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Thirumalasetty SR, Schubert T, Naumann R, Reichardt I, Rohm ML, Landgraf D, Gembardt F, Peitzsch M, Hartmann MF, Sarov M, Wudy SA, Reisch N, Huebner A, Koehler K. A Humanized and Viable Animal Model for Congenital Adrenal Hyperplasia- CYP21A2-R484Q Mutant Mouse. Int J Mol Sci 2024; 25:5062. [PMID: 38791102 DOI: 10.3390/ijms25105062] [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: 03/15/2024] [Revised: 04/26/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Congenital Adrenal Hyperplasia (CAH) is an autosomal recessive disorder impairing cortisol synthesis due to reduced enzymatic activity. This leads to persistent adrenocortical overstimulation and the accumulation of precursors before the blocked enzymatic step. The predominant form of CAH arises from mutations in CYP21A2, causing 21-hydroxylase deficiency (21-OHD). Despite emerging treatment options for CAH, it is not always possible to physiologically replace cortisol levels and counteract hyperandrogenism. Moreover, there is a notable absence of an effective in vivo model for pre-clinical testing. In this work, we developed an animal model for CAH with the clinically relevant point mutation p.R484Q in the previously humanized CYP21A2 mouse strain. Mutant mice showed hyperplastic adrenals and exhibited reduced levels of corticosterone and 11-deoxycorticosterone and an increase in progesterone. Female mutants presented with higher aldosterone concentrations, but blood pressure remained similar between wildtype and mutant mice in both sexes. Male mutant mice have normal fertility with a typical testicular appearance, whereas female mutants are infertile, exhibit an abnormal ovarian structure, and remain in a consistent diestrus phase. Conclusively, we show that the animal model has the potential to contribute to testing new treatment options and to prevent comorbidities that result from hormone-related derangements and treatment-related side effects in CAH patients.
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Affiliation(s)
- Shamini Ramkumar Thirumalasetty
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Tina Schubert
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ronald Naumann
- Transgenic Core Facility, Max Planck Institute of Molecular Cell Biology and Genetics, 01307 Dresden, Germany
| | - Ilka Reichardt
- Genome Engineering Facility, Max Planck Institute of Molecular Cell Biology and Genetics, 01307 Dresden, Germany
| | - Marie-Luise Rohm
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Dana Landgraf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Florian Gembardt
- Division of Nephrology, Medizinische Klinik III, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Michaela F Hartmann
- Steroid Research & Mass Spectrometry Unit, Paediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig Universität, 35392 Giessen, Germany
| | - Mihail Sarov
- Genome Engineering Facility, Max Planck Institute of Molecular Cell Biology and Genetics, 01307 Dresden, Germany
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Paediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig Universität, 35392 Giessen, Germany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, LMU Klinikum München, 80336 Munich, Germany
| | - Angela Huebner
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Katrin Koehler
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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Evrard R, Manon J, Rafferty C, Fieve L, Cornu O, Kirchgesner T, Lecouvet FE, Schubert T, Lengele B. Vascular study of decellularized porcine long bones: Characterization of a tissue engineering model. Bone 2024; 182:117073. [PMID: 38493932 DOI: 10.1016/j.bone.2024.117073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Massive bone allografts enable the reconstruction of critical bone defects in numerous conditions (e.g. tumoral, infection or trauma). Unfortunately, their biological integration remains insufficient and the reconstruction may suffer from several postoperative complications. Perfusion-decellularization emerges as a tissue engineering potential solution to enhance osseointegration. Therefore, an intrinsic vascular study of this novel tissue engineering tool becomes essential to understand its efficacy and applicability. MATERIAL AND METHODS 32 porcine long bones (humeri and femurs) were used to assess the quality of their vascular network prior and after undergoing a perfusion-decellularization protocol. 12 paired bones were used to assess the vascular matrix prior (N = 6) and after our protocol (N = 6) by immunohistochemistry. Collagen IV, Von Willebrand factor and CD31 were targeted then quantified. The medullary macroscopic vascular network was evaluated with 12 bones: 6 were decellularized and the other 6 were, as control, not treated. All 12 underwent a contrast-agent injection through the nutrient artery prior an angio CT-scan acquisition. The images were processed and the length of medullary vessels filled with contrast agent were measured on angiographic cT images obtained in control and decellularized bones by 4 independent observers to evaluate the vascular network preservation. The microscopic cortical vascular network was evaluated on 8 bones: 4 control and 4 decellularized. After injection of gelatinous fluorochrome mixture (calcein green), non-decalcified fluoroscopic microscopy was performed in order to assess the perfusion quality of cortical vascular lacunae. RESULTS The continuity of the microscopic vascular network was assessed with Collagen IV immunohistochemistry (p-value = 0.805) while the decellularization quality was observed through CD31 and Von Willebrand factor immunohistochemistry (p-values <0.001). The macroscopic vascular network was severely impaired after perfusion-decellularization; nutrient arteries were still patent but the amount of medullary vascular channels measured was significantly higher in the control group compared to the decellularized group (p-value <0.001). On average, the observers show good agreement on these results, except in the decellularized group where more inter-observer discrepancies were observed. The microscopic vascular network was observed with green fluoroscopic signal in almost every canals and lacunae of the bone cortices, in three different bone locations (proximal metaphysis, diaphysis and distal metaphysis). CONCLUSION Despite the aggressiveness of the decellularization protocol on medullary vessels, total porcine long bones decellularized by perfusion retain an acellular cortical microvascular network. By injection through the intact nutrient arteries, this latter vascular network can still be used as a total bone infusion access for bone tissue engineering in order to enhance massive bone allografts prior implantation.
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Affiliation(s)
- R Evrard
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo-Skeletal Lab, Université Catholique de Louvain (UCLouvain), Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium; Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium.
| | - J Manon
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo-Skeletal Lab, Université Catholique de Louvain (UCLouvain), Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium; Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - C Rafferty
- Institut de Recherche Expérimentale et Clinique, Pôle Morphologie, UCLouvain, Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium
| | - L Fieve
- Institut de Recherche Expérimentale et Clinique, Pôle Morphologie, UCLouvain, Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium
| | - O Cornu
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo-Skeletal Lab, Université Catholique de Louvain (UCLouvain), Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium; Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium; Unité de Thérapie Tissulaire et Cellulaire de l'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - T Kirchgesner
- Département d'Imagerie Médicale, Institut de Recherche Expérimentale et Clinique (Pôle IMAG), Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - F E Lecouvet
- Département d'Imagerie Médicale, Institut de Recherche Expérimentale et Clinique (Pôle IMAG), Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - T Schubert
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo-Skeletal Lab, Université Catholique de Louvain (UCLouvain), Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium; Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium; Unité de Thérapie Tissulaire et Cellulaire de l'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - B Lengele
- Institut de Recherche Expérimentale et Clinique, Pôle Morphologie, UCLouvain, Avenue E. Mounier, 52-B1.52.04, 1200 Bruxelles, Belgium; Service de Chirurgie Plastique, Reconstructrice et Esthétique, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
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Quitter F, Flury M, Waldmueller S, Schubert T, Koehler K, Huebner A. Acromicric dysplasia due to a novel missense mutation in the fibrillin 1 gene in a three-generation family. J Pediatr Endocrinol Metab 2022; 35:1443-1447. [PMID: 35942587 DOI: 10.1515/jpem-2022-0287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Short stature is one of the most common reasons for consulting a paediatric endocrinologist. Targeted diagnosis of familial short stature can be challenging due to a broad spectrum of differential diagnoses. CASE PRESENTATION Here we report a novel mutation in the fibrillin 1 gene (FBN1) in six family members causing a mild phenotype of acromicric dysplasia. Additionally, we present the effects of growth hormone therapy in one of the affected children. CONCLUSIONS Acromicric dysplasia is a very rare skeletal dysplasia with a prevalence of <1 of 1.000.000 with only about 60 cases being reported worldwide. It is characterized by short stature, acromelia, mild facial dysmorphy but normal intelligence. This study aims to exemplify the clinical and molecular features of FBN1-related acromicric dysplasia and illustrates its pleiotropy by presenting a new, mild phenotype.
