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Gebert P, Hage AM, Blohmer JU, Roehle R, Karsten MM. Longitudinal assessment of real-world patient adherence: a 12-month electronic patient-reported outcomes follow-up of women with early breast cancer undergoing treatment. Support Care Cancer 2024; 32:344. [PMID: 38740611 DOI: 10.1007/s00520-024-08547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Electronic patient-reported outcomes (ePROs) assess patients' health status and quality of life, improving patient care and treatment effects, yet little is known about their use and adherence in routine patient care. AIMS We evaluated the adherence of invasive breast cancer and ductal carcinoma in situ (DCIS) patients to ePROs follow-up and whether specific patient characteristics are related to longitudinal non-adherence. METHODS Since November 2016, the Breast Center at Charité - Universitätsmedizin Berlin has implemented an ongoing prospective PRO routine program, requiring patients to complete ePROs assessments and consent to email-based follow-up in the first 12 months after therapy starts. Frequencies and summary statistics are presented. Multiple logistic regression models were performed to determine an association between patient characteristics and non-adherence. RESULTS Out of 578 patients, 239 patients (41.3%, 95%CI: 37.3-45.5%) completed baseline assessment and all five ePROs follow-up during the first 12 months after therapy. On average, above 70% of those patients responded to the ePROs follow-up assessment. Adherence to the ePROs follow-up was higher during the COVID-19 pandemic than in the time periods before (47.4% (111/234) vs. 33.6% (71/211)). Factors associated with longitudinal non-adherence were younger age, a higher number of comorbidities, no chemotherapy, and a low physical functioning score in the EORTC QLQ-C30 at baseline. CONCLUSIONS The study reveals moderate adherence to 12-month ePROs follow-up assessments in invasive early breast cancer and DCIS patients, with response rates ranging from 60 to 80%. Emphasizing the benefits for young patients and those with high disease burdens might further increase adherence.
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Affiliation(s)
- Pimrapat Gebert
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Maria Hage
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Roehle
- Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Leistner DM, Laguna-Fernandez A, Haghikia A, Abdelwahed YS, Schatz AS, Erbay A, Roehle R, Fonseca AF, Ferber P, Landmesser U. Impact of elevated lipoprotein(a) on coronary artery disease phenotype and severity. Eur J Prev Cardiol 2024; 31:856-865. [PMID: 38348689 DOI: 10.1093/eurjpc/zwae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/19/2024]
Abstract
AIMS A thorough characterization of the relationship between elevated lipoprotein(a) [Lp(a)] and coronary artery disease (CAD) is lacking. This study aimed to quantitatively assess the association of increasing Lp(a) levels and CAD severity in a real-world population. METHODS AND RESULTS This non-interventional, cross-sectional, LipidCardio study included patients aged ≥21 years undergoing angiography (October 2016-March 2018) at a tertiary cardiology centre, who have at least one Lp(a) measurement. The association between Lp(a) and CAD severity was determined by synergy between PCI with taxus and cardiac surgery (SYNTAX)-I and Gensini scores and angiographic characteristics. Overall, 975 patients (mean age: 69.5 years) were included; 70.1% were male, 97.5% had Caucasian ancestry, and 33.2% had a family history of premature atherosclerotic cardiovascular disease. Median baseline Lp(a) level was 19.3 nmol/L. Patients were stratified by baseline Lp(a): 72.9% had < 65 nmol/L, 21.0% had ≥100 nmol/L, 17.2% had ≥125 nmol/L, and 12.9% had ≥150 nmol/L. Compared with the normal (Lp(a) < 65 nmol/L) group, elevated Lp(a) groups (e.g. ≥ 150 nmol/L) had a higher proportion of patients with prior CAD (48.4% vs. 62.7%; P < 0.01), prior coronary revascularization (39.1% vs. 51.6%; P = 0.01), prior coronary artery bypass graft (6.0% vs. 15.1%; P < 0.01), vessel(s) with lesions (68.5% vs. 81.3%; P = 0.03), diffusely narrowed vessels (10.9% vs. 16.5%; P = 0.01) or chronic total occlusion lesions (14.3% vs. 25.2%; P < 0.01), and higher median SYNTAX-I (3.0 vs. 5.5; P = 0.01) and Gensini (10.0 vs. 16.0; P < 0.01) scores. CONCLUSION Elevated Lp(a) was associated with a more severe presentation of CAD. Awareness of Lp(a) levels in patients with CAD may have implications in their clinical management.
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Affiliation(s)
- David M Leistner
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- University Hospital Frankfurt and Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | | | - Arash Haghikia
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anne-Sophie Schatz
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Aslihan Erbay
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- University Hospital Frankfurt and Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Robert Roehle
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ana F Fonseca
- Novartis Pharma AG, Fabrikstrasse 2, CH-4056 Basel, Switzerland
| | - Philippe Ferber
- Novartis Pharma AG, Fabrikstrasse 2, CH-4056 Basel, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Zilski N, Speiser D, Bartley J, Roehle R, Blohmer JU, Keilholz U, Goerling U. Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant. J Sex Med 2023; 21:33-39. [PMID: 37973412 DOI: 10.1093/jsxmed/qdad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause. AIM To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL). METHODS The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints. OUTCOMES RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women. RESULTS In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = -0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = -0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = -1.09, P = .13) than women who were postmenopausal at the time of RRSO. CLINICAL IMPLICATIONS The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women. STRENGTHS AND LIMITATIONS Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors. CONCLUSION Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.
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Affiliation(s)
- Nicole Zilski
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Dorothee Speiser
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Julia Bartley
- Department of Gynecology, Universitätsklinikum Magdeburg, 39108 Magdeburg, Germany
- TFP Fertility Berlin, 10117 Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Clinical Study Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, 10178, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ulrich Keilholz
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ute Goerling
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
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Afshar-Bakshloo M, Albers S, Richter C, Berninger O, Blohmer JU, Roehle R, Speiser D, Karsten MM. How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes. BMC Cancer 2023; 23:705. [PMID: 37507687 PMCID: PMC10375629 DOI: 10.1186/s12885-023-11172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. METHODS EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. RESULTS BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). CONCLUSIONS Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
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Affiliation(s)
- Melissa Afshar-Bakshloo
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Albers
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Chiara Richter
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ottilia Berninger
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dorothee Speiser
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Piper SK, Zocholl D, Toelch U, Roehle R, Stroux A, Hoessler J, Zinke A, Konietschke F. Statistical review of animal trials-A guideline. Biom J 2023; 65:e2200061. [PMID: 36071025 DOI: 10.1002/bimj.202200061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 11/11/2022]
Abstract
Any experiment involving living organisms requires justification of the need and moral defensibleness of the study. Statistical planning, design, and sample size calculation of the experiment are no less important review criteria than general medical and ethical points to consider. Errors made in the statistical planning and data evaluation phase can have severe consequences on both results and conclusions. They might proliferate and thus impact future trials-an unintended outcome of fundamental research with profound ethical consequences. Unified statistical standards are currently missing for animal review boards in Germany. In order to accompany, we developed a biometric form to be filled and handed in with the proposal at the concerned local authority on animal welfare. It addresses relevant points to consider for biostatistical planning of animal experiments and can help both the applicants and the reviewers in overseeing the entire experiment(s) planned. Furthermore, the form might also aid in meeting the current standards set by the 3+3R's principle of animal experimentation: Replacement, Reduction, Refinement as well as Robustness, Registration, and Reporting. The form has already been in use by the concerned local authority of animal welfare in Berlin, Germany. In addition, we provide reference to our user guide giving more detailed explanation and examples for each section of the biometric form. Unifying the set of biostatistical aspects will help both the applicants and the reviewers to equal standards and increase quality of preclinical research projects, also for translational, multicenter, or international studies.
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Affiliation(s)
- Sophie K Piper
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dario Zocholl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Toelch
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Germany
| | - Robert Roehle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinical Trial Office, Berlin, Germany
| | - Andrea Stroux
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Hoessler
- Landesamt für Gesundheit und Soziales, Referat für gesundheitlichen Verbraucherschutz, Berlin, Germany
| | - Anne Zinke
- Landesamt für Gesundheit und Soziales, Referat für gesundheitlichen Verbraucherschutz, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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6
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Witt C, Kienast C, Bölke G, Hoffmann C, Roehle R, Bender O, Nowak D, Tauber R, Gunga HC, Hoffmann P, Coats AJS, Liebers U. Long-term indoor gunshot exposure of special police forces induces bronchitic reactions and elevated blood lead levels-The Berlin shooting range study. J Cachexia Sarcopenia Muscle 2023; 14:452-463. [PMID: 36539958 PMCID: PMC9891938 DOI: 10.1002/jcsm.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gunshot emissions contain toxic elements that can harm those frequently exposed, such as police officers. Several years ago, police indoor firing ranges were closed by the Berlin municipality in response to police officer health complaints, and an investigation was launched into the possible respiratory health risks of frequent gunshot emission exposure. We, therefore, conducted an exploratory cross-sectional study to investigate clinical and functional parameters of respiratory health as well as the burden of trace elements in policemen with long-term high exposure to indoor gunshot emissions, compared to low-exposure and control groups. METHODS We conducted lung function tests and collected blood and urine samples from Berlin police officers and government employees who were divided into three subject groups based on exposure to gunshot emissions: high exposure (n = 53), low exposure (n = 94) and no exposure (n = 76). Lung function was examined using body plethysmography. Blood and urine samples were tested via inductively coupled plasma mass spectrometry for the presence of common gunshot powder elements (antimony, lead and manganese). Exposure and symptoms were assessed using records as well as questionnaires. RESULTS Higher exposure was associated with more respiratory symptoms during gun shooting practice (64% vs. 21%, P < 0.001) compared to the low-exposure group. Headache, cough, discoloured mucous and shortness of breath were also more common as were some other symptoms. The cough symptomatology of the high-exposure group also persisted significantly longer (median: 0.67 vs. 0.01 days, range: 0 to 5 days, P = 0.029) compared to the low-exposure group. They also showed a lower forced expiratory volume in 1 s/forced vital capacity quotient (Tiffeneau index), P = 0.018 between the three groups and P = 0.005 for the high-exposure group, a possible marker of early, subclinical bronchial obstruction. We observed increased blood lead concentrations depending on subject's age (+1.2% per year, 95% confidence interval: 0.5-1.9%, P < 0.001) and cumulative gunshot exposure (+0.34% per 100 000 shots, 0.02-0.66%, P = 0.037). CONCLUSIONS These first results suggest that long-term exposure to indoor gunshot emissions induces bronchitic reactions due to repeated irritation of the airways. Higher levels of exposure lead to more negatively impacted lung function and higher blood lead levels with the possible reason that more frequent exposure may mean shorter regeneration phases for the respiratory mucous membrane. We recommend a reduction of exposure to gunshot emissions in order to decrease symptoms and avoid any-even small-deterioration in spirometry.
