski
- Medizinische Poliklinik, University of Munich, Germany
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Abstract
A 29-year-old female suffering from full-blown AIDS received fluconazole 400 mg day-1 for a long period for treatment of oral candidosis, pseudomembranous type. She had previously received this drug repeatedly for the same reason, yet manifest disease persisted. She was therefore put on parenteral amphotericin B, which led to clinical, but not mycological, cure in the short term. IC30 testing revealed a minimum inhibitory concentration (MIC) > 128 micrograms ml-1 for fluconazole. The isolate, however, was susceptible in vitro to ketoconazole, itraconazole and amphotericin B. The same antimicrobial susceptibility pattern was found with a second isolate obtained later. Resistance to fluconazole might become a major problem in HIV-infected patients receiving this drug for long periods.
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Affiliation(s)
- E Thomas-Greber
- Department of Dermatology, Ludwigs-Maximilians-Univeristy, Munich, Germany
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43
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Abstract
A previously healthy 48-year-old woman developed, over several months, increasing pain in her hips, cervical and lumbar spine as well as the shoulders. In addition she developed intermittent claudication after walking 100-200 m. Erythrocyte sedimentation rate (ESR) was 35-43 mm in the first hour; the IgM concentration was raised to 610 mg/dl. Angiography demonstrated symmetrical occlusion of both superficial femoral arteries. An attempt at thrombolysis having failed, a biopsy of the femoral artery wall was obtained. This revealed a florid arteritis, in part as giant-cell arteritis with destruction of the elastic structures, while the adjacent muscle was unchanged. Subsequent biopsy of the temporal artery was normal. Treatment consisted at first of 60 mg prednisolone and 100 mg aspirin, both daily for 4 weeks. The ESR fell and the free-of-pain walking distance rose. There has been no recurrence of pain after stepwise reduction over one year of the steroid dosage until its discontinuation.
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Steinberg R, Kimmig V, Raith L, Günther W, Bogner J, Timmermann T. Music psychopathology. IV. The course of musical expression during music therapy with psychiatric inpatients. Psychopathology 1991; 24:121-9. [PMID: 1754642 DOI: 10.1159/000284704] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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] [Indexed: 12/28/2022]
Abstract
The music therapeutic productions of 67 psychiatric inpatients were analyzed concerning a systematic variation in the course of therapy. The impairment of performance was not as regular as with customary music, nevertheless with growing remission it was reversible in all diagnostic subgroups. The change for the better of rhythmic and motor skills of endogenous-depressed patients was seen to the same extent as with traditional music. The polarity profile developed for the assessment of music proved meaningful in the characterization of music therapeutic utterances.
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Affiliation(s)
- R Steinberg
- Pfalzklinik Landeck, Klingenmünster, Munich, FRG
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Abstract
This study presents clinical neurophysiologic evidence of altered upper brainstem function in patients with generalized epilepsy who do not otherwise differ clinically from the general population. While the differences in absolute latencies are not great enough to support the use of BAERs in routine evaluation, this data does support experimental studies implicating brainstem structures in the pathophysiology of primary generalized epilepsy. The lack of evidence of brainstem involvement in complex partial seizures may suggest a mechanism of seizure spread that is not dependent upon primary brainstem pathology, or may indicate that any brainstem abnormality in epilepsy may involve areas not mediating transmission of auditory stimuli and therefore not assessed by BAERs.
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Affiliation(s)
- B Phillips
- Department of Neurology, Ohio State University College of Medicine, Columbus
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46
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Bogner J. Buchbesprechungen. J Mol Med (Berl) 1990. [DOI: 10.1007/bf01662719] [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: 10/25/2022]
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Tatsch K, Knesewitsch P, Kirsch CM, Küffer G, Dörner G, Matuschke A, Bogner J, Goebel FD, Moser E. [The place of 67Ga scintigraphy in the primary diagnosis and follow-up evaluation of opportunistic pneumonia in patients with AIDS]. Nuklearmedizin 1988; 27:219-25. [PMID: 2848224] [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: 01/02/2023]
Abstract
Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve prognosis. This study was designed to assess the value of 67Ga scintigraphy in the primary detection and follow-up of these special pneumonias. 67Ga scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). 67Ga scan results were compared with current chest radiographs and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft-tissue uptake ratio. Only 8/30 patients had a normal scan, 22/30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In 7/8 patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi's sarcoma. In 11/22 patients the 67Ga scan and chest radiograph were positive simultaneously. In the other 11/22 patients with positive scans chest radiographs were initially negative but showed pathology in 5 cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were only observed in two cases. The defined uptake ratio demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative 67Ga scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS.
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Affiliation(s)
- K Tatsch
- Radiologische Klinik und Poliklinik, Universität München, BRD
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Knesewitsch P, Kirsch CM, Küffer G, Dörner G, Matuschke A, Bogner J, Goebel FD, Moser E, Tatsch K. Stellenwert der 67Ga-Szintigraphie in der Primärdiagnostik und Verlaufsbeurteilung opportunistischer Pneumonien bei Patienten mit AIDS. Nuklearmedizin 1988. [DOI: 10.1055/s-0038-1629454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve prognosis. This study was designed to assess the value of 67Ga scintigraphy in the primary detection and follow-up of these special pneumonias. 67Ga scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). 67Ga scan results were compared with current chest radiographs and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft-tissue uptake ratio. Only 8/30 patients had a normal scan, 22/30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In 7/8 patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi’s sarcoma. In 11/22 patients the 67Ga scan and chest radiograph were positive simultaneously. In the other 11/22 patients with positive scans chest radiographs were initially negative but showed pathology in 5 cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were only observed in two cases. The defined uptake ratio demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative 67Ga scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS.
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Bogner J, Spatz A. Sixteen or sixty; does it make a difference? J Pract Nurs 1975; 25:20-1. [PMID: 1042142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bogner J, Spatz A. Independent approach to learning. J Pract Nurs 1974; 24:22-3. [PMID: 4493972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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