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Affiliation(s)
- Friederike Quitter
- Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Monika Flury
- Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan Waldmueller
- University Hospital Tübingen, Institut für Medizinische Genetik und Angewandte Genomik Tübingen, Germany
| | - Tina Schubert
- Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katrin Koehler
- Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Angela Huebner
- Children's Hospital, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Boehmer AA, Schubert T, Zezyk C, Kaess B, Ehrlich JR. ARNI effects in HFrEF. Risk reduction beyond LVEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The imbalance of cardiac autonomic nervous system function plays an important role in heart failure associated mortality. ARNI has demonstrated a paramount effect in reducing risk of death and hospitalization for worsening of heart failure. However, its exact mechanism of action remains only partly understood. We sought to prospectively compare heart rate variability as a noninvasive measure of cardiac autonomic nervous system function.
Methods
The study design was prospective sequential observational. Patients served as their own internal control. Patients with heart failure with reduced ejection fraction (HFrEF) receiving optimal medical therapy who were scheduled for a switch to ARNI therapy underwent echocardiography and a standardized 30-minute 12-lead Holter ECG recording before starting ARNI therapy. A monitoring of the parameters was performed 3 months after the start of therapy. Physicians were instructed to increase ARNI dose to the highest tolerated or maximum dose. Besides left ventricular ejection fraction (LVEF) we assessed heart rate (HR), standard deviation of normal-to-normal intervals (SDNN) and mean square of differences between consecutive R-R intervals (RMSSD).
Results
We recruited 55 patients and baseline characteristics were as follows: age 65±12 years, male sex 78%, NT-proBNP 4989±809 pg/ml, LVEF 28±6%, HR 75±9 bpm, SDNN 43±2 ms, RMSSD 19±2 ms. All patients received beta-blocker therapy and the dosage was similar at baseline and follow-up. After 3 months of ARNI therapy, heart rate showed a significant reduction of 7% (74±14 bpm vs. 69±11 min, P=0.005). SDNN increased by 49% (43±2 ms vs. 64±4 ms, P<0.001) and RMSSD by 42% (19±2 ms vs. 27±3 ms, P=0.01). These results were accompanied by increased LVEF (28±6% vs. 38±10%, P<0.001) and reduced plasma NT-proBNP levels (4989±809 pg/ml vs. 2602±87 pg/ml, P<0.04). NYHA Class of affected patients changed from III to II.
Conclusion
After changing from ACE/AT1-I to ARNI, significant improvement of autonomic cardiac nervous system function could be observed. ARNI apparently activates the parasympathetic nervous system as suggested by decreased HR and increased SDNN and RMSSD. Therefore, part of its cardioprotective and beneficial effects may relate to the restoration of autonomic cardiac nervous system function. Potential beneficial effects regarding incidence of sudden cardiac arrest may relate to these observations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A A Boehmer
- St. Josefs-Hospital Wiesbaden , Wiesbaden , Germany
| | - T Schubert
- St. Josefs-Hospital Wiesbaden , Wiesbaden , Germany
| | - C Zezyk
- St. Josefs-Hospital Wiesbaden , Wiesbaden , Germany
| | - B Kaess
- St. Josefs-Hospital Wiesbaden , Wiesbaden , Germany
| | - J R Ehrlich
- St. Josefs-Hospital Wiesbaden , Wiesbaden , Germany
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Schubert T, Reisch N, Naumann R, Reichardt I, Landgraf D, Quitter F, Thirumalasetty SR, Heninger AK, Sarov M, Peitzsch M, Huebner A, Koehler K. CYP21A2 gene expression in a humanized 21-hydroxylase mouse model does not affect adrenocortical morphology and function. J Endocr Soc 2022; 6:bvac062. [PMID: 35592511 PMCID: PMC9113096 DOI: 10.1210/jendso/bvac062] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Steroid 21-hydroxylase is an enzyme of the steroid pathway that is involved in the biosynthesis of cortisol and aldosterone by hydroxylation of 17α-hydroxyprogesterone and progesterone at the C21 position. Mutations in CYP21A2, the gene encoding 21-hydroxylase, cause the most frequent form of the autosomal recessive disorder congenital adrenal hyperplasia (CAH). In this study, we generated a humanized 21-hydroxylase mouse model as the first step to the generation of mutant mice with different CAH-causing mutations. We replaced the mouse Cyp21a1 gene with the human CYP21A2 gene using homologous recombination in combination with CRISPR/Cas9 technique. The aim of this study was to characterize the new humanized mouse model. All results described are related to the homozygous animals in comparison with wild-type mice. We show analogous expression patterns of human 21-hydroxylase by the murine promoter and regulatory elements in comparison to murine 21-hydroxylase in wild-type animals. As expected, no Cyp21a1 transcript was detected in homozygous CYP21A2 adrenal glands. Alterations in adrenal gene expression were observed for Cyp11a1, Star, and Cyb11b1. These differences, however, were not pathological. Outward appearance, viability, growth, and fertility were not affected in the humanized CYP21A2 mice. Plasma steroid levels of corticosterone and aldosterone showed no pathological reduction. In addition, adrenal gland morphology and zonation were similar in both the humanized and the wild-type mice. In conclusion, humanized homozygous CYP21A2 mice developed normally and showed no differences in histological analyses, no reduction in adrenal and gonadal gene expression, or in plasma steroids in comparison with wild-type littermates.
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Affiliation(s)
- Tina Schubert
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Ronald Naumann
- Transgenic Core Facility, Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstrasse 108, 01307 Dresden, Germany
| | - Ilka Reichardt
- Genome Engineering Facility, Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstrasse 108, 01307 Dresden, Germany
| | - Dana Landgraf
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Friederike Quitter
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Shamini Ramkumar Thirumalasetty
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anne-Kristin Heninger
- Genome Engineering Facility, Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstrasse 108, 01307 Dresden, Germany
- University Cancer Center (UCC) Dresden, Medical Systems Biology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Mihail Sarov
- Genome Engineering Facility, Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstrasse 108, 01307 Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Angela Huebner
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Katrin Koehler
- Children’s Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Appelt K, Takes M, Zech CJ, Blackham KA, Schubert T. Complication rates of percutaneous brachial artery puncture: effect of live ultrasound guidance. CVIR Endovasc 2021; 4:74. [PMID: 34633563 PMCID: PMC8505595 DOI: 10.1186/s42155-021-00262-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.
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Affiliation(s)
- K Appelt
- Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland.
| | - M Takes
- Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - C J Zech
- Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - K A Blackham
- Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
| | - T Schubert
- Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zürich, Switzerland
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Lechleitner A, Schubert T, Lehner M, Hofer W. Modellierung einer industriellen Kunststoff Co‐Pyrolyse. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055167] [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: 11/06/2022]
Affiliation(s)
- A. Lechleitner
- Montanuniversität Lehrstuhl für Verfahrenstechnik des industriellen Umweltschutzes Franz-Josef-Str. 18 8700 Leoben Österreich
| | - T. Schubert
- Montanuniversität Lehrstuhl für Verfahrenstechnik des industriellen Umweltschutzes Franz-Josef-Str. 18 8700 Leoben Österreich
| | - M. Lehner
- Montanuniversität Lehrstuhl für Verfahrenstechnik des industriellen Umweltschutzes Franz-Josef-Str. 18 8700 Leoben Österreich
| | - W. Hofer
- OMV Refining & Marketing GmbH RD-I Technology&Innovation Mgmt P2O Mannswörther Str. 28 2320 Schwechat Österreich
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Gakis G, Karl A, Bertz S, Burger M, Fritsche HM, Hartmann A, Jokisch F, Kempkensteffen C, Miller K, Mundhenk J, Schneevoigt BS, Schubert T, Schwentner C, Wullich B, Stenzl A. Transurethral en bloc submucosal hydrodissection vs conventional resection for resection of non-muscle-invasive bladder cancer (HYBRIDBLUE): a randomised, multicentre trial. BJU Int 2020; 126:509-519. [PMID: 32578332 DOI: 10.1111/bju.15150] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether transurethral en bloc submucosal hydrodissection of bladder tumours (TUEB) improves the quality of the resection compared to conventional transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS A randomised, multicentre trial (HYBRIDBLUE) was conducted with a superiority design. Six German academic centres participated between September 2012 and August 2015. Based on literature analysis, a sample size for accurate histopathological assessment concerning muscle invasion was assumed to be feasible in 50% (P0 = 0.5) of TURBT and 80% of TUEB cases. After pre-screening of a total of 305 patients, participants were allocated to two study arms: Group I: hexaminolevulinate (HAL)-guided TUEB; Group II: conventional HAL-guided TURBT. The primary endpoint was the proportion of specimens that could be reliably evaluated pathologically concerning muscle invasiveness. Secondary endpoints included rates of histopathological completeness of the resection, muscularis propria content, recurrence, and complication rates. RESULTS A total of 115 patients (TUEB 56; TURBT 59) were eligible for final analysis. Adequate histopathological assessment, which included muscularis propria content and tumour margins (R0 vs R1), was present in 48/56 (86%) TUEB patients compared to 37/59 (63%; P = 0.006) in the TURBT group. R0 was confirmed in 30/56 TUEB patients (57%) and five of 59 TURBT patients (9%; P < 0.001). No complications of Grade ≥III were observed in both arms. At 3 and 12 months, three and 19 patients recurred in the TUEB group vs seven and 11 patients in the TURBT group, respectively (P = 0.33 and P = 0.08). CONCLUSIONS In this randomised study, TUEB was shown to be clinically safe regarding perioperative endpoints. An adequate histopathological assessment concerning muscle invasion was significantly better assessable in the TUEB arm compared to standard TURBT. This finding indicates the clinical potential for reducing the rate of early re-resections. Yet, a larger study with recurrence-free survival as the primary endpoint is needed to assess the oncological efficacy between both techniques.