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Affiliation(s)
- Christian Witt
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Camilla Kienast
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georg Bölke
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Hoffmann
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Roehle
- Charité Coordinating Center for Clinical Studies (KKS), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olaf Bender
- Charité Coordinating Center for Clinical Studies (KKS), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich; Comprehensive Pneumology Center (CPC) Munich, member DZL, German Center for Lung Research, Munich, Germany
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanns-Christian Gunga
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Hoffmann
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Uta Liebers
- Department of Outpatient Pneumology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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7
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Karsten MM, Roehle R, Albers S, Pross T, Hage AM, Weiler K, Fischer F, Rose M, Kühn F, Blohmer JU. Corrigendum to 'Real-world reference scores for EORTC QLQ-C30 and EORTC QLQ-BR23 in early breast cancer patients [European Journal of Cancer 163 (2022) 128-139]. Eur J Cancer 2022; 174:325-327. [PMID: 35970736 DOI: 10.1016/j.ejca.2022.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Maria M Karsten
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany.
| | - Robert Roehle
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Sarah Albers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Therese Pross
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Anna M Hage
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Karoline Weiler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany; Klinikum Dritter Orden, Munich, Germany
| | - Felix Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Jens-Uwe Blohmer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
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8
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Krege S, Falhammar H, Lax H, Roehle R, Claahsen-van der Grinten H, Kortmann B, Duranteau L, Nordenskjöld A. Long-Term Results of Surgical Treatment and Patient-Reported Outcomes in Congenital Adrenal Hyperplasia-A Multicenter European Registry Study. J Clin Med 2022; 11:jcm11154629. [PMID: 35956243 PMCID: PMC9369813 DOI: 10.3390/jcm11154629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Representatives for congenital adrenal hyperplasia (CAH) continue to desire early feminizing surgery in girls with 46,XX-CAH. The aim of this analysis, which included 174 46,XX- individuals with salt-wasting (SW) or simple-virilizing (SV) CAH, a female gender identity, and an age > 16 years participating in a multicenter cross-sectional clinical evaluation study (dsd-LIFE), was to evaluate the long-term results of surgery and patient-reported outcomes (PRO). The gynecological examination (n = 84) revealed some shortcomings concerning surgical feminization. A clitoris was absent in 9.5% of cases, while a clitoral hood was missing in 36.7% of cases. Though all women had large labia, they didn’t look normal in 22.6% of cases. Small labia were absent in 23.8% of cases. There was no introitus vaginae, and the urethra and vagina had no separate opening in 5.1% of cases. A mucosal lining was missing in 15.4% of cases. Furthermore, 86.2% of the women had scars at the region of their external genitalia. A vaginal stenosis was described in 16.5% of cases, and a meatal stenosis was described in 2.6% of cases. Additionally, PRO data showed a very-/high satisfaction rate of 21.3%/40.2% with cosmesis and 23.8%/38.1% with functionality, while 3.3%/10.7% showed a very-/low satisfaction with cosmesis as well as 5.6%/10.3% with functionality. The remaining women—24.6% and 23.8%—were indifferent. Satisfaction concerning sex life was very-/high in 9.6%/27.7%. In 12.0%/16.9% it was very-/low. Furthermore, 33.7% had no opinion. Furthermore, 27.0%/31.6% of the women reported that clitoriplasty, but not clitoridectomy, had a very-/positive influence on their lives, while 1.3%/8.9% felt it to be very-/negative, and 28.4% were indifferent. Vaginoplasty had a very-/positive influence in 25.7%/33.8% and a very-/negative effect in 3.6%/6.8%. 29.7% had no opinion. Additionally, 75.7% of the women preferred feminizing surgery during infancy/childhood, especially concerning clitoreduction. In conclusion, though the majority of the participants (76%) preferred early feminizing surgery and 60% described a positive effect on their lives, about 10% felt it to have been negative. About 15% of the women suffered from insufficient cosmesis and functionality after surgery. Sex life was even described as poor in nearly 30%. Therefore, the decision about early genital surgery in 46,XX-CAH girls should be considered carefully. Parents should get detailed information about possible complications of surgery and should receive support to understand that postponing surgery does not inevitably cause harm for their child. Importantly, genital surgery when performed in children should only be performed in expert centers with a specialized team including surgeons who are trained in feminizing surgery.
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Affiliation(s)
- Susanne Krege
- Department of Urology, Pediatric Urology and Urooncology, Kliniken Essen Mitte, 45136 Essen, Germany
- Correspondence: ; Tel.: +49-201-174-29003; Fax: +49-201-174-29000
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology, University of Essen, 45147 Essen, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charite-University Medicine Berlin, 10117 Berlin, Germany
- Institute of Health, Charite-University Medicine Berlin, 10117 Berlin, Germany
| | | | - Barbara Kortmann
- Department of Pediatric Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Lise Duranteau
- Department of Medical Gynaecology and Reference Centre for Rare Diseases of Genital Development, Bicetre Hospital, APHP Paris Saclay University, 94270 Le Kremlin Bicetre, France
| | - Agneta Nordenskjöld
- Department of Women’s and Children’s Health, Center of Molecular Medicine, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Pediatric Surgery, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 17176 Stockholm, Sweden
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9
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Gebert P, Dordevic AD, Roehle R, Hage AM, Karsten MM. Data of real-world reference scores for EORTC QLQ-C30 and QLQ-BR23 at baseline in women with early breast cancer and other breast diseases. Data Brief 2022; 43:108347. [PMID: 35720770 PMCID: PMC9198306 DOI: 10.1016/j.dib.2022.108347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Patient-reported outcomes are information about health status and health-related quality of life collected directly from patients. The data in this publication contain the first assessment of patient-reported outcomes (PROs) from real-life measurements in the breast cancer center at Charité – Universitätsmedizin Berlin between November 2016 and March 2021. At baseline (before the start of treatment), 1727 ambulatory patients with early breast cancer, ductal carcinoma in situ (DCIS), fibroadenoma, and other breast diseases were registered in the digital PRO-system as part of clinical routine. Patients’ sociodemographic data, medical history, clinical variables, and raw scores of the EORTC QLQ-C30 and EORTC QLQ-BR23 are provided in this publication. This dataset can be used as a reference for PROs in a clinical care setting or in clinical studies with breast diseases and contribute to the discussion about the interpretation of score values. Furthermore, the association between patients’ sociodemographic data, clinical variables, and PRO data at baseline can be analysed further.
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Affiliation(s)
- Pimrapat Gebert
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Adam David Dordevic
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Roehle
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Maria Hage
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Corresponding author.
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10
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Bojarski C, Tangermann P, Barmeyer C, Buchkremer J, Kiesslich R, Ellrichmann M, Schreiber S, Schmidt C, Stallmach A, Roehle R, Loddenkemper C, Daum S, Siegmund B, Schumann M, Ullrich R. Prospective, double-blind diagnostic multicentre study of confocal laser endomicroscopy for wheat sensitivity in patients with irritable bowel syndrome. Gut 2022; 71:1567-1576. [PMID: 34544843 PMCID: PMC9279748 DOI: 10.1136/gutjnl-2021-325181] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A considerable proportion of patients with irritable bowel syndrome (IBS) may be wheat-sensitive and respond to a gluten-free diet (GFD) although they do not have coeliac disease. However, a diagnostic test for wheat sensitivity (WS) is missing. Our study evaluated the diagnostic accuracy (sensitivity and specificity) of confocal laser endomicroscopy (CLE) for the identification of WS as primary outcome. DESIGN In this prospective, double-blind diagnostic study 147 non-coeliac patients fulfilling the Rome III criteria for IBS were tested by CLE for duodenal changes after wheat (index test), soy, yeast or milk exposure. Patients with IBS responding to 2 months of GFD were classified as having WS (reference test) using response criteria recommended by regulatory bodies for pharmaceutical trials of patients with IBS. After 2 months, CLE results were unblinded and patients were advised to exclude those food components that had led to a positive CLE reaction. The clinical response was assessed at follow-up after 6 and 12 months. RESULTS Of 130 patients who completed the study per protocol, 74 (56.9%) responded to GFD and were classified as WS after 2 months, and 38 of these 74 patients were correctly identified by CLE (sensitivity 51.4%; 97.5% CI: 38.7% to 63.9%). A total of 38 of 56 patients without WS were correctly identified by CLE (specificity 67.9%; 97.5% CI: 52.9% to 79.9%). At 6 months follow-up, CLE correctly identified 49 of 59 food-sensitive patients (sensitivity 83.1%; 97.5% CI: 69.9% to 91.3%) but specificity was only 32% (97.5% CI: 15.7% to 54.3%). CONCLUSION In light of the high proportion of patients with IBS responding to GFD, the diagnostic accuracy of CLE is too low to recommend widespread use of this invasive procedure. TRAIL REGISTRATION NUMBER This study was registered as clinical trial in the German Registry for Clinical Studies (DRKS00010123).
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Affiliation(s)
- Christian Bojarski
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Paul Tangermann
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Christian Barmeyer
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Juliane Buchkremer
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Ralf Kiesslich
- Helios Dr. Horst Schmidt Kliniken Wiesbaden, Internal Medicine II Gastroenterology, Hepatology and Endocrinology, Wiesbaden, Germany
| | - Mark Ellrichmann
- Universitätsklinikum Schleswig-Holstein, Medical Department I, Kiel, Germany
| | - Stefan Schreiber
- Universitätsklinikum Schleswig-Holstein, Medical Department I, Kiel, Germany
| | - Carsten Schmidt
- Universitätsklinikum Jena, Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena, Germany,Klinikum Fulda, Medical Clinic II, Fulda, Germany
| | - Andreas Stallmach
- Universitätsklinikum Jena, Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena, Germany
| | - Robert Roehle
- Charité – Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany,Charité – Universitätsmedizin Berlin, Clinical Study Center, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Severin Daum
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Britta Siegmund
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Michael Schumann
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
| | - Reiner Ullrich
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Department for Internal Medicine (Gastroenterology, Infectious Diseases, Rheumatology, Berlin, Germany
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11
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Karsten MM, Roehle R, Albers S, Pross T, Hage AM, Weiler K, Fischer F, Rose M, Kühn F, Blohmer JU. Real-world reference scores for EORTC QLQ-C30 and EORTC QLQ-BR23 in early breast cancer patients. Eur J Cancer 2022; 163:128-139. [DOI: 10.1016/j.ejca.2021.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022]
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12
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Swolinsky JS, Tuvshinbat E, Leistner DM, Edelmann F, Knebel F, Nerger NP, Lemke C, Roehle R, Haase M, Costanzo MR, Rauch G, Mitrovic V, Gasanin E, Meier D, McCullough PA, Eckardt KU, Molitoris BA, Schmidt-Ott KM. Discordance between estimated and measured changes in plasma volume among patients with acute heart failure. ESC Heart Fail 2021; 9:66-76. [PMID: 34881523 PMCID: PMC8788058 DOI: 10.1002/ehf2.13739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022] Open
Abstract
Aims In acute heart failure (AHF), changes of venous haemoglobin (Hb) concentrations, haematocrit (Hct), and estimated plasma volume (ePV) have been proposed as surrogates of decongestion. These estimates are based on the theoretical assumptions that changes of Hb concentrations and Hct are driven by the intravascular volume status and that the intravascular Hb pool remains stable. The objective of this study was to assess the relationship of changes of measured plasma volume (mPV) with changes of Hb, Hct, and ePV in AHF. Methods and results We studied 36 AHF patients, who received two sequential assessments of mPV, measured red cell volume (mRCV) and measured total blood volume (mTBV) (48 h apart), during the course of diuretic therapy using a novel visible fluorescent injectate (VFI) technique based on the indicator dilution principle. Changes of ePV were calculated based on the Kaplan–Hakim or Strauss formula. AHF patients receiving diuretics (median intravenous furosemide equivalent 160 mg/48 h) displayed a wide range of changes of mPV (−25.4% to +37.0%). Changes in mPV were not significantly correlated with changes of Hb concentration [Pearson's r (r) = −0.241, P = 0.157], Hct (r = −0.307, P = 0.069), ePVKaplan–Hakim (r = 0.228, P = 0.182), or ePVStrauss (r = 0.237, P = 0.163). In contrast to theoretical assumptions, changes of mTBV were poorly correlated with changes of Hb concentrations and some patients displayed unanticipated variability of mRCV, suggesting an unstable intravascular red cell pool. Conclusions Changes of Hb or Hct were not reflective of directly measured changes of intravascular volume status in AHF patients. Basing clinical assessment of decongestion on changes of Hb or Hct may misguide clinical decision‐making on an individual patient level.