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Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Alexander Karl
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | - Simone Bertz
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Maximillian Burger
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Department of Pathology, University Hospital of Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital of Munich-Grosshadern, Munich, Germany
| | | | - Kurt Miller
- Department of Urology, Charite, University Hospital of Berlin, Berlin, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | | | - Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.,Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
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Demerath T, Blackham K, Anastasopoulos C, Block K, Stieltjes B, Schubert T. Golden-Angle Radial Sparse Parallel (GRASP) MRI differentiates head & neck paragangliomas from schwannomas. Magn Reson Imaging 2020; 70:73-80. [DOI: 10.1016/j.mri.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
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10
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Schubert T, Nicke L, Schanze A, Reisch N, Geyer A, Koehler K, Huebner A. MON-185 ACTH-Derived Peptide Antagonists as an Alternative Treatment Strategy for Congenital Adrenal Hyperplasia. J Endocr Soc 2020. [PMCID: PMC7209623 DOI: 10.1210/jendso/bvaa046.589] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by different enzyme deficiencies in the steroid hormone synthesis leading to a disturbed cortisol biosynthesis. The medical treatment of CAH includes suboptimal ACTH-suppressing high glucocorticoid doses to reduce adrenal hyperplasia and overproduction of androgens. These inappropriate corticoid substitutions are often associated with undesirable side effects such as arterial hypertension, growth failure and obesity. Since the current therapy of patients with CAH is often unsatisfactory, innovative treatment options are required. The aim of our study was to specifically block the melanocortin 2 receptor (MC2R) signaling pathway as an alternative treatment strategy for CAH. We tested ACTH-derived selective peptides with incorporation of various synthetic non-natural amino acids in the activation motif of ACTH. To study the antagonistic activity of the peptides, cAMP production of MC2R/MRAP stably transfected human embryonic kidney (HEK) 293 cells were measured. All new synthesized peptide antagonists reduced ACTH-stimulated MC2R activity as competitive inhibitors indicated by a reduced in vitro cAMP response. Cells pre-incubated with peptide LNP009 showed the most efficient blockade of the MC2R and the highest shift of EC50 of ACTH (33.8 nM ± 0.08 vs. 7.3 nM ± 0.09). LNP009 was additionally tested for specificity concerning the other known melanocortin receptors and showed no antagonistic effect up to 1 μM on MC3, MC4 or MC5 receptor transiently transfected HEK 293 cells. To further investigate the inhibitory effect of our most potent antagonist peptide LNP009 on the steroid hormone response, we assessed steroidogenic enzyme expression of the human adrenocortical tumor cell line NCI-H295RA and performed mass spectrometry analyzes of steroids in the cell culture supernatant. Pre-incubation with LNP009 reduced the expression of the genes CYP21A2, CYP11B1 and HSD3B2 in NCI-H295RA cells and significantly reduced the synthesis of aldosterone (P=0.046; n=3), cortisol (P=0.020; n=3) and corticosterone (P=0.035; n=3). With the successful blocking of the ACTH binding and signal transduction by our antagonistic peptides, we anticipate an alternative approach for optimizing the treatment of CAH patients lacking the side effects of the currently used ACTH-suppressing corticoid therapy.
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Affiliation(s)
- Tina Schubert
- Division of Paediatric Endocrinology and Diabetes, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lennart Nicke
- Department of Chemistry, Philipps University Marburg, Marburg, Germany
| | - André Schanze
- Division of Paediatric Endocrinology and Diabetes, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Armin Geyer
- Department of Chemistry, Philipps University Marburg, Marburg, Germany
| | - Katrin Koehler
- Division of Paediatric Endocrinology and Diabetes, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Angela Huebner
- Division of Paediatric Endocrinology and Diabetes, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
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11
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Schubert T, Renninger M, Schmid MA, Hassan FN, Sokolakis I, Fahmy O, Hatzichristodoulou G, Stenzl A, Gakis G. Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer. Urol Oncol 2019; 38:4.e7-4.e15. [PMID: 31537484 DOI: 10.1016/j.urolonc.2019.08.013] [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: 04/16/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). MATERIAL AND METHODS A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55). RESULTS Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. CONCLUSIONS In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.
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Affiliation(s)
- Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Ioannis Sokolakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Omar Fahmy
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany; Department of Urology, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany.
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Koehler K, Hackmann K, Landgraf D, Schubert T, Shakiba M, Kariminejad A, Huebner A. Homozygous deletion of the entire AAAS gene in a triple A syndrome patient. Eur J Med Genet 2019; 62:103665. [PMID: 31071487 DOI: 10.1016/j.ejmg.2019.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/15/2019] [Accepted: 05/04/2019] [Indexed: 12/16/2022]
Abstract
Triple A syndrome, a multisystemic autosomal recessive disease, is characterized by the clinical triad of adrenal insufficiency, alacrima and achalasia in combination with progressive neurological impairments. The disorder is caused by homozygous or compound heterozygous mutations in the AAAS gene. Here we present the clinical and molecular data of a ten year old patient with triple A syndrome. Array CGH analysis confirmed the PCR-based assumption of a homozygous deletion of the entire AAAS gene in the patient and a heterozygous deletion in both parents. We demonstrate that the patient carries a 15 kb deletion and identified the 5' and 3' breakpoints outside the AAAS gene. This is the first report of a triple A syndrome patient with a homozygous deletion of the entire AAAS gene.
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Affiliation(s)
- Katrin Koehler
- Children's Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Karl Hackmann
- Institute of Clinical Genetics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Dana Landgraf
- Children's Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Tina Schubert
- Children's Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Marjan Shakiba
- Pediatric Endocrinology Department, Mofid Children Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Angela Huebner
- Children's Hospital, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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13
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Sokolakis I, Schubert T, Oelschläger M, Krebs M, Gschwend J, Holzapfel K, Kübler H, Gakis G, Hatzichristodoulou G. HP-06-001 The role of magnetic resonance imaging for the diagnosis of penile fracture in real life emergency settings: Comparative analysis with intraoperative findings. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Renninger M, Fahmy O, Schubert T, Schmid MA, Hassan F, Stenzl A, Gakis G. The prognostic impact of hexaminolevulinate-based bladder tumor resection in patients with primary non-muscle invasive bladder cancer treated with radical cystectomy. World J Urol 2019; 38:397-406. [PMID: 31030231 DOI: 10.1007/s00345-019-02780-0] [Citation(s) in RCA: 5] [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: 02/13/2019] [Accepted: 04/20/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.
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Affiliation(s)
- Markus Renninger
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany
| | - Omar Fahmy
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany.,Department of Urology, University Putra Malaysia (UPM), Selangor, Malaysia
| | - Tina Schubert
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany.,Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany
| | - Fahmy Hassan
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany.,Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany
| | - Georgios Gakis
- Department of Urology, University Hospital of Tübingen, Eberhard-Karls University, Tübingen, Germany. .,Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany.