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Affiliation(s)
- Jutta S Swolinsky
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Enkhtuvshin Tuvshinbat
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - David M Leistner
- Department of Internal Medicine and Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Frank Edelmann
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niklas P Nerger
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Caroline Lemke
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Robert Roehle
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Study Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Haase
- Medical Faculty, Otto von-Guericke-University Magdeburg, Magdeburg, Germany.,Diaverum Renal Care Center, Potsdam, Germany
| | | | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | | | | | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany
| | - Bruce A Molitoris
- FAST BioMedical, Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA
| | - Kai M Schmidt-Ott
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin, 12203, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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13
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Liedmeier A, Jendryczko D, Rapp M, Roehle R, Thyen U, Kreukels BP. The influence of psychosocial and sexual wellbeing on quality of life in women with differences of sexual development. Comprehensive Psychoneuroendocrinology 2021; 8:100087. [PMID: 35757661 PMCID: PMC9216410 DOI: 10.1016/j.cpnec.2021.100087] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Previous research indicating that women with differences of sexual development (DSD), namely women with Turner syndrome (TS), women with congenital adrenal hyperplasia (CAH), and women with XY-DSD, have an impaired psychosocial and sexual well-being and quality of life (QOL), was often limited by small samples and inadequate control groups (CGs). Only few studies analysed which psychosocial and sexual factors influence QOL in women with DSD and no study so far has examined whether the DSD-condition itself and the diagnostic group to which they belong moderate this influence. Methods We compared 301 women with TS, 221 women with CAH and 142 women with XY-DSD with 603 non-DSD women regarding depression, anxiety, self-esteem, attention deficit hyperactivity disorder, autism, social participation, body acceptance, relationship status, sexual satisfaction and QOL. Furthermore, we investigated the influence of psychosocial and sexual well-being on QOL within and between diagnostic groups and examined whether the DSD-condition moderates the influence of psychosocial and sexual well-being on QOL. Results Women with DSD reported average psychosocial well-being and QOL; only women with CAH reported an impaired physical QOL. However, women with DSD were less satisfied with their body and had less often a partner than women in the CG. Women with CAH and XY-DSD were less satisfied with their sex life compared to women in the CG. Across groups, better health and lower depression scores predicted better QOL, whereas higher self-esteem especially predicted better QOL in women with DSD. The presence of DSD moderated the influence of psychosocial and sexual well-being on QOL, however, the specific diagnosis group mainly moderated the influence on physical QOL. Conclusion We have learned that body and sexual satisfaction need further attention in women with DSD. To optimize their QOL, psychosocial well-being should be taken in account. The improvement of self-esteem seems particularly relevant for women with DSD, as this helps coping with having a variant of sexual development. Psychosocial wellbeing and QOL in women with DSD are similar compared to women of the general population. Psychosexual wellbeing and body satisfaction in women with DSD are still reduced. Quality of life in women with DSD is best predicted by good health, low depression and high self-esteem. Self-esteem predicts quality of life better in women with than without DSD.
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14
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Swolinsky JS, Nerger NP, Leistner DM, Edelmann F, Knebel F, Tuvshinbat E, Lemke C, Roehle R, Haase M, Costanzo MR, Rauch G, Mitrovic V, Gasanin E, Meier D, McCullough PA, Eckardt K, Molitoris BA, Schmidt‐Ott KM. Serum creatinine and cystatin C-based estimates of glomerular filtration rate are misleading in acute heart failure. ESC Heart Fail 2021; 8:3070-3081. [PMID: 33955699 PMCID: PMC8318462 DOI: 10.1002/ehf2.13404] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS We aimed to test whether the endogenous filtration markers serum creatinine or cystatin C and equation-based estimates of glomerular filtration rate (GFR) based on these markers appropriately reflect changes of measured GFR in patients with acute heart failure. METHODS In this prospective cohort study of 50 hospitalized acute heart failure patients undergoing decongestive therapy, we applied an intravenous visible fluorescent injectate (VFI), consisting of a low molecular weight component to measure GFR and a high molecular weight component to correct for measured plasma volume. Thirty-eight patients had two sequential GFR measurements 48 h apart. The co-primary endpoints of the study were safety of VFI and plasma stability of the high molecular weight component. A key secondary endpoint was to compare changes in measured GFR (mGFR) to changes of serum creatinine, cystatin C and estimated GFR. RESULTS VFI-based GFR measurements were safe and consistent with plasma stability of the high molecular weight component and glomerular filtration of the low molecular weight component. Filtration marker-based point estimates of GFR, when compared with mGFR, provided only moderate correlation (Pearson's r, range 0.80-0.88, depending on equation used), precision (r2 , range 0.65-0.78) and accuracy (56%-74% of estimates scored within 30% of mGFR). Correlations of 48-h changes GFR estimates and changes of mGFR were significant (P < 0.05) but weak (Pearson's r, range 0.35-0.39). Observed decreases of eGFR by more than 15% had a low sensitivity (range 38%-46%, depending on equation used) in detecting true worsening mGFR, defined by a >15% decrease in mGFR. CONCLUSIONS In patients hospitalized for acute heart failure, serum creatinine- and cystatin C-based predictions performed poorly in detecting actual changes of GFR. These data challenge current clinical strategies to evaluate dynamics of kidney function in acute heart failure.
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Affiliation(s)
- Jutta S. Swolinsky
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Niklas P. Nerger
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - David M. Leistner
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus Benjamin FranklinBerlinGermany
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research) Partner Site BerlinBerlinGermany
| | - Frank Edelmann
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research) Partner Site BerlinBerlinGermany
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus Virchow KlinikumBerlinGermany
| | - Fabian Knebel
- Department of Cardiology and AngiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus MitteBerlinGermany
| | - Enkhtuvshin Tuvshinbat
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Caroline Lemke
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Robert Roehle
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Institute of Biometry and Clinical EpidemiologyCharité – Universtitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Coordinating Center for Clinical StudiesCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Michael Haase
- Faculty of MedicineOtto von‐Guericke‐University MagdeburgMagdeburgGermany
| | | | - Geraldine Rauch
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Institute of Biometry and Clinical EpidemiologyCharité – Universtitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | | | - Edis Gasanin
- Department of CardiologyKerckhoff KlinikBad NauheimGermany
| | | | - Peter A. McCullough
- Baylor University Medical Center, Baylor Heart and Vascular HospitalBaylor Heart and Vascular InstituteDallasTXUSA
| | - Kai‐Uwe Eckardt
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | | | - Kai M. Schmidt‐Ott
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
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15
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Gong XL, Raile K, Slowikowska-Hilczer J, Pienkowski C, Quinkler M, Roehle R, Nordenström A, Neumann U. Physical and Reported Subjective Health Status in 222 Individuals with XY Disorder of Sex Development. J Endocr Soc 2021; 5:bvab103. [PMID: 34258493 PMCID: PMC8271184 DOI: 10.1210/jendso/bvab103] [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: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Context Little is known about the physical health of individuals with 46,XY disorders of sex development (DSD). Objective To assess physical and reported subjective health of individuals with XY DSD. Methods As part of the dsd-LIFE study, patients with an XY DSD condition were analyzed in different diagnosis groups for metabolic parameters, comorbidities, metabolic syndrome, bone outcomes, and reported subjective health. Findings were evaluated by descriptive statistics. Results A total of 222 patients with XY DSD were included with a mean age of 28.8 ± 12.2 years, mean height of 175.3 ± 7.7 cm, mean weight of 74.3 ± 20.0 kg, and mean body mass index of 24.1 ± 6.0 kg/m2. Obesity rate was not increased when descriptively compared with Eurostat data. Fourteen patients had metabolic syndrome (14/175; 8.0%). In descriptive comparison with data from the DECODE study and World Health Organization, subjects fared better in the categories waist circumference, glucose, triglyceride, cholesterol, and high-density lipoprotein. Of participants with available bone health data, 19/122 (15.6%) patients had a Z-score ≤ –2.0 at lumbar spine indicating lowered bone mineral density (BMD). Mostly gonadectomized individuals with complete androgen insensitivity syndrome (CAIS) and no estrogen therapy had lowered BMD at lumbar spine. Individuals with XY DSD performed poorly in the category subjective health in descriptive comparison with Eurostat data. Conclusion Participants reported a lower subjective health status than Eurostat data but their overall metabolic health status was good. Decreased BMD at lumbar spine was especially present in gonadectomized individuals with CAIS and no estrogen therapy.
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Affiliation(s)
- Xin Li Gong
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Klemens Raile
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Endocrinology and Diabetology, Berlin, Germany
| | | | - Catherine Pienkowski
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Unit, Children's Hospital, CHU Toulouse, France
| | | | - Robert Roehle
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Coordinating Center for Clinical Studies, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Nordenström
- Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Uta Neumann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for chronic sick children, Department of Pediatric Endocrinology, Berlin, Germany
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16
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Rapp M, Duranteau L, van de Grift TC, Schober J, Hirschberg AL, Krege S, Nordenstrom A, Roehle R, Thyen U, Bouvattier C, Kreukels BPC, Nordenskjold A. Self- and proxy-reported outcomes after surgery in people with disorders/differences of sex development (DSD) in Europe (dsd-LIFE). J Pediatr Urol 2021; 17:353-365. [PMID: 33358555 DOI: 10.1016/j.jpurol.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/14/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conference in 2006, multidisciplinary care is provided to a higher degree with psychological support and more restricted surgical procedures. Outcome studies after genital surgery often lack of patient's perspective. OBJECTIVE To describe surgical procedures in relation to diagnosis, to evaluate the outcomes of surgery through genital examination, and through patient's and observer's satisfaction with the anatomical and functional result after genital surgery. STUDY DESIGN In a cross-sectional clinical study performed in six European countries in 2014/15, we have included 500 participants where surgery was performed, from a total of 1040 adolescents (≥16years) and adults with a DSD. Diagnoses included Turner syndrome (n = 301), mixed gonadal dysgenesis (45,XO/46,XY; n = 45), Klinefelter syndrome (n = 218), XYY (n = 1), 46, XY DSD (n = 222) and 46, XX DSD (n = 253). Study protocol included clinical report files, an optional gynecological or urological examination, patient reported outcomes including received surgical interventions, satisfaction with appearance and function after surgery, and impact of the surgical procedure on life. RESULTS Five hundred participants had received genital or breast surgery, with the highest rate in 46, XY DSD and the lowest in Turner syndrome. Altogether; 240 participants had feminizing surgery, 112 had masculinizing surgery, and 217 underwent gonadectomy. Physicians evaluated anatomical appearance at genital examination as poor in less than 10%. Dissatisfaction with anatomical appearance was reported by 22% of the participants, dissatisfaction with function by 20%. Being (very) dissatisfied with anatomical appearance and function was reported by 13% of the study participants. Most participants reported no impact, or positive impact, of the surgical procedures on their lives, but 29% experienced a negative effect of gonadectomy on their life. DISCUSSION There might be a selection bias and/or a recall bias for participating in our studies. Due to poor data quality about surgical procedures performed in the past, we also relied on participants memory about surgical procedures in their past. Ideally, patient reported outcomes should be evaluated both before and after surgical procedures. CONCLUSION A vast majority are satisfied with appearance and function, but still genital or breast surgery have a long-lasting effect on patient's life. Self-reported satisfaction is usually lower than the observer's evaluation regarding both appearance and function.
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Affiliation(s)
- Marion Rapp
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, Lubeck, 23538, Germany.
| | - Lise Duranteau
- Adolescent and Young Adult Gynecology Unit, Centre de Reference des Maladies Rares du Développement Génital, Hôpital Bicêtre, AP.HP Paris Saclay University, 78 rue du General Leclerc, Le Kremlin Bicêtre, 94270, France.
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, location VUmc, PO Box 7057, Amsterdam. 1007, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Centers, location VUmc, PO Box 7057, Amsterdam, 1007, the Netherlands.
| | - Justine Schober
- UPMC Hamot, Department of Urology, 201 State St. Erie, PA, 16550, USA.
| | - Angelica L Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, 171 76, Sweden.
| | - Susanne Krege
- Kliniken Essen-Mitte, Klinik fur Urologie, Kinderurologie und urologische Onkologie, Evangelische Huyssens Stiftung/Knappschaft GmbH, Essen, 45136, Germany.
| | - Anna Nordenstrom
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, 171 76, Sweden.
| | - Robert Roehle
- Charité - Universitätsmedizin Berlin, Coordinating Center for Clinical Studies, Berlin, 13353, Germany.
| | - Ute Thyen
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, Lubeck, 23538, Germany.
| | - Claire Bouvattier
- Endocrinologie pediatrique, Centre de Reference des Maladies Rares du Développement Génital, Hôpitaux Universitaires Paris Saclay (Bicêtre), 78 rue du General Leclerc, Le Kremlin Bicetre, 94270, France.
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Centers, location VUmc, PO Box 7057, Amsterdam, 1007, the Netherlands.
| | - Agneta Nordenskjold
- Department of Women's and Children's Health and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Pediatric Surgery, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden.
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17
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SWOLINSKY J, Nerger N, Leistner D, Edelmann F, Knebel F, Tuvshinbat E, Lemke C, Roehle R, Rauch G, Mitrovic V, Gasanin E, Meier D, McCullough P, Eckardt K, Molitoris B, Schmidt-Ott K. POS-055 ESTIMATED VERSUS MEASURED GLOMERULAR FILTRATION RATE IN ACUTE DECOMPENSATED HEART FAILURE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Ziegeler K, Kreutzinger V, Diekhoff T, Roehle R, Poddubnyy D, Pumberger M, Hamm B, Hermann KGA. Impact of age, sex, and joint form on degenerative lesions of the sacroiliac joints on CT in the normal population. Sci Rep 2021; 11:5903. [PMID: 33723315 PMCID: PMC7960989 DOI: 10.1038/s41598-021-85303-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
Degeneration of the sacroiliac joints (SIJs) is a common finding, while its underlying cause and development remain incompletely understood. The aim of this investigation was to describe the spatial distribution of degenerative SIJ changes across age groups and to investigate for the first time their relationship to anatomical form and sex. For this IRB-approved investigation, demographic data of 818 patients without SIJ disease were retrieved from electronic patient records. High-resolution computed tomography (CT) datasets of all patients were analysed retrospectively for seven predefined age groups (ten-year increments, from < 25 to ≥ 75). A structured scoring system was applied to assess sclerosis, osteophytes, joint space alterations, and anatomical form. Chi-square tests were used to compare frequencies of degenerative lesions, and logistic regression analyses were performed to investigate associations between demographic data, anatomical form, and the presence of structural lesions. Sclerosis and osteophytes were common findings, with an overall prevalence of 45.7% and 46.8%, respectively. Female sex had an odds ratio (OR) of 0.15 (95% CI: 0.08-0.27) for the presence of ventral osteophytes and of 4.42 (95% CI: 2.77-7.04) for dorsal osteophytes. Atypical joint forms were significantly more prevalent in women with 62.1% vs. 14.1% in men (p < 0.001). Accessory joints increased the likelihood of dorsal sclerosis (OR 2.735; 95% CI 1.376-5.436) while a typical joint form decreased its likelihood (OR 0.174; 95% CI 0.104-0.293). Sex and anatomical joint form have a major impact on the development of degenerative lesions of the SIJs and their spatial distribution.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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19
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Lehner LJ, Kalb K, Weigand K, Pein U, Schenker P, Seeger W, Roehle R, Dienes K, Halleck F, Budde K. STABIL-study: The Course of Therapy, Safety and Pharmacokinetic Parameters of Conversion of Prograf® to Tacrolimus HEXAL®/Crilomus® in Renal Transplant Recipients - an Observational Study in Germany. ACTA ACUST UNITED AC 2021; 16:357-368. [PMID: 33588739 DOI: 10.2174/1574884716666210215102756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND/OBJECTIVE Tacrolimus HEXAL®/Crilomus® is an approved generic immunosuppressant for the prevention and treatment of rejection following renal transplantation. For safe and socioeconomically efficient conversion from the innovator to generic formulation, high-quality data are necessary, in view of the different and country-specific comorbidities and pharmacokinetics in kidney transplant recipients. PATIENTS AND METHODS From 2014 to 2017, we enrolled 32 kidney transplant recipients, receiving newly prescribed Tacrolimus HEXAL®/Crilomus® in 5 German centers. Efficacy and safety data were collected over 6-8 months and retrospectively compared to the period prior to conversion. RESULTS The mean tacrolimus trough level was 4.91 ng/mL standard deviation (SD) (SD ±1.7) before and 5.06 ng/mL (SD ±1.97) after conversion. Mean tacrolimus trough concentration-dose-ratio (+/- SD) was 187.1 ng/mL/mg/kg/day (SD 99.2) for the reference and 205.1 ng/mL/mg/kg/day (SD 133) for the generic product, resulting in a non-significant difference of 18.0 ng/mL/mg/kg/day (SD 71.8) (p=0.84, Wilcoxon V=180). Overall, dosing had to be changed in 4 (14.8%) patients. Graft function remained stable and no rejections occurred. CONCLUSION In conclusion, conversion to the generic tacrolimus formulation can be considered safe and feasible in long-term kidney transplant recipients in Germany. As suggested by guidelines, a vigilant therapeutic drug monitoring is recommended to account for possible tacrolimus concentration variability on the individual patient level.
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Affiliation(s)
- Lukas J Lehner
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin. Germany
| | - Klaus Kalb
- Klinikum Lüdenscheid, Dialysezentrum, Lüdenscheid. Germany
| | - Karl Weigand
- Klinik und Poliklinik für Urologie und Nierentransplantation, Universitätsklinikum Halle (Saale), Halle Saale. Germany
| | - Ulrich Pein
- Universitätsklinik und Poliklinik für innere Medizin II, Universitätsklinikum Halle (Saale), Halle Saale. Germany
| | - Peter Schenker
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum. Germany
| | - Wolfgang Seeger
- Ärztezentrum Helle Mitte, Praxis für Nierenkrankheiten/Tagesklinik, Berlin. Germany
| | - Robert Roehle
- Charité - Universitätsmedizin Berlin, Coordinating Center for Clinical Studies and Institute of Biometry and Clinical Epidemiology as well Berlin Institute of Health (BIH), Berlin. Germany
| | | | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin. Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin. Germany
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20
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Eibach L, Scheffel S, Cardebring M, Lettau M, Özgür Celik M, Morguet A, Roehle R, Stein C. Cannabidivarin for HIV-Associated Neuropathic Pain: A Randomized, Blinded, Controlled Clinical Trial. Clin Pharmacol Ther 2020; 109:1055-1062. [PMID: 32770831 DOI: 10.1002/cpt.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/25/2020] [Indexed: 01/02/2023]
Abstract
HIV remains a major burden to the health care system and neuropathic pain is the most common neurological complication of HIV infection. Because current treatment strategies often lack satisfying pain relief, cannabinoids (CBs) are discussed as a new option. We investigated cannabidivarin (CBDV) as treatment for HIV-associated neuropathic pain. We conducted a randomized, double-blind, placebo-controlled crossover study. Patients underwent two successive treatment phases (4 weeks each) and were treated with CBDV (400 mg/day) or placebo in a randomized order. A 3-week washout phase was designed to eliminate potential carry-over effects. Patients were followed up for 3 weeks after the end of the second treatment phase. The primary end point was pain intensity on an 11-point numeric rating scale, recorded in a diary. Secondary end points were additional pain medication, pain characteristics, and quality of life. We included 32 patients. The mean pain intensity under CBDV was 0.62 points higher compared with placebo (P = 0.16, 95% confidence interval -0.27 to 1.51). CBDV did not influence the amount of additional pain medication, pain characteristics, or quality of life. The incidence of adverse events was similar during both treatments. No suspected unexpected adverse reactions occurred during either treatment. CBDV was safe but failed to reduce neuropathic pain in patients with HIV. This may be explained by a lack of CB receptor activation, as indicated by preclinical experiments. Although a larger patient number might be desirable, we would not expect a change in the conclusions because the present differences are far from statistical significance. Therefore, we would currently not consider CBDV as a clinically meaningful treatment option for neuropathic pain.