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15
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16
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Wu Y, Shaughnessy G, Hoffman CA, Oberstar EL, Schafer S, Schubert T, Ruedinger KL, Davis BJ, Mistretta CA, Strother CM, Speidel MA. Quantification of Blood Velocity with 4D Digital Subtraction Angiography Using the Shifted Least-Squares Method. AJNR Am J Neuroradiol 2018; 39:1871-1877. [PMID: 30213811 PMCID: PMC6177311 DOI: 10.3174/ajnr.a5793] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/11/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA provides time-resolved 3D-DSA volumes with high temporal and spatial resolutions. The purpose of this study is to investigate a shifted least squares method to estimate the blood velocity from the 4D DSA images. Quantitative validation was performed using a flow phantom with an ultrasonic flow probe as ground truth. Quantification of blood velocity in human internal carotid arteries was compared with measurements generated from 3D phase-contrast MR imaging. MATERIALS AND METHODS The centerlines of selected vascular segments and the time concentration curves of each voxel along the centerlines were determined from the 4D-DSA dataset. The temporal shift required to achieve a minimum difference between any point and other points along the centerline of a segment was calculated. The temporal shift as a function of centerline point position was fit to a straight line to generate the velocity. The proposed shifted least-squares method was first validated using a flow phantom study. Blood velocities were also estimated in the 14 ICAs of human subjects who had both 4D-DSA and phase-contrast MR imaging studies. Linear regression and correlation analysis were performed on both the phantom study and clinical study, respectively. RESULTS Mean velocities of the flow phantom calculated from 4D-DSA matched very well with ultrasonic flow probe measurements with 11% relative root mean square error. Mean blood velocities of ICAs calculated from 4D-DSA correlated well with phase-contrast MR imaging measurements with Pearson correlation coefficient r = 0.835. CONCLUSIONS The availability of 4D-DSA provides the opportunity to use the shifted least-squares method to estimate velocity in vessels within a 3D volume.
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Affiliation(s)
- Y Wu
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | - G Shaughnessy
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | - C A Hoffman
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.)
| | | | | | - T Schubert
- Radiology (C.A.M., C.M.S., T.S.).,Department of Radiology and Nuclear Medicine (T.S.), Basel University Hospital, Basel, Switzerland
| | | | - B J Davis
- Biomedical Engineering (E.L.O., K.L.R., B.J.D.)
| | - C A Mistretta
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.).,Radiology (C.A.M., C.M.S., T.S.)
| | | | - M A Speidel
- From the Departments of Medical Physics (Y.W., G.S., C.A.H., C.A.M., M.A.S.).,Medicine (M.A.S.), University of Wisconsin, Madison, Wisconsin
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Perlepe V, Omoumi P, Larbi A, Putineanu D, Dubuc JE, Schubert T, Vande Berg B. Can we assess healing of surgically treated long bone fractures on radiograph? Diagn Interv Imaging 2018; 99:381-386. [DOI: 10.1016/j.diii.2018.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/12/2018] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
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Fahmy O, Khairul-Asri M, Schubert T, Stenzl A, Hassan F, Renninger M, Kübler H, Gakis G. MP78-17 LONG-TERM ONCOLOGICAL OUTCOMES AFTER TRIMODALITY THERAPY AND RADICAL CYSTECTOMY WITH OR WITHOUT NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2565] [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: 11/30/2022]
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19
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Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Kübler H, Stenzl A, Gakis G. Urethral recurrence after radical cystectomy for urothelial carcinoma: A systematic review and meta-analysis. Urol Oncol 2018; 36:54-59. [DOI: 10.1016/j.urolonc.2017.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/05/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
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20
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Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Malek R, Kübler H, Stenzl A, Gakis G. A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol 2017; 36:43-53. [PMID: 29102254 DOI: 10.1016/j.urolonc.2017.10.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/19/2017] [Accepted: 10/02/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed. RESULTS The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001). Complete response (CR) was achieved in 1,545 (75.3%) of 2,051 evaluable patients treated with TMT. A 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively. Downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC was reported in 2,416 (29.1%) of 8,311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (P = 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3-4. A 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively. CONCLUSION In this analysis, the survival outcomes of patients after TMT and RC for MIBC were comparable. Patients who experienced downstaging after NAC and RC exhibited improved survival compared to patients treated with RC only. Best survival outcomes after TMT are associated with CR to this approach.
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Affiliation(s)
- Omar Fahmy
- Department of Urology, Universiti Putra Malaysia (UPM), Selangor, Malaysia.
| | | | - Tina Schubert
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
| | - Markus Renninger
- Department of Urology, Eberhard-Karls University, Tübingen, Germany
| | - Rohan Malek
- Department of Urology, Hospital Selayang, Selangor, Malaysia
| | - Hubert Kübler
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tübingen, Germany
| | - Georgios Gakis
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
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Schubert T, Rausch S, Fahmy O, Gakis G, Stenzl A. Optical improvements in the diagnosis of bladder cancer: implications for clinical practice. Ther Adv Urol 2017; 9:251-260. [PMID: 29662543 DOI: 10.1177/1756287217720401] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background For over 100 years white-light cystoscopy has remained the gold-standard technique for the detection of bladder cancer (BCa). Some limitations in the detection of flat lesions (CIS), the differentiation between inflammation and malignancy, the inaccurate determination of the tumor margin status as well as the tumor depth, have led to a variety of technological improvements. The aim of this review is to evaluate the impact of these improvements in the diagnosis of BCa and their effectiveness in clinical practice. Methods A systematic literature search was conducted according to the PRISMA statement to identify studies reporting on imaging modalities in the diagnosis of NMIBC between 2000 and 2017. A two-stage selection process was utilized to determine eligible studies. A total of 74 studies were considered for final analysis. Results Optical imaging technologies have emerged as an adjunct to white-light cystoscopy and can be classified according to their scope as macroscopic, microscopic and molecular. Macroscopic techniques including photodynamic diagnosis (PDD), narrow-band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S, formerly known as SPIES) are similar to white-light cystoscopy, but are superior in the detection of bladder tumors by means of contrast enhancement. Especially the detection rate of very mute lesions in the bladder mucosa (CIS) could be significantly increased by the use of these methods. Microscopic imaging techniques like confocal laser endomicroscopy and optical coherence tomography permit a real-time high-resolution assessment of the bladder mucosa at a cellular and sub-cellular level with spatial resolutions similar to histology, enabling the surgeon to perform an 'optical biopsy'. Molecular techniques are based on the combination of optical imaging technologies with fluorescence labeling of cancer-specific molecular agents like antibodies. This labeling is intended to favor an optical distinction between benign and malignant tissue. Conclusions Optical improvements of the standard white-light cystoscopy have proven their benefit in the detection of BCa and have found their way into clinical practice. Especially the combination of macroscopic and microscopic techniques may improve diagnostic accuracy. Nevertheless, HAL-PDD guided cystoscopy is the only approach approved for routine use in the diagnosis of BCa by most urological associations in the EU and USA to date.
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Affiliation(s)
- Tina Schubert
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | - Omar Fahmy
- Department of Urology, University Putra Malaysia (UPM), Selangor, Malaysia
| | - Georgios Gakis
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany
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22
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Stiefel C, Schubert T, Morlock GE. Bioprofiling of Cosmetics with Focus on Streamlined Coumarin Analysis. ACS Omega 2017; 2:5242-5250. [PMID: 30023744 PMCID: PMC6044641 DOI: 10.1021/acsomega.7b00562] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/17/2017] [Indexed: 05/20/2023]
Abstract
Facing the widespread use of cosmetic products in daily use and recognizing the very limited information obtained by target analysis, a method suited for comprehensive characterization of cosmetics was aimed at. The biological activity of ingredients of 20 cosmetics taken from 16 different product groups and their coumarin contents were investigated via chromatography linked to bioassays (direct bioautography) and mass spectrometry. It allows for screening a large number of cosmetic products within a short time to generate a more valid database on their coumarin content and their contribution to the overall exposure. Bioactivity profiling of cosmetics with regard to bioactive ingredients opens new avenues for a comprehensive characterization of important substances in products of daily use, helpful for the legally required safety and risk assessment of cosmetic products, especially for multiple product usage. As for coumarin, a ubiquitary fragrance compound of allergenic potential, which is under recurrent discussion due to its hepatoxic properties, it is necessary to be able to estimate the regular intake via cosmetics for a valid risk assessment. This newly developed bioprofiling method allowed a selective determination of coumarin down to 1.3 mg kg-1, even for very matrix-rich cosmetics despite minimalism in sample preparation. The declaration limits according to European Cosmetics Regulation were completely covered. Mean coumarin contents of 20 cosmetic products reached up to 2218 mg kg-1. The repeatabilities (%RSD, n = 3) were between 1.1 and 2.9%, and the mean recoveries (n = 5) were between 96 and 102% for the different cosmetic matrices.
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Kruck S, Hennenlotter J, Amend B, Geiger M, Filipova E, Neumann T, Stühler V, Schubert T, Todenhöfer T, Rausch S, Huettig F, Stenzl A, Bedke J. Chronic Periodontitis Does Not Impact Serum Levels of Prostate-specific Antigen. Anticancer Res 2017; 37:3163-3167. [PMID: 28551659 DOI: 10.21873/anticanres.11675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Chronic periodontitis (CP) has already been associated with altered PSA values in men undergoing biopsy. This study addressed the impact of CP treatment on PSA screening. PATIENTS AND METHODS Fifty-two asymptomatic men presenting for CP treatment were prospectively enrolled. Total (t)PSA, free (f)PSA and %PSA were determined (n=47) before and after therapy. Pre- and post-therapy values were correlated pairwise regarding patients and dental characteristics. RESULTS Median age was 54 years (SD=±7.7 years) and mean tPSA was 1.3 ng/ml (±1.9 ng/ml). tPSA and fPSA correlated linearly and positively with age (p<0.002). After stratification by age, tPSA/fPSA remained significantly lower in smokers (p<0.05). No other patient or dental factor was associated with tPSA, fPSA, %PSA. CP therapy had no effect on PSA reduction and did not affect indication for biopsy. CONCLUSION The potential influence of CP on PSA testing seems to be excludable in asymptomatic men.
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Affiliation(s)
- Stephan Kruck
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Jörg Hennenlotter
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Bastian Amend
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Maya Geiger
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Elitsa Filipova
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Tim Neumann
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Viktoria Stühler
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Tina Schubert
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Fabian Huettig
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany.,Department of Prosthodontics, Center of Dentistry, Oral Medicine, and Maxillofacial Surgery, Eberhard-Karls-University, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
| | - Jens Bedke
- Department of Urology, Eberhard-Karls-University, Tuebingen, Germany
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van Steenberghe M, Schubert T, Guiot Y, Goebbels RM, Gianello P. Improvement of mesh recolonization in abdominal wall reconstruction with adipose vs. bone marrow mesenchymal stem cells in a rodent model. J Pediatr Surg 2017; 52:1355-1362. [PMID: 27939203 DOI: 10.1016/j.jpedsurg.2016.11.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/03/2016] [Accepted: 11/27/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction of muscle defects remains a challenge. Our work assessed the potential of an engineered construct made of a human acellular collagen matrix (HACM) seeded with porcine mesenchymal stem cells (MSCs) to reconstruct abdominal wall muscle defects in a rodent model. METHODS This study compared 2 sources of MSCs (bone-marrow, BMSCs, and adipose, ASCs) in vitro and in vivo for parietal defect reconstruction. Cellular viability and growth factor release (VEGF, FGF-Beta, HGF, IGF-1, TGF-Beta) were investigated under normoxic/hypoxic culture conditions. Processed and recellularized HACMs were mechanically assessed. The construct was tested in vivo in full thickness abdominal wall defect treated with HACM alone vs. HACM+ASCs or BMSCs (n=14). Tissue remodeling was studied at day 30 for neo-angiogenesis and muscular reconstruction. RESULTS A significantly lower secretion of IGF was observed with ASCs vs. BMSCs under hypoxic conditions (-97.6%, p<0.005) whereas significantly higher VEGF/FGF secretions were found with ASCs (+92%, p<0.001 and +72%, p<0.05, respectively). Processing and recellularization did not impair the mechanical properties of the HACM. In vivo, angiogenesis and muscle healing were significantly improved by the HACM+ASCs in comparison to BMSCs (p<0.05) at day 30. CONCLUSION A composite graft made of an HACM seeded with ASCs can improve muscle repair by specific growth factor release in hypoxic conditions and by in vivo remodeling (neo-angiogenesis/graft integration) while maintaining mechanical properties.
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Affiliation(s)
- M van Steenberghe
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Avenue Mounier 55, B-1200 Brussels, Belgium; Cardiac Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - T Schubert
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Avenue Mounier 55, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Y Guiot
- Cliniques universitaires Saint-Luc, Service d'anatomopathologie, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - R M Goebbels
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Avenue Mounier 55, B-1200 Brussels, Belgium
| | - P Gianello
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Avenue Mounier 55, B-1200 Brussels, Belgium
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Schuh W, Schubert T, Knipfer L, Wallrapp A, Jäck HM. The role of Krueppel-like factor 2 in B cell activation and plasma cell homeostasis. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.74.9] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Upon contact to antigen, B cells differentiate into memory B cells or antibody secreting short-lived or long-lived plasma cells (PC). The survival of long-lived PCs depends on interaction with survival niches in the spleen or in the bone marrow. However, the molecular mechanisms controlling PC generation, migration, homing and survival are poorly understood. We recently reported that Krueppel-like factor 2 (KLF2) is an important regulator of PC homeostasis. KLF2-deficient B cells express lower levels of homing factors, such as beta7-Integrin and L-Selectin. Numbers of antigen-specific PCs in the bone marrow of immunized KLF2-deficient mice are drastically reduced, indicating that KLF2 plays a crucial role in controlling PC homing and/or survival. Based on these findings we wanted to further characterize the functional impact of KLF2 on B cell activation and PC homeostasis. We observed that KLF2-deficient follicular B cells show a lower activation threshold and differentiate faster into plasma blasts in response to lower LPS concentrations in vitro compared to wildtype B cells. Furthermore, KLF2-deficient B cells proliferate faster as measured by CFSE. Target genes and signalling pathways modulated by KLF2 in B cells and PCs are currently analysed by gene expression profiling. We conclude that KLF2 acts as a quiescence factor in mature B cells by setting their activation threshold. In addition, KLF2 is crucial for PC homeostasis. KLF2-mediated signalling pathways and KLF2-regulated target genes which set the threshold for B cell activation, regulate plasma blast homing and mediate plasma cell survival will be identified by transcriptome analyses. This study was supported by DFG grants FOR832 and TRR130 to H.-M.J. and ELAN grant to W.S.
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Affiliation(s)
- Wolfgang Schuh
- 1Division of Molecular Immunology, Department of Internal Medicine III, Nikolaus-Fiebiger-Center, University of Erlangen-Nürnberg, Germany
| | - Tina Schubert
- 1Division of Molecular Immunology, Department of Internal Medicine III, Nikolaus-Fiebiger-Center, University of Erlangen-Nürnberg, Germany
| | - Lisa Knipfer
- 1Division of Molecular Immunology, Department of Internal Medicine III, Nikolaus-Fiebiger-Center, University of Erlangen-Nürnberg, Germany
| | - Antonia Wallrapp
- 1Division of Molecular Immunology, Department of Internal Medicine III, Nikolaus-Fiebiger-Center, University of Erlangen-Nürnberg, Germany
| | - Hans-Martin Jäck
- 1Division of Molecular Immunology, Department of Internal Medicine III, Nikolaus-Fiebiger-Center, University of Erlangen-Nürnberg, Germany
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Schubert T, Schmid MA, Lütfrenk T, Renninger M, Stenzl A, Gakis G. MP88-01 THE PROGNOSTIC VALUE OF PRE-CYSTECTOMY SERUM G-GLUTAMYLTRANSFERASE LEVELS IN PATIENTS WITH INVASIVE BLADDER CANCER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2726] [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: 10/19/2022]
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27
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Sandoval-Garcia C, Yang P, Schubert T, Schafer S, Hetzel S, Ahmed A, Strother C. Comparison of the Diagnostic Utility of 4D-DSA with Conventional 2D- and 3D-DSA in the Diagnosis of Cerebrovascular Abnormalities. AJNR Am J Neuroradiol 2017; 38:729-734. [PMID: 28279986 DOI: 10.3174/ajnr.a5137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA is a time-resolved technique that allows viewing of a contrast bolus at any time and from any desired viewing angle. Our hypothesis was that the information content in a 4D-DSA reconstruction was essentially equivalent to that in a combination of 2D acquisitions and a 3D-DSA reconstruction. MATERIALS AND METHODS Twenty-six consecutive patients who had both 2D- and 3D-DSA acquisitions were included in the study. The angiography report was used to obtain diagnoses and characteristics of abnormalities. Diagnoses included AVM/AVFs, aneurysms, stenosis, and healthy individuals. 4D-DSA reconstructions were independently reviewed by 3 experienced observers who had no part in the clinical care. Using an electronic evaluation form, these observers recorded their assessments based only on the 4D reconstructions. The clinical evaluations were then compared with the 4D evaluations for diagnosis and lesion characteristics. RESULTS Results showed both interrater and interclass agreements (κ = 0.813 and 0.858). Comparing the 4D diagnosis with the clinical diagnosis for the 3 observers yielded κ values of 0.906, 0.912, and 0.906. The κ values for agreement among the 3 observers for the type of abnormality were 0.949, 0.845, and 0.895. There was complete agreement on the presence of an abnormality between the clinical and 4D-DSA in 23/26 cases. In 2 cases, there were conflicting opinions. CONCLUSIONS In this study, the information content of 4D-DSA reconstructions was largely equivalent to that of the combined 2D/3D studies. The availability of 4D-DSA should reduce the requirement for 2D-DSA acquisitions.