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Affiliation(s)
- Luca Eibach
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Simone Scheffel
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.,SteriPharm Pharmazeutische Produkte, Berlin, Germany
| | - Madeleine Cardebring
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.,Vivantes Klinikum Kaulsdorf, Berlin, Germany
| | - Marie Lettau
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - M Özgür Celik
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Morguet
- Department of Cardiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Coordinating Center for Clinical Studies, Berlin Institute of Health, Charité Universitätsmedizin, Berlin, Germany
| | - Christoph Stein
- Department of Anesthesiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
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21
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Dreger H, Mattig I, Hewing B, Knebel F, Lauten A, Lembcke A, Thoenes M, Roehle R, Stangl V, Landmesser U, Grubitzsch H, Stangl K, Laule M. Treatment of Severe TRIcuspid Regurgitation in Patients with Advanced Heart Failure with CAval Vein Implantation of the Edwards Sapien XT VALve (TRICAVAL): a randomised controlled trial. EUROINTERVENTION 2020; 15:1506-1513. [PMID: 31929100 DOI: 10.4244/eij-d-19-00901] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of our study was to compare the impact of implantation of a balloon-expandable transcatheter valve into the inferior vena cava (CAVI) on exercise capacity with optimal medical therapy (OMT) in patients with severe tricuspid regurgitation (TR) and high surgical risk. METHODS AND RESULTS Twenty-eight patients were randomised to OMT (n=14) or CAVI (n=14). The primary endpoint was maximal oxygen uptake at the three-month follow-up. Secondary endpoints included six-minute walk test, NYHA class, NT-proBNP levels, right heart function, unscheduled heart failure hospitalisation, and quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients underwent follow-up examinations one, three, six, and twelve months after randomisation. Maximal oxygen uptake did not change significantly in either group after three months and there was no difference between the OMT and CAVI groups (-0.1±1.8 ml∙kg-1∙min-1 vs -1.0±1.6 ml∙kg-1∙min-1, p=0.4995). Compared to baseline, CAVI improved NYHA class, dyspnoea, and quality of life after three months. However, there were no statistically significant differences in the secondary endpoints between the groups. Four periprocedural complications occurred after CAVI, resulting in open heart surgery. Four patients in the OMT group and eight patients (including four after conversion to surgery) in the CAVI group died from right heart failure, sepsis or haemorrhage. CONCLUSIONS CAVI did not result in a superior functional outcome compared to OMT. Due to an unexpectedly high rate of valve dislocations, the study was stopped for safety reasons.
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Affiliation(s)
- Henryk Dreger
- Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Riehl G, Reisch N, Roehle R, Claahsen van der Grinten H, Falhammar H, Quinkler M. Bone mineral density and fractures in congenital adrenal hyperplasia: Findings from the dsd-LIFE study. Clin Endocrinol (Oxf) 2020; 92:284-294. [PMID: 31886890 DOI: 10.1111/cen.14149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with congenital adrenal hyperplasia (CAH) type and doses of glucocorticoids used as well as sex hormone secretion during puberty have important actions on bone mineral density (BMD) in adulthood. AIM To evaluate BMD in adult CAH patients depending on current glucocorticoid therapy and on androgen levels in adulthood and at age 16 years. METHODS We included 244 CAH patients from the dsd-LIFE cohort (women n = 147, men n = 97; salt-wasting n = 148, simple-virilizing n = 71, nonclassical n = 25) in which BMD and bloods were available. Clinical and hormonal data at age 16years were retrieved from patients' files. RESULTS Simple-virilizing women showed lower BMD compared to salt-wasting women at trochanter (0.65 ± 0.12 vs 0.75 ± 0.15 g/cm2 ; P < .050), whole femur T-score (-0.87 ± 1.08 vs -0.16 ± 1.24; P < .05) and lumbar T-score (-0.81 ± 1.34 vs 0.09 ± 1.3; P < .050). Fracture prevalence did not differ significantly between the CAH groups. Prednisolone vs. hydrocortisone only therapy caused worse trochanter Z-score (-1.38 ± 1.46 vs -0.47 ± 1.16; P < .050). In women lumbar spine, BMD correlated negatively with hydrocortisone-equivalent dose per body surface (r2 = 0.695, P < .001). Furthermore, BMI at age 16years correlated positively with lumbar spine T-score (r2 = 0.439, P = .003) and BMD (r2 = 0.420, P = .002) in women. The androstenedione/testosterone ratio at age 16years correlated positively with lumbar spine Z-score in women (r2 = 0.284, P = .024) and trochanter Z-score in men (r2 = 0.600, P = .025). CONCLUSION Higher glucocorticoid doses seemed to cause lower BMD especially in women. Prednisolone appeared to have more detrimental effects on BMD than hydrocortisone. Higher glucocorticoid doses (lower androstenedione/testosterone ratio) during adolescence may cause lower BMD in adulthood.
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Affiliation(s)
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany
| | - Robert Roehle
- Charité Universitätsmedizin Berlin, Coordinating Center for Clinical Studies, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Hedi Claahsen van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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23
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Troesch B, Demmelmair J, Gimpfl M, Hecht C, Lakovic G, Roehle R, Sipka L, Trisic B, Vusurovic M, Schoop R, Zdjelar S, Koletzko B. Suitability and safety of L-5-methyltetrahydrofolate as a folate source in infant formula: A randomized-controlled trial. PLoS One 2019; 14:e0216790. [PMID: 31425504 PMCID: PMC6699731 DOI: 10.1371/journal.pone.0216790] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
L-5-methyltetrahydrofolate is the predominant folate form in human milk but is currently not approved as a folate source for infant and follow-on formula. We aimed to assess the suitability of L-5-methyltetrahydrofolate as a folate source for infants. Growth and tolerance in healthy term infants fed formulae containing equimolar doses of L-5-methyltetrahydrofolate (10.4 μg/ 100 ml, n = 120, intervention group) or folic acid (10.0 μg/ 100 ml, n = 120, control group) was assessed in a randomized, double-blind, parallel, controlled trial. A reference group of breastfed infants was followed. Both formulae were well accepted without differences in tolerance or occurrence of adverse events. The most common adverse events were common cold, poor weight gain or growth, rash, eczema, or dry skin and respiratory tract infection. Weight gain (the primary outcome) was equivalent in the two groups (95% CI -2.11; 1.68 g/d). In line with this, there was only a small difference in absolute body weight adjusted for birth weight and sex at visit 4 (95% CI -235; 135 g). Equivalence was also shown for gain in head circumference but not for recumbent length gain and increase in calorie intake. Given the nature of the test, this does not indicate an actual difference, and adjusted means at visit 4 were not significantly different for any of these parameters. Infants receiving formula containing L-5-methyltetrahydrofolate had lower mean plasma levels of unmetabolized folic acid (intervention: 0.73 nmol/L, control: 1.15 nmol/L, p<0.0001) and higher levels of red cell folate (intervention: 907.0 ±192.8 nmol/L, control: 839.4 ±142.4 nmol/L, p = 0.0095). We conclude that L-5-methyltetrahydrofolate is suitable for use in infant and follow-on formula, and there are no indications of untoward effects. Trial registration: This trial was registered at ClinicalTrials.gov (NCT02437721).
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Affiliation(s)
| | - Johann Demmelmair
- LMU -Ludwig-Maximilians Universität Munich, Dr von Hauner Children’s Hospital, Munich, Germany
| | | | | | - Goran Lakovic
- Clinical Hospital Center "Dr Dragiša Mišović-Dedinje", Belgrade, Serbia
| | - Robert Roehle
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, KKS Charité, Berlin, Germany
| | - Ljilja Sipka
- Clinical Hospital Center "Dr Dragiša Mišović-Dedinje", Belgrade, Serbia
| | | | - Milica Vusurovic
- Clinical Hospital Center "Dr Dragiša Mišović-Dedinje", Belgrade, Serbia
| | | | - Sznezana Zdjelar
- Clinical Hospital Center "Dr Dragiša Mišović-Dedinje", Belgrade, Serbia
| | - Berthold Koletzko
- LMU -Ludwig-Maximilians Universität Munich, Dr von Hauner Children’s Hospital, Munich, Germany
- * E-mail:
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24
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Muenzfeld H, Mahjoub S, Roehle R, Pelzer U, Bahra M, Boening G, Hamm B, Geisel D, Auer TA. Split-bolus vs. multiphasic contrast bolus protocol in patients with pancreatic cancer or cholangiocarcinoma. Eur J Radiol 2019; 119:108626. [PMID: 31430661 DOI: 10.1016/j.ejrad.2019.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the image quality, diagnostic accuracy, and dose reduction potential of a split-bolus protocol(SBP) compared with a multiphasic protocol(MPP) in the detection of recurrent or progressive pancreatic ductal adenocarcinoma(PDAC) or cholangiocarcinoma(CC) using contrast- enhanced computed tomography(CECT). MATERIALS AND METHODS This prospective study included 56 patients who underwent CECT, 28 with our institutional standard MPP(100 ml contrast bolus) and 28 with a novel SBP(110 ml). Radiation exposure was determined in terms of total dose- length product(DLP) and computed tomography dose index(CTDI). Image quality was measured objectively by analysis of attenuation in Hounsfield units(HU) in regions of interest(ROIs) and subjectively by two blinded readers using a Likert scale. Diagnostic accuracy and interreader variability were tested. RESULTS The total DLP of the SBP group(498.1 ± 43.7 mGy*cm) was significantly lower than in the MPP group(1,092.5 ± 106.9 mGy*cm; p < 0.001). The SBP showed higher contrast enhancement of all critical anatomical structures including portal vein, liver, and pancreas compared with the MPP, except for the aorta(SBP: 326.9 ± 15.7 HU vs. MPP: 246.7 ± 12.2 HU; p < 0.001). Subjective analysis revealed poorer image quality ratings for important landmarks with the MPP (resection surface: p = 0.624, portal vein: p = 0.395, liver p = 0.361). The two blinded readers correlated significantly. Sensitivity, specificity, positive and negative predictive values (PPV/NPV), and overall interreader variabilities correlated significantly. Furthermore, significantly fewer slices per exam were required for the SBP(1,823 vs. 3,235; p < 0.001). CONCLUSION The SBP provides the same image quality and diagnostic accuracy as an MPP while significantly lowering radiation exposure in CT follow-up of PDAC or CC.
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Affiliation(s)
- Hanna Muenzfeld
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany.
| | - Samy Mahjoub
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Robert Roehle
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany
| | - Uwe Pelzer
- Department of Hematology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Georg Boening
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Germany
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25
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Kreukels BPC, Cohen-Kettenis PT, Roehle R, van de Grift TC, Slowikowska-Hilczer J, Claahsen-van der Grinten H, Lindén Hirschberg A, de Vries ALC, Reisch N, Bouvattier C, Nordenström A, Thyen U, Köhler B, Group OBOTDL. Sexuality in Adults with Differences/Disorders of Sex Development (DSD): Findings from the dsd-LIFE Study. J Sex Marital Ther 2019; 45:688-705. [PMID: 31034334 DOI: 10.1080/0092623x.2019.1610123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
For various reasons, sexuality of individuals with differences/disorders of sex development (DSD) may be affected. The aim of the study was to describe sexual activity, satisfaction with sex life, satisfaction with genital function, and sexual problems in people with different DSD conditions. Data were collected from 1,040 participants in Europe. Many people with a variety of DSD conditions do not appear to be satisfied with their sex life, experience a variety of sexual problems, and are less sexually active than the general population; therefore sexuality should be explicitly addressed in the care of people with DSD.
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Affiliation(s)
| | - Peggy T Cohen-Kettenis
- Medische psychologie, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Robert Roehle
- Charite - Universitätsmedizin Berlin, Koordinierungszentrum fur Klinische Studien (KKS Charite) , Berlin , Germany
| | - Tim C van de Grift
- Medische psychologie, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
- Plastische, Reconstructieve en Handchirurgie, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | | | | | - Angelica Lindén Hirschberg
- Department Gynaecology and Reproductive Medicine, Karolinska University Hospital , Stockholm , Sweden
- Department of Women's and Children's Health, Karolinska Institutet , Stockholm , Sweden
| | - Annelou L C de Vries
- Kinderpsychiatrie, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Nicole Reisch
- Department of Endocrinology, University Hospital Munich , Munich , Germany
| | - Claire Bouvattier
- Department of Pediatric Endocrinology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, France , Le Kremlin Bicêtre , France
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet , Stockholm , Sweden
| | - Ute Thyen
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck , Lubeck , Germany
| | - Birgit Köhler
- Klinik fur Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charite - Universitätsmedizin Berlin , Berlin , Germany
| | - On Behalf Of The Dsd-Life Group
- The dsd-LIFE group: Birgit Köhler, Berlin; Peggy Cohen-Kettenis and Annelou de Vries, Amsterdam; Wiebke Arlt, Birmingham and Claudia Wiesemann, Göttingen; Jolanta Slowikowska-Hilczer, Lodz; Aude Brac de la Perriere, Lyon; Charles Sultan and Francoise Paris, Montpellier; Claire Bouvattier, Paris; Ute Thyen, Lubeck; Nicole Reisch, Munich; Annette Richter-Unruh, Munster; Hedi Claahsen-van der Grinten, Nijmegen; Anna Nordenström, Stockholm; Catherine Pienkowski, Toulouse ; and Maria Szarras-Czapnik , Warsaw
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26
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Negatsch V, Voulgaris A, Seidel P, Roehle R, Opitz-Welke A. Identifying Violent Behavior Using the Oxford Mental Illness and Violence Tool in a Psychiatric Ward of a German Prison Hospital. Front Psychiatry 2019; 10:264. [PMID: 31065245 PMCID: PMC6489833 DOI: 10.3389/fpsyt.2019.00264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Although there is evidence that individuals who suffer from severe mental disorders are at higher risk for aggressive behavior, only a minority eventually become violent. In 2017, Fazel et al. developed a risk calculator (Oxford Mental Illness and Violence tool, OxMIV) to identify the risk of violent crime in patients with mental disorders. For the first time, we tested the predictive validity of the OxMIV in the department of psychiatry at the prison hospital in Berlin, Germany, and presented findings from our internal validation. Materials and Methods: We designed a cohort study with 474 patients aged 16-65 years old who met the inclusion criteria of schizophrenia-spectrum or bipolar disorder and classified the patients into two groups: a violent group with 191 patients and a nonviolent group with 283 patients. Violence was defined as the aggressive behavior of a patient with the necessity of special observation. We obtained all the required information retrospectively through patient files, applied the OxMIV tool on each subject, and compared the results of both groups. Sensitivity, specificity, and positive/negative predictive values were determined. We used logistic regression including variable selection and internal validation to identify relevant predictors of aggressive behavior in our cohort. Results: The OxMIV score was significantly higher in the violent group [median 4.21%; Interquartile range (IQR) 8.51%] compared to the nonviolent group (median 1.77%; IQR 2.01%; p < 0.0001). For the risk of violent behavior, using the 5% cutoff for "increased risk," the sensitivity was 44%, and the specificity was 89%, with a positive predictive value of 72% and a negative predictive value of 70%. Applying logistic regression, four items were statistically significant in predicting violent behavior: previous violent crime (adjusted odds ratio 5.29 [95% CI 3.10-9.05], p < 0.0001), previous drug abuse (1.80 [1.08-3.02], p = 0.025), and previous alcohol abuse (1.89 [1.21-2.95], p = 0.005). The item recent antidepressant treatment (0.28 [0.17-0.47]. p < 0.0001) had a statistically significant risk reduction effect. Conclusions: In our opinion, the risk assessment tool OxMIV succeeded in predicting violent behavior in imprisoned psychiatric patients. As a result, it may be applicable for identification of patients with special needs in a prison environment and, thus, improving prison safety.
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Affiliation(s)
- Vincent Negatsch
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
| | - Alexander Voulgaris
- Universitätsklinikum Hamburg-Eppendorf, Institute of Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - Peter Seidel
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Robert Roehle
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Coordinating Center for Clinical Studies, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Annette Opitz-Welke
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
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Thyen U, Ittermann T, Flessa S, Muehlan H, Birnbaum W, Rapp M, Marshall L, Szarras-Capnik M, Bouvattier C, Kreukels BPC, Nordenstroem A, Roehle R, Koehler B. Quality of health care in adolescents and adults with disorders/differences of sex development (DSD) in six European countries (dsd-LIFE). BMC Health Serv Res 2018; 18:527. [PMID: 29976186 PMCID: PMC6034291 DOI: 10.1186/s12913-018-3342-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 06/28/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To investigate the association between the structural quality of care and patient satisfaction with care in individuals with disorders/ differences of sex development (DSD). METHODS A multicenter cross-sectional comparative study was conducted in 14 clinics in six European countries. We assessed the level of structural quality of care in each center using a self-constructed measure (Center Score) and the level of participant satisfaction with care using the customer satisfaction questionnaire (CSQ-4) and an adopted version of the Youth Health Care - Satisfaction, Utilization & Needs (YHC-SUN-SF). Data were obtained from individuals with Turner Syndrome (261), Klinefelter Syndrome (173), 46, XX congenital adrenal hyperplasia (190) and XY-DSD (257). RESULTS We found large variations between the scores for structural quality of care both within a diagnostic group and within a country; the overall association between participant satisfaction with the center score was significant. CONCLUSIONS Comparative effectiveness research across Europe can lead to more insight on beneficial structures and processes and the overall strategy to care for people with rare diseases in general and specific conditions such as disorders/ differences of sex development. Appreciation of higher levels of structural quality of the centers in this study supports the concept of comprehensive care. TRIAL REGISTRATION German Clinical Trials Register: Registration identification number: DRKS00006072 , date of registration April 17th, 2014. DRKS00006072 (German Clinical Trials Register).
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Affiliation(s)
- Ute Thyen
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany
| | - Till Ittermann
- Institute for Community Medicine – SHIP-KEF, Ernst-Moritz-Arndt University Greifswald, Walther-Rathenau-Str. 48, 17487 Greifswald, Germany
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, 17487 Greifswald, Germany
| | - Holger Muehlan
- Institute of Psychology, Department Health & Prevention, Ernst-Moritz-Arndt University Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| | - Wiebke Birnbaum
- Klinik fur Kinder- und Jugendmedizin, Sektion Padiatrische Endokrinologie, Universitat zu Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany
| | - Marion Rapp
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany
| | - Louise Marshall
- Klinik fur Kinder- und Jugendmedizin, Sektion Padiatrische Endokrinologie, Universitat zu Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany
| | - Maria Szarras-Capnik
- Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Warsaw, Poland
| | - Claire Bouvattier
- Endocrinologie pediatrique, Centre de reference des maladies rares du developpement sexuel, Hopital Bicetre, Universite Paris-Sud, 78 rue du General Leclerc, 94270 Paris, Le Kremlin Bicetre France
| | - Baudewijntje P. C. Kreukels
- Medische Psychologie en Medisch Maatschappelijk Werk, VU Medisch Centrum, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Anna Nordenstroem
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Robert Roehle
- Koordinierungszentrum fur Klinische Studien (KKS) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Birgit Koehler
- Klinik für Padiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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28
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Roehle R, Wieske V, Schuetz GM, Gueret P, Andreini D, Meijboom WB, Pontone G, Garcia M, Alkadhi H, Honoris L, Hausleiter J, Bettencourt N, Zimmermann E, Leschka S, Gerber B, Rochitte C, Schoepf UJ, Shabestari AA, Nørgaard B, Sato A, Knuuti J, Meijs MFL, Brodoefel H, Jenkins SMM, Øvrehus KA, Diederichsen ACP, Hamdan A, Halvorsen BA, Rodriguez VM, Wan YL, Rixe J, Sheikh M, Langer C, Ghostine S, Martuscelli E, Niinuma H, Scholte A, Nikolaou K, Ulimoen G, Zhang Z, Mickley H, Nieman K, Kaufmann PA, Buechel RR, Herzog BA, Clouse M, Halon DA, Leipsic J, Bush D, Jakamy R, Sun K, Yang L, Johnson T, Laissy JP, Marcus R, Muraglia S, Tardif JC, Chow B, Paul N, Maintz D, Hoe J, de Roos A, Haase R, Laule M, Schlattmann P, Dewey M. Correction to: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset. Eur Radiol 2018; 28:4919-4921. [PMID: 29858635 DOI: 10.1007/s00330-018-5521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.
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Affiliation(s)
- Robert Roehle
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Georg M Schuetz
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Pascal Gueret
- Cardiology Department, Henri Mondor Hospital, University Paris Est Creteil, Créteil, France
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mario Garcia
- Montefiore, Albert Einstein College of Medicine, New York City, NY, USA
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Leschka
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bernhard Gerber
- Division of Cardiology, Cardiovascular Center, Cliniques Universitaires St. Luc, Institut de Recherche Clinique et Experimentale, Brussels, Belgium
| | - Carlos Rochitte
- Heart Institute - InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Abbas Arjmand Shabestari
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne Nørgaard
- Department Cardiology B, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Juhani Knuuti
- Turku University Hospital, University of Turku, Turku, Finland
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harald Brodoefel
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | | | - Kristian Altern Øvrehus
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Lillebælt Hospital -Vejle, Vejle, Denmark
| | | | - Ashraf Hamdan
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Yung Liang Wan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Johannes Rixe
- Medizinische Klinik I (Kardiologie, Angiologie), Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Mubarak Al Kabeer Hospital, Jabriya, Kuwait
| | - Christoph Langer
- Klinik für Innere Medizin III mit Schwerpunkt Kardiologie und Angiologie, UKSH, Kiel, Germany.,Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Said Ghostine
- Cardiologie diagnostique et interventionnelle, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hiroyuki Niinuma
- Department of Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Arthur Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Zhaoqi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Koen Nieman
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny Ralf Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Bernhard A Herzog
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Melvin Clouse
- Department of Radiology, Beth Israel Deaconess, Harvard University, Boston, MA, USA
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Jonathan Leipsic
- Department of Radiology and Division of Cardiology UBC, St Paul's Hospital, Vancouver, Canada
| | - David Bush
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA.,Department of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Reda Jakamy
- Department of Interventional Cardiology, University Hospital Cochin, Paris, France
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou Shi, Inner Mongolia Province, China
| | - Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Thorsten Johnson
- Department of Clinical Radiology, Hospital Grosshadern of the University of Munich, Munich, Germany
| | - Jean-Pierre Laissy
- Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France
| | - Roy Marcus
- Department of Clinical Radiology, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Jean-Claude Tardif
- Research Center Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Benjamin Chow
- Heart Institute, University of Ottawa, Ottawa, Canada
| | - Narinder Paul
- Joint Department of Medical Imaging, Mount Sinai and Women's College Hospitals, University Health Network, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - David Maintz
- Institute and Polyclinic for Diagnostic Radiology, University of Cologne, Cologne, Germany
| | - John Hoe
- Department of Diagnostic Radiology, Mt Elizabeth Hospital, Singapore, Singapore
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Rapp M, Mueller-Godeffroy E, Lee P, Roehle R, Kreukels BPC, Köhler B, Nordenström A, Bouvattier C, Thyen U. Multicentre cross-sectional clinical evaluation study about quality of life in adults with disorders/differences of sex development (DSD) compared to country specific reference populations (dsd-LIFE). Health Qual Life Outcomes 2018; 16:54. [PMID: 29615040 PMCID: PMC5883311 DOI: 10.1186/s12955-018-0881-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies in quality of life (QOL) in individuals with disorders/differences of sex development (DSD) have been restricted to subpopulations of the condition. We describe QOL in adult persons with DSD compared to country specific references and assess the impact of diagnosis. Methods The multicentre cross-sectional clinical evaluation (dsd-LIFE) took place in 14 specialized clinics in six European countries. Adolescents (≥16 years) and adults having a DSD condition were included from 02/2014 to 09/2015. The main outcome QOL was measured by the WHOQOL-BREF (domains of physical health, psychological, social relationships, and environment). QOL was compared to country specific reference populations by using unpaired t-tests. Linear regression models explained the additional variance of the diagnosis on QOL. Results Three hundred one individuals with Turner Syndrome, 219 with Klinefelter Syndrome (including XYY), 226 with 46,XX CAH and 294 with rare DSD conditions (gonadal dysgenesis, androgen insensitivity syndrome, severe hypospadias, and androgen synthesis errors or other diagnosis) took part. Compared to healthy European populations, QOL was similar in psychological, slightly worse in physical health, and slightly better in environment. In social relationships, QOL was significantly poorer compared to healthy and non-healthy reference populations. In linear regression models health status was the most important predictor of QOL; additional variance was explained by feelings about household’s income in all domains, and the relationship status in social relationships. Diagnosis explained nearly no additional variance. Conclusions Except for social relationships, most people with DSD adapt well to their life circumstances and report a good QOL. Not diagnosis, but the individual’s health status is much more important than previously thought. Therefore care for people with DSD should focus more on chronic physical or mental health problems both related and unrelated to the diagnosis itself. Trial registration German Clinical Trials Register DRKS00006072.