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Affiliation(s)
| | - P Yang
- Department of Neurosurgery (P.Y.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - S Schafer
- Siemens Healthineers, USA (S.S.), Hoffman Estates, Illinois
| | - S Hetzel
- Biostatistics and Medical Informatics (S.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Ahmed
- From the Departments of Neurological Surgery (C.S.-G., A.A.)
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Hoeller U, Schubert T, Mueller T, Budach V, Ghadjar P, Brenner W, Kuschke W. Planning study for Merkel cell carcinoma based on the relapse pattern. Radiother Oncol 2017; 123:154-157. [PMID: 28284495 DOI: 10.1016/j.radonc.2017.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/23/2016] [Revised: 01/29/2017] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To develop a technique for radiation (RT) of in-transit path ways (IT) in Merkel cell carcinoma. METHOD In the planning study, IT were ink-marked on the skin during sentinel lymphscintigraphy and wire-marked in planning-CT. Pre- and post-operative planning-CTs were acquired. The clinical target volume (CTV) included tumor bed plus safety margin, IT and draining nodes, the planning volume (PTV) the CTV plus 0.5-1cm margin. VMAT plans with 2-3 arcs were analyzed. RESULTS A planning study was performed for five pts. including two pts. with primary tumor (PT) in head and neck, 1 pt. each with PT of elbow, forearm and upper leg respectively. Plans showed satisfactory PTV coverage: Dmean 100%±0%, D98% 92.4%±2.24%, homogeneity index (HI) 0.095±0.01, conformation number (CN) 0.84±0.01 and conformality index (CI) 0.95±0.01. CONCLUSION The planning study confirms feasibility of highly conformal irradiation of IT pathways based on individualized target delineation. Currently, patients referred for non-metastatic MCC are encouraged to enroll in a prospective clinical study that evaluates the feasibility of radiation of IT pathways.
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Affiliation(s)
- Ulrike Hoeller
- Radiation Oncology, Charité University Medicine Berlin, Germany.
| | - Tina Schubert
- Radiation Oncology, Charité University Medicine Berlin, Germany
| | - Thomas Mueller
- Radiation Oncology, Charité University Medicine Berlin, Germany
| | - Volker Budach
- Radiation Oncology, Charité University Medicine Berlin, Germany
| | - Pirus Ghadjar
- Radiation Oncology, Charité University Medicine Berlin, Germany
| | | | - Wolf Kuschke
- Radiation Oncology, Charité University Medicine Berlin, Germany
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van Steenberghe M, Schubert T, Guiot Y, Bouzin C, Bollen X, Gianello P. Enhanced vascular biocompatibility of decellularized xeno-/allogeneic matrices in a rodent model. Cell Tissue Bank 2017; 18:249-262. [PMID: 28238108 DOI: 10.1007/s10561-017-9610-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 07/25/2016] [Accepted: 02/09/2017] [Indexed: 02/03/2023]
Abstract
Glutaraldehyde preservation is the gold standard for cardiovascular biological prosthesis. However, secondary calcifications and the absence of tissue growth remain major limitations. Our study assessed in vitro and in vivo the biocompatibility of human (fascia lata, pericardium) and porcine tissues (pericardium, peritoneum) treated with a physicochemical procedure for decellularization and non-conventional pathogens inactivation. Biopsies were performed before and after treatment to assess decellularization (HE/Dapi staining/DNA quantification/MHC I/alpha gal immunostaining) and mechanical integrity. Forty-five rats received an abdominal aortic patch of native cryopreserved tissues (n = 20), treated tissues (n = 20) or glutaraldehyde-preserved bovine pericardium (GBP, control, n = 5). Grafts were explanted at 4 weeks and processed for HE/von Kossa staining and immunohistochemistries for lymphocytes (CD3)/macrophages (CD68) histomorphometry. 95% of decellularization was obtained for all tissues except for fascia lata (75%). Mechanical properties were slightly altered. In the in vivo model, a significant increase of CD3 and CD68 infiltrations was found in native and control implants in comparison with decellularized tissues (p < 0.05). Calcifications were found in 3 controls. Decellularized tissues were recolonized. GBP showed the most inflammatory response. This physicochemical treatment improves the biocompatibility of selected xeno/allogeneic tissues in comparison with their respective native cryopreserved tissues and with GBP. Incomplete decellularization is associated with a significantly higher inflammatory response. Our treatment is a promising tool in the field of tissue decellularization and tissue banking.
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Affiliation(s)
- M van Steenberghe
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Université catholique de Louvain, Avenue Mounier 55, 1200, Brussels, Belgium. .,Cardiac Surgery Department, University Clinical Hospital (CHUV), Lausanne, Switzerland.
| | - T Schubert
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Université catholique de Louvain, Avenue Mounier 55, 1200, Brussels, Belgium.,Service d'orthopédie et de traumatologie de l'appareil locomoteur, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Unité de thérapie tissulaire et cellulaire de l'appareil locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Y Guiot
- Service d'anatomopathologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - C Bouzin
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Pharmacologie et de Thérapeutique (FATH), Université catholique de Louvain, Avenue Mounier 52, 1200, Brussels, Belgium
| | - X Bollen
- Secteur des Sciences et Technologies, Institute of Mechanics, Materials and Civil Engineering, Centre de Recherche en Energie et Mécatronique (CEREM), Université catholique de Louvain, Place du Levant, 2 L5-04-01, 1348, Louvain-la-Neuve, Belgium
| | - P Gianello
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Université catholique de Louvain, Avenue Mounier 55, 1200, Brussels, Belgium
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Fahmy O, Schubert T, Khairul-Asri MG, Stenzl A, Gakis G. Total proximal ureter substitution using buccal mucosa. Int J Urol 2017; 24:320-323. [PMID: 28208217 DOI: 10.1111/iju.13307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/09/2017] [Indexed: 12/14/2022]
Abstract
The surgical treatment of a long proximal ureteral stricture is a challenging situation for reconstructive surgeons. Despite the underlying morbidities, ileal interposition and autotransplantation are the options available to treat complex cases of long segment ureteral stricture. Buccal mucosa has shown excellent results in urethroplasty. However, its use in ureteral reconstruction is infrequent. We report on a 64-year-old female patient with multiple comorbidities and prior abdominal surgeries for Crohn's disease who underwent a successful total substitution of a long segment of the proximal ureter using buccal mucosa. Regular postoperative isotope scans showed improvement in renal function. Based on the pleasant outcome of this case and review of the literature, buccal mucosa might be a viable option with low morbidity in selected cases.
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Affiliation(s)
- Omar Fahmy
- Department of Urology, University of Putra Malaysia, Selangor, Malaysia
| | - Tina Schubert
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | - Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, Gakis G. Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review. Eur Urol 2016; 70:293-8. [DOI: 10.1016/j.eururo.2015.12.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
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Gakis G, Efstathiou JA, Daneshmand S, Keegan KA, Clayman RH, Hrbacek J, Ali-El-Dein B, Zaid HB, Schubert T, Mischinger J, Todenhöfer T, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Morgan TM. Oncological Outcomes of Patients with Concomitant Bladder and Urethral Carcinoma. Urol Int 2016; 97:134-41. [PMID: 27462702 PMCID: PMC10176496 DOI: 10.1159/000448335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/12/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study aimed to investigate oncological outcomes of patients with concomitant bladder cancer (BC) and urethral carcinoma. METHODS This is a multicenter series of 110 patients (74 men, 36 women) diagnosed with urethral carcinoma at 10 referral centers between 1993 and 2012. Kaplan-Meier analysis was used to investigate the impact of BC on survival, and Cox regression multivariable analysis was performed to identify predictors of recurrence. RESULTS Synchronous BC was diagnosed in 13 (12%) patients, and the median follow-up was 21 months (interquartile range 4-48). Urethral cancers were of higher grade in patients with synchronous BC compared to patients with non-synchronous BC (p = 0.020). Patients with synchronous BC exhibited significantly inferior 3-year recurrence-free survival (RFS) compared to patients with non-synchronous BC (63.2 vs. 34.4%; p = 0.026). In multivariable analysis, inferior RFS was associated with clinically advanced nodal stage (p < 0.001), proximal tumor location (p < 0.001) and synchronous BC (p = 0.020). CONCLUSION The synchronous presence of BC in patients diagnosed with urethral carcinoma has a significant adverse impact on RFS and should be an impetus for a multimodal approach.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University of Michigan, Ann Arbor, Mich., USA
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Gakis G, Schubert T, Alemozaffar M, Bellmunt J, Bochner BH, Boorjian SA, Daneshmand S, Huang WC, Kondo T, Konety BR, Laguna MP, Matin SF, Siefker-Radtke AO, Shariat SF, Stenzl A. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol 2016; 35:327-335. [DOI: 10.1007/s00345-016-1819-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
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Fahmy O, Scharpf M, Schubert T, Feyerabend S, Stenzl A, Schwentner C, Fend F, Gakis G. Ten Years of Complete Remission of Pulmonary Metastasis after Post-Cystectomy Palliative Cisplatin-Gemcitabine Chemotherapy with Gefitinib for Muscle Invasive Bladder Cancer: A Case Report. Urol Int 2016; 97:485-488. [PMID: 26863306 DOI: 10.1159/000441700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/08/2015] [Indexed: 11/19/2022]
Abstract
Muscle-invasive bladder cancer (MIBC) is considered one of the most lethal malignancies with high metastatic potential. Usually, metastatic bladder cancer carries worse prognosis with a median survival rate of approximately 6 months, which can be prolonged for up to 14 months with palliative systemic chemotherapy. We present the case of a 61-year-old male patient diagnosed with localized MIBC 10 years ago. He underwent nerve-sparing radical cystectomy with ileal neobladder, but developed pulmonary metastatic disease 7 months postoperatively. Six cycles of gemcitabine/cisplatin combination chemotherapy with an addition of gefitinib as daily oral medication were administered within a randomized phase II clinical trial; this resulted in complete remission of the pulmonary metastases. Until now, the patient is still on gefitinib daily without any side effects. Although, the addition of gefitinib to standard systemic chemotherapy has not been shown to improve the survival in metastatic urothelial cancer, this case represents a very pleasant albeit uncommon long-term outcome.
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Affiliation(s)
- Omar Fahmy
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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Gakis G, Rink M, Fritsche HM, Graefen M, Schubert T, Hassan F, Chun FK, Brummeisl W, Fisch M, Burger M, Stenzl A, Renninger M. Prognostic Significance of Incidental Prostate Cancer at Radical Cystoprostatectomy for Bladder Cancer. Urol Int 2016; 97:42-8. [DOI: 10.1159/000443239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
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Simakova IL, Demidova YS, Gläsel J, Murzina EV, Schubert T, Prosvirin IP, Etzold BJM, Murzin DY. Controlled synthesis of PVP-based carbon-supported Ru nanoparticles: synthesis approaches, characterization, capping agent removal and catalytic behavior. Catal Sci Technol 2016. [DOI: 10.1039/c6cy02086k] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PVP-capped Ru nanoparticles were synthesized, immobilized on several carbon supports and tested in galactose hydrogenation.
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Affiliation(s)
- I. L. Simakova
- Boreskov Institute of Catalysis
- Novosibirsk
- Russia
- Novosibirsk State University
- Novosibirsk
| | - Yu. S. Demidova
- Boreskov Institute of Catalysis
- Novosibirsk
- Russia
- Novosibirsk State University
- Novosibirsk
| | - J. Gläsel
- Technische Universität Darmstadt
- Ernst-Berl-Institut für Technische und Makromolekulare Chemie
- Darmstadt
- Germany
| | | | | | | | - B. J. M. Etzold
- Technische Universität Darmstadt
- Ernst-Berl-Institut für Technische und Makromolekulare Chemie
- Darmstadt
- Germany
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Gakis G, Morgan TM, Efstathiou JA, Keegan KA, Mischinger J, Todenhoefer T, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Daneshmand S. Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma. World J Urol 2015; 34:97-103. [PMID: 25981402 PMCID: PMC10176500 DOI: 10.1007/s00345-015-1583-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/28/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate risk factors for survival in a large international cohort of patients with primary urethral cancer (PUC). METHODS A series of 154 patients (109 men, 45 women) were diagnosed with PUC in ten referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank test was used to investigate various potential prognostic factors for recurrence-free (RFS) and overall survival (OS). Multivariate models were constructed to evaluate independent risk factors for recurrence and death. RESULTS Median age at definitive treatment was 66 years (IQR 58-76). Histology was urothelial carcinoma in 72 (47 %), squamous cell carcinoma in 46 (30 %), adenocarcinoma in 17 (11 %), and mixed and other histology in 11 (7 %) and nine (6 %), respectively. A high degree of concordance between clinical and pathologic nodal staging (cN+/cN0 vs. pN+/pN0; p < 0.001) was noted. For clinical nodal staging, the corresponding sensitivity, specificity, and overall accuracy for predicting pathologic nodal stage were 92.8, 92.3, and 92.4 %, respectively. In multivariable Cox-regression analysis for patients staged cM0 at initial diagnosis, RFS was significantly associated with clinical nodal stage (p < 0.001), tumor location (p < 0.001), and age (p = 0.001), whereas clinical nodal stage was the only independent predictor for OS (p = 0.026). CONCLUSIONS These data suggest that clinical nodal stage is a critical parameter for outcomes in PUC.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University of Tübingen, Tübingen, Germany.
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Kirk A Keegan
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Tina Schubert
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Harras B Zaid
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jan Hrbacek
- Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Rebecca H Clayman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sigolene Galland
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kola Olugbade
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Maximilian Burger
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marko Babjuk
- Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - George N Thalmann
- Department of Urology, University Hospital Berne, Berne, Switzerland
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA, USA
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Gakis G, Morgan TM, Daneshmand S, Keegan KA, Todenhöfer T, Mischinger J, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Efstathiou JA. Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma. Ann Oncol 2015; 26:1754-9. [PMID: 25969370 DOI: 10.1093/annonc/mdv230] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 10/12/2014] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC). PATIENTS AND METHODS A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48). RESULTS Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005). CONCLUSION In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.
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Affiliation(s)
- G Gakis
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - T M Morgan
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - S Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles
| | - K A Keegan
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - T Todenhöfer
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - J Mischinger
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - T Schubert
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - H B Zaid
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - J Hrbacek
- 2nd Medical School, Department of Urology, Charles University, Prague, Czech Republic
| | - B Ali-El-Dein
- Urology and Nephrology Center, Mansoura Clinic, Mansoura, Egypt
| | - R H Clayman
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - S Galland
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - K Olugbade
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - H-M Fritsche
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - M Burger
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - S S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - M Babjuk
- 2nd Medical School, Department of Urology, Charles University, Prague, Czech Republic
| | - G N Thalmann
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - A Stenzl
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - J A Efstathiou
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Wang L, Al Hussein Al Awamlh B, Schubert T, Laudano M, Lee D, Davidson W, Schulster M, Zhao F, Chughtai B, Lee R. MP32-16 TRENDS IN MESH USE IN PELVIC ORGAN PROLAPSE REPAIR. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1412] [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: 11/30/2022]
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Schubert T, Pansini M, Bieri O, Stippich C, Wetzel S, Schaedelin S, von Hessling A, Santini F. Attenuation of blood flow pulsatility along the Atlas slope: a physiologic property of the distal vertebral artery? AJNR Am J Neuroradiol 2015; 36:562-7. [PMID: 25395658 DOI: 10.3174/ajnr.a4148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Physiologic and pathologic arterial tortuosity may attenuate blood flow pulsatility. The aim of this prospective study was to assess a potential effect of the curved V3 segment (Atlas slope) of the vertebral artery on arterial flow pulsatility. The pulsatility index and resistance index were used to assess blood flow pulsatility. MATERIALS AND METHODS Twenty-one healthy volunteers (17 men, 4 women; mean age, 32 years) were examined with a 3T MR imaging system. Blood velocities were measured at 2 locations below (I and II) and at 1 location above the V3 segment (III) of the vertebral artery by using a high-resolution 2D-phase-contrast sequence with multidirectional velocity-encoding. RESULTS Pulsatility and resistance indices decreased along all measurement locations from proximal to distal. The pulsatility index decreased significantly from location II to III and from I to II. However, the decrease was more pronounced along the Atlas slope than in the straight-vessel section below. The decrease of the resistance index was highly significant along the Atlas slope (location II to III). The decrease from location I to II was small and not significant. CONCLUSIONS The pronounced decrease in pulsatility and resistance indices along the interindividually uniformly bent V3 segment compared with a straight segment of the vertebral artery indicates a physiologic attenuating effect of the Atlas slope on arterial flow pulsatility. A similar effect has been described for the carotid siphon. A physiologic reduction of pulsatility in brain-supplying arteries would be in accordance with several recent publications reporting a correlation of increased arterial flow pulsatility with leukoencephalopathy and lacunar stroke.
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Affiliation(s)
- T Schubert
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - M Pansini
- Department of Radiology (M.P.), Bruderholz Cantonal Hospital, Basel, Switzerland
| | - O Bieri
- Radiological Physics (O.B., F.S.), Clinic of Radiology and Nuclear Medicine
| | - C Stippich
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - S Wetzel
- Department of Neuroradiology (S.W.), Hirslanden Clinic, Zurich, Switzerland
| | - S Schaedelin
- Clinical Trial Unit (S.S.), Basel University Hospital, Basel, Switzerland
| | - A von Hessling
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - F Santini
- Radiological Physics (O.B., F.S.), Clinic of Radiology and Nuclear Medicine
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Rieken M, Schubert T, Xylinas E, Kluth L, Rouprêt M, Trinh QD, Lee R, Al Hussein Al Awamlh B, Fajkovic H, Novara G, Margulis V, Lotan Y, Martinez-Salamanca J, Matsumoto K, Seitz C, Remzi M, Karakiewicz P, Scherr D, Briganti A, Bachmann A, Shariat S. Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur J Surg Oncol 2014; 40:1693-9. [DOI: 10.1016/j.ejso.2014.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/16/2014] [Accepted: 03/20/2014] [Indexed: 12/24/2022] Open
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Hoeller U, Mueller T, Schubert T, Budach V, Ghadjar P, Brenner W, Kiecker F, Schicke B, Haase O. Regional nodal relapse in surgically staged Merkel cell carcinoma. Strahlenther Onkol 2014; 191:51-8. [PMID: 25293726 DOI: 10.1007/s00066-014-0756-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/05/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE The nodal relapse pattern of surgically staged Merkel cell carcinoma (MCC) with/without elective nodal radiotherapy (RT) was studied in a single institution. METHOD A total of 51 patients with MCC, 33% UICC stage I, 14% II, 53% III (4 lymph node metastases of unknown primary) were eligible. All patients had surgical staging: 23 patients sentinel node biopsy (SNB), 22 patients SNB followed by lymphadenectomy (LAD) and 6 patients LAD. In all, 94% of the primary tumors (PT) were completely resected; 57% of patients received RT, 51% of known PT sites, 33% (8/24 patients) regional RT to snN0 nodes and 68% (17/27 patients) to pN+ nodes, mean reference dose 51.5 and 50 Gy, respectively. Mean follow-up was 6 years (range 2-14 years). RESULTS A total of 22% (11/51) patients developed regional relapses (RR); the 5-year RR rate was 27%. In snN0 sites (stage I/II), relapse occurred in 5 of 14 nonirradiated vs. none of 8 irradiated sites (p = 0.054), resulting in a 5-year RR rate of 33% versus 0% (p = 0.16). The crude RR rate was lower in stage I (12%, 2/17 patients) than for stage II (43%, 3/7 patients). In stage III (pN+), RR appeared to be less frequent in irradiated sites (18%, 3/14 patients) compared with nonirradiated sites (33%, 3/10 patients, p = 0.45) with 5-year RR rates of 23% vs. 34%, respectively. DISCUSSION Our data suggest that adjuvant nodal RT plays a major role even if the sentinel nodes were negative. CONCLUSION Adjuvant RT of the lymph nodes in patients with stage IIa tumors and RT after LAD in stage III tumors is proposed and should be evaluated prospectively.
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Affiliation(s)
- Ulrike Hoeller
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany,
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Babu B, Dankers H, Newberry E, Baker C, Schubert T, Knox G, Paret M. First Report of Rose rosette virus Associated with Rose Rosette Disease Infecting Knockout Roses in Florida. Plant Dis 2014; 98:1449. [PMID: 30703988 DOI: 10.1094/pdis-05-14-0501-pdn] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Roses are one of the most popular flowering shrubs in the United States, with a total wholesale value of US$194 million. Among the major states, Florida is the fourth largest producer of roses with a total value exceeding US$20 million (4). In Florida, the roses have become especially popular in recent years with the introduction of Knock Out and other shrub roses. Virus-like symptoms including witches'-broom, excessive thorns, abnormal red discoloration of shoots and foliages, distorted leaves, and deformed buds and flowers were initially observed on Knock Out roses in a commercial nursery in Quincy, FL, in November 2013. Fifteen plants out of ~250,000 plants showed these characteristic symptoms. Total RNA extracts (RNeasy Plant Mini Kit, Qiagen, Valencia, CA) from eight symptomatic and two non-symptomatic rose samples were subjected to reverse-transcription (RT) assays using SuperScript III Reverse transcriptase (Invitrogen, Life Technologies, NY) and random hexamer primers. The cDNA synthesized was then subjected to PCR assay using Platinum Taq DNA polymerase (Invitrogen, Life Technologies) and using Rose rosette virus (RRV) specific primers RRV-F and RRV-R (1), targeting the core region of the RNA1 genome of the virus. The RT-PCR assays using the specific primers produced amplicons of 375 bp, only in the symptomatic leaf samples. The obtained amplicons were PCR purified and sequenced directly (GenBank Accession Nos. KF990370 to KF990377). BLAST analysis of these sequences revealed a higher identity of 99% with the RRV (HQ871942) in the NCBI database. Pairwise comparison of the eight RRV sequences exhibited 99 to 100% identity among themselves. These results revealed the association of RRV with the symptomatic rose plants. Eight symptomatic and two non-symptomatic rose plant samples were tested for RRV using blot hybridization assay, utilizing a digoxigenin-labeled DNA probe of 511 bp, targeting the RNA1 genome of the RRV. All eight symptomatic rose plants showed a positive reaction to the RRV-specific probes, confirming the presence of RRV in the samples, while the non-symptomatic and the buffer control did not produce any reactions. Even though the virus is reported to spread by an eriophyid mite Phyllocoptes fructiphilus, thorough examination of the infected samples showed absence of the vector. The samples were also tested using RT-PCR for the presence of Rose cryptic virus (RCV) and Blackberry chlorotic ringspot virus (BCRV) using specific primers (2,3). The samples tested negative for the RCV and BCRV. This is the first report of occurrence of RRV on rose in Florida. Considering the economic importance of the rose plants and the highly destructive nature of RRV, this report underscores the need for immediate effective quarantine and management of the virus for protecting the economically important rose industry in Florida. References: (1) A. G. Laney et al. J. Gen. Virol. 92:1727, 2011. (2) S. Sabanadzovic and N. Abou Ghanem-Sabanadzovic. J. Plant Pathol. 90:287, 2008. (3) I. E. Tzanetakis et al. Plant Pathol. 55:568, 2006. (4) USDA. 2007 Census of Agriculture 3:25, Washington, DC, 2010.
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Affiliation(s)
- B Babu
- North Florida Research and Education Center, University of Florida, Quincy 32351
| | - H Dankers
- North Florida Research and Education Center, University of Florida, Quincy 32351
| | - E Newberry
- North Florida Research and Education Center, University of Florida, Quincy 32351
| | - C Baker
- Division of Plant Industry, Florida Department of Agriculture