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Affiliation(s)
- Marion Rapp
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany.
| | - Esther Mueller-Godeffroy
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany
| | - Peter Lee
- Pediatrics, Penn State College of Medicine, Hershey, PA, 17033, USA
| | - Robert Roehle
- Charite, Campus Virchow-Klinikum, Koordinierungszentrum fur Klinische Studien (KKS Charite), 13353, Berlin, Germany
| | - Baudewijntje P C Kreukels
- Medische Psychologie en Medisch Maatschappelijk Werk, VU Medisch Centrum, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Birgit Köhler
- Charite, Campus Virchow-Klinikum, Klinik fur Padiatrie mit Schwerpunkt Endokrinologie und Diabetologie, 13353, Berlin, Germany
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Claire Bouvattier
- Endocrinologie pediatrique, Centre de reference des maladies rares du developpement sexuel, Hopital Bicetre, Universite Paris-Sud, 78 rue du General Leclerc, 94270, Le Kremlin Bicetre, France
| | - Ute Thyen
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany
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Kreukels BPC, Köhler B, Nordenström A, Roehle R, Thyen U, Bouvattier C, de Vries ALC, Cohen-Kettenis PT. Gender Dysphoria and Gender Change in Disorders of Sex Development/Intersex Conditions: Results From the dsd-LIFE Study. J Sex Med 2018; 15:777-785. [PMID: 29606626 DOI: 10.1016/j.jsxm.2018.02.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information on the psychosexual outcome of individuals with disorders of sex development (DSDs) and intersex conditions is of great importance for sex assignment at birth of newborns with DSD. AIM To assess gender change and gender dysphoria in a large sample of individuals with different DSDs. METHODS A cross-sectional study was conducted in 14 European centers with 1,040 participants (717 female-identifying and 311 male-identifying persons and 12 persons identifying with another gender) with different forms of DSD. The cohort (mean age = 32.36 years, SD = 13.57) was divided into 6 major subgroups: women with 45,X DSD and variants (Turner syndrome; n = 325), men with 47,XXY DSD and variants (Klinefelter syndrome; n = 219), women with XY DSD without androgen effects (n = 107) and with androgen effects (n = 63), men with XY DSD (n = 87), and women with 46,XX congenital adrenal hyperplasia (n = 221). Data on psychosexual outcome were gathered by medical interviews and questionnaires. OUTCOMES Gender change and gender dysphoria. RESULTS Although gender changes were reported by 5% of participants, only in 1% (3% if those with Klinefelter and Turner syndromes-conditions in which gender issues are not prominent-are excluded) did the gender change take place after puberty and was likely initiated by the patient. 39 participants (4%) reported gender variance: between male and female, a gender other than male or female, or gender queer, alternating gender roles, or a gender expression that differed from the reported gender. This group had lower self-esteem and more anxiety and depression than the other participants. CLINICAL IMPLICATIONS Clinicians should be aware of and sensitive to the possibility that their patients with DSD not only might have transgender feelings and a desire to change gender, but also identify as different from male or female. The complexity of their feelings might require counseling for some patients. STRENGTHS AND LIMITATIONS The study is unique in the large number of participants from many different clinics, with sizable numbers in most subgroups, and in the large number of aspects that were measured. However, the very broadness of the study made it impossible to focus in detail on gender issues. Also, there is a need for instruments specifically measuring gender dysphoria in individuals with DSD that take non-binary genders into account. CONCLUSION To make appropriate gender care possible for people with DSD, the gender-normative and gender-variant development of children with DSD should be studied in longitudinal studies. Kreukels BPC, Köhler B, Nordenström A, et al. Gender Dysphoria and Gender Change in Disorders of Sex Development/Intersex Conditions: Results From the dsd-LIFE Study. J Sex Med 2018;15:777-785.
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Affiliation(s)
- Baudewijntje P C Kreukels
- Department of Medical Psychology and Medical Social Work, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - Birgit Köhler
- Klinik für Pädiatrie m.S. Pädiatrische Endokrinologie CVK, Charité Universitätsmedizin, Berlin, Germany
| | - Anna Nordenström
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Robert Roehle
- Koordinierungszentrum Klinische Studien (KKS), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Thyen
- Klinik für Kinder- und Jugendmedizin Universität zu Lübeck, Lübeck, Germany
| | - Claire Bouvattier
- Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Paris Sud University, Paris, France
| | - Annelou L C de Vries
- Department of Child Psychiatry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology and Medical Social Work, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Roehle R, Wieske V, Schuetz GM, Gueret P, Andreini D, Meijboom WB, Pontone G, Garcia M, Alkadhi H, Honoris L, Hausleiter J, Bettencourt N, Zimmermann E, Leschka S, Gerber B, Rochitte C, Schoepf UJ, Shabestari AA, Nørgaard B, Sato A, Knuuti J, Meijs MFL, Brodoefel H, Jenkins SMM, Øvrehus KA, Diederichsen ACP, Hamdan A, Halvorsen BA, Mendoza Rodriguez V, Wan YL, Rixe J, Sheikh M, Langer C, Ghostine S, Martuscelli E, Niinuma H, Scholte A, Nikolaou K, Ulimoen G, Zhang Z, Mickley H, Nieman K, Kaufmann PA, Buechel RR, Herzog BA, Clouse M, Halon DA, Leipsic J, Bush D, Jakamy R, Sun K, Yang L, Johnson T, Laissy JP, Marcus R, Muraglia S, Tardif JC, Chow B, Paul N, Maintz D, Hoe J, de Roos A, Haase R, Laule M, Schlattmann P, Dewey M. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset. Eur Radiol 2018; 28:4006-4017. [PMID: 29556770 DOI: 10.1007/s00330-018-5322-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/13/2017] [Accepted: 01/10/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.
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Affiliation(s)
- Robert Roehle
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Georg M Schuetz
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Pascal Gueret
- Cardiology Department, Henri Mondor Hospital, University Paris Est Creteil, Créteil, France
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mario Garcia
- Montefiore, the University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Leschka
- Department of Radiology and Nuclear Medicine Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bernhard Gerber
- Division of Cardiology, Cardiovascular Center, Cliniques Universitaires St. Luc, Institut de Recherche Clinique et Experimentale, Brussels, Belgium
| | - Carlos Rochitte
- Heart Institute - InCor - University of São Paulo Medical School, São Paulo, Brazil
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Abbas Arjmand Shabestari
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne Nørgaard
- Department Cardiology B, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harald Brodoefel
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | | | - Kristian Altern Øvrehus
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology Lillebælt Hospital -Vejle, Vejle, Denmark
| | | | - Ashraf Hamdan
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Yung Liang Wan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Johannes Rixe
- Medizinische Klinik I (Kardiologie, Angiologie), Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Mubarak Al Kabeer Hospital, Jabriya, Kuwait
| | - Christoph Langer
- Klinik für Innere Medizin III mit Schwerpunkt Kardiologie und Angiologie, UKSH, Kiel, Germany.,Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Said Ghostine
- Cardiologie diagnostique et interventionnelle, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hiroyuki Niinuma
- Department of Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Arthur Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Zhaoqi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Koen Nieman
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny Ralf Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Bernhard A Herzog
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Melvin Clouse
- Department of Radiology, Beth Israel Deaconess, Harvard University, Boston, MA, USA
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Jonathan Leipsic
- Department of Radiology and Division of Cardiology UBC, St Paul's Hospital, Vancouver, Canada
| | - David Bush
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA.,Department of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Reda Jakamy
- Department of Interventional Cardiology, University Hospital Cochin, Paris, France
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou Shi, Inner Mongolia Province, China
| | - Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Thorsten Johnson
- Department of Clinical Radiology, Hospital Grosshadern of the University of Munich, Munich, Germany
| | - Jean-Pierre Laissy
- Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France
| | - Roy Marcus
- Department of Clinical Radiology, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Jean-Claude Tardif
- Research Center Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Benjamin Chow
- University of Ottawa, Heart Institute, Ottawa, Canada
| | - Narinder Paul
- Joint Department of Medical Imaging, University Health Network, Mount Sinai and Women's College Hospitals, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - David Maintz
- Institute and Polyclinic for Diagnostic Radiology, University of Cologne, Cologne, Germany
| | - John Hoe
- Department of Diagnostic Radiology, Mt Elizabeth Hospital, Singapore, Singapore
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Falhammar H, Claahsen-van der Grinten H, Reisch N, Slowikowska-Hilczer J, Nordenström A, Roehle R, Bouvattier C, Kreukels BPC, Köhler B. Health status in 1040 adults with disorders of sex development (DSD): a European multicenter study. Endocr Connect 2018; 7:466-478. [PMID: 29490934 PMCID: PMC5861372 DOI: 10.1530/ec-18-0031] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The knowledge about health status in adults with disorder of sex development (DSD) is scarce. DESIGN AND METHODS A cross-sectional observational study in 14 European tertiary centers recruited 1040 participants (717 females, 311 males, 12 others) with DSD. Mean age was 32.4 ± 13.6 year (range 16-75). The cohort was divided into: Turner (n = 301), Klinefelter (n = 224), XY-DSD (n = 222), XX-DSD (excluding congenital adrenal hyperplasia (CAH) and 46,XX males) (n = 21), 46,XX-CAH (n = 226) and 45,X/46,XY (n = 45). Perceived and objective health statuses were measured and compared to European control data. RESULTS In DSD, fair to very good general health was reported by 91.4% and only 8.6% reported (very) bad general health (controls 94.0% and 6.0%, P < 0.0001). Longstanding health issues other than DSD and feeling limited in daily life were reported in 51.0% and 38.6%, respectively (controls 24.5% and 13.8%, P < 0.0001 both). Any disorder except DSD was present in 84.3% (controls 24.6%, P < 0.0001). Males reported worse health than females. In the subgroup analysis, Klinefelter and 46,XX-DSD patients reported bad general health in 15.7% and 16.7%, respectively (Turner 3.2% and CAH 7.4%). Comorbidities were prevalent in all DSD subgroups but Klinefelter and Turner were most affected. Early diagnosis of DSD and a healthy lifestyle were associated with less comorbidities. CONCLUSIONS Overall, general health appeared to be good but a number of medical problems were reported, especially in Klinefelter and Turner. Early diagnosis of DSD and a healthy lifestyle seemed to be important. Lifelong follow-up at specialized centers is necessary.
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Affiliation(s)
- Henrik Falhammar
- Department of EndocrinologyMetabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | | | - Nicole Reisch
- Medizinische Klinik and Poliklinik IVDepartment of Endocrinology, University Hospital Munich, Munich, Germany
| | | | - Anna Nordenström
- Department of Women's and Children's HealthKarolinska Institutet, Stockholm, Sweden
- Department of Paediatric EndocrinologyAstrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Roehle
- Coordinating Center for Clinical StudiesCharité Universitätsmedizin, Berlin, Germany
| | - Claire Bouvattier
- Paris-Sud UniversityOrsay, France
- Department of Pediatric EndocrinologyHôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | | | - Birgit Köhler
- Department of Paediatric Endocrinology and DiabetologyCharité Universitätsmedizin, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Attanasio PJ, Qaiyumi D, Roehle R, Wutzler A, Safak E, Muntean B, Boldt LH, Pieske B, Haverkamp W, Huemer M. P1733Coronary sinus signal amplitude predicts left atrial scarring. Europace 2017. [DOI: 10.1093/ehjci/eux161.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Napp AE, Enders J, Roehle R, Diederichs G, Rief M, Zimmermann E, Martus P, Dewey M. Analysis and Prediction of Claustrophobia during MR Imaging with the Claustrophobia Questionnaire: An Observational Prospective 18-month Single-Center Study of 6500 Patients. Radiology 2017; 283:148-157. [DOI: 10.1148/radiol.2016160476] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adriane E. Napp
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Judith Enders
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Robert Roehle
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerd Diederichs
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Rief
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Elke Zimmermann
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Martus
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Marc Dewey
- From the Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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35
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Schuetz GM, Schlattmann P, Achenbach S, Budoff M, Garcia MJ, Roehle R, Pontone G, Meijboom WB, Andreini D, Alkadhi H, Honoris L, Bettencourt N, Hausleiter J, Leschka S, Gerber BL, Meijs MF, Shabestari AA, Sato A, Zimmermann E, Schoepf UJ, Diederichsen A, Halon DA, Mendoza-Rodriguez V, Hamdan A, Nørgaard BL, Brodoefel H, Ovrehus KA, Jenkins SM, Halvorsen BA, Rixe J, Sheikh M, Langer C, Martuscelli E, Romagnoli A, Scholte AJ, Marcus RP, Ulimoen GR, Nieman K, Mickley H, Nikolaou K, Tardif JC, Johnson TR, Muraglia S, Chow BJ, Maintz D, Laule M, Dewey M. Individual patient data meta-analysis for the clinical assessment of coronary computed tomography angiography: protocol of the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). Syst Rev 2013; 2:13. [PMID: 23414575 PMCID: PMC3576350 DOI: 10.1186/2046-4053-2-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/17/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Coronary computed tomography angiography has become the foremost noninvasive imaging modality of the coronary arteries and is used as an alternative to the reference standard, conventional coronary angiography, for direct visualization and detection of coronary artery stenoses in patients with suspected coronary artery disease. Nevertheless, there is considerable debate regarding the optimal target population to maximize clinical performance and patient benefit. The most obvious indication for noninvasive coronary computed tomography angiography in patients with suspected coronary artery disease would be to reliably exclude significant stenosis and, thus, avoid unnecessary invasive conventional coronary angiography. To do this, a test should have, at clinically appropriate pretest likelihoods, minimal false-negative outcomes resulting in a high negative predictive value. However, little is known about the influence of patient characteristics on the clinical predictive values of coronary computed tomography angiography. Previous regular systematic reviews and meta-analyses had to rely on limited summary patient cohort data offered by primary studies. Performing an individual patient data meta-analysis will enable a much more detailed and powerful analysis and thus increase representativeness and generalizability of the results. The individual patient data meta-analysis is registered with the PROSPERO database (CoMe-CCT, CRD42012002780). METHODS/DESIGN The analysis will include individual patient data from published and unpublished prospective diagnostic accuracy studies comparing coronary computed tomography angiography with conventional coronary angiography. These studies will be identified performing a systematic search in several electronic databases. Corresponding authors will be contacted and asked to provide obligatory and additional data. Risk factors, previous test results and symptoms of individual patients will be used to estimate the pretest likelihood of coronary artery disease. A bivariate random-effects model will be used to calculate pooled mean negative and positive predictive values as well as sensitivity and specificity. The primary outcome of interest will be positive and negative predictive values of coronary computed tomography angiography for the presence of coronary artery disease as a function of pretest likelihood of coronary artery disease, analyzed by meta-regression. As a secondary endpoint, factors that may influence the diagnostic performance and clinical value of computed tomography, such as heart rate and body mass index of patients, number of detector rows, and administration of beta blockade and nitroglycerin, will be investigated by integrating them as further covariates into the bivariate random-effects model. DISCUSSION This collaborative individual patient data meta-analysis should provide answers to the pivotal question of which patients benefit most from noninvasive coronary computed tomography angiography and thus help to adequately select the right patients for this test.
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Affiliation(s)
- Georg M Schuetz
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin 10117, Germany
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Rega G, Kaun C, Demyanets S, Pfaffenberger S, Rychli K, Hohensinner PJ, Kastl SP, Speidl WS, Weiss TW, Breuss JM, Furnkranz A, Uhrin P, Zaujec J, Zilberfarb V, Frey M, Roehle R, Maurer G, Huber K, Wojta J. Vascular endothelial growth factor is induced by the inflammatory cytokines interleukin-6 and oncostatin m in human adipose tissue in vitro and in murine adipose tissue in vivo. Arterioscler Thromb Vasc Biol 2007; 27:1587-95. [PMID: 17525365 DOI: 10.1161/atvbaha.107.143081] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [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: 01/04/2023]
Abstract
OBJECTIVES It is believed that adipose tissue acts as an endocrine organ by producing inflammatory mediators and thereby contributes to the increased cardiovascular risk seen in obesity. A link between adipose tissue mass and angiogenesis has been suggested. Vascular endothelial growth factor (VEGF) seems to be implicated in this process. Members of the glycoprotein (gp)130 ligand family regulate VEGF expression in other cells. METHODS AND RESULTS We used tissue explants as well as primary cultures of preadipocytes and adipocytes from human subcutaneous and visceral adipose tissue to investigate whether the gp130 ligands oncostatin M (OSM), interleukin-6 (IL-6), leukemia inhibitory factor (LIF), and cardiotrophin-1 (CT-1) regulate VEGF expression in human adipose tissue. Human subcutaneous and visceral adipose tissue responded to treatment with IL-6 and OSM with a significant increase in VEGF production. Human preadipocytes were isolated from subcutaneous and visceral adipose tissue. Adipocyte-differentiation was induced by hormone-supplementation. All cell types responded to IL-6 and OSM with a robust increase in VEGF protein production and a similar increase in VEGF-specific mRNA. Furthermore, IL-1beta synergistically enhanced the effect of OSM on VEGF production. AG-490, a JAK/STAT inhibitor, abolished the OSM-dependent VEGF induction almost completely. In mice, IL-6 and OSM increased serum levels of VEGF and VEGF mRNA and vessel density in adipose tissue. CONCLUSION We speculate that the inflammatory cytokines IL-6 and OSM might support angiogenesis during adipose tissue growth by upregulating VEGF.
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Affiliation(s)
- G Rega
- Department of Internal Medicine II, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Rega G, Kaun C, Weiss TW, Demyanets S, Zorn G, Kastl SP, Steiner S, Seidinger D, Kopp CW, Frey M, Roehle R, Maurer G, Huber K, Wojta J. Inflammatory Cytokines Interleukin-6 and Oncostatin M Induce Plasminogen Activator Inhibitor-1 in Human Adipose Tissue. Circulation 2005; 111:1938-45. [PMID: 15837947 DOI: 10.1161/01.cir.0000161823.55935.be] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [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: 01/30/2023]
Abstract
Background—
Adipose tissue is a prominent source of plasminogen activator inhibitor-1 (PAI-1), the primary physiological inhibitor of plasminogen activation. Increased PAI-1 expression acts as a cardiovascular risk factor, and plasma levels of PAI-1 strongly correlate with body mass index (BMI). Elevated serum levels of interleukin-6 (IL-6), an inflammatory cytokine and a member of the glycoprotein 130 (gp130) ligand family, are found in obese patients and might indicate low-grade systemic inflammation. Another gp130 ligand, oncostatin M (OSM), upregulates PAI-1 in cardiac myocytes, astrocytes, and endothelial cells. We used tissue explants and primary cultures of preadipocytes and adipocytes from human subcutaneous and visceral adipose tissue to investigate whether IL-6 and OSM affect PAI-1 expression in fat.
Methods and Results—
Human subcutaneous and visceral adipose tissue responded to treatment with IL-6 and OSM with a significant increase in PAI-1 production. Human preadipocytes were isolated from subcutaneous and visceral adipose tissue. Adipocyte differentiation was induced by hormone supplementation. All cell types expressed receptors for IL-6 and OSM and produced up to 12-fold increased levels of PAI-1 protein and up to 9-fold increased levels of PAI-1 mRNA on stimulation with IL-6 and OSM. AG-490, a janus kinase/signal transducer and activator of transcription inhibitor, abolished the OSM-dependent PAI-1 induction almost completely.
Conclusions—
We have for the first time established a link between the gp130 ligands, the proinflammatory mediators IL-6 and OSM, and the expression of PAI-1 in human adipose tissue. Thus, we speculate that IL-6 and OSM, by upregulating PAI-1 in adipose tissue, can contribute to the increased cardiovascular risk of obese patients.
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Affiliation(s)
- G Rega
- Department of Internal Medicine II, Medical University Vienna, and the Ludwig Boltzmann Foundation for Cardiovascular Research, Vienna, Austria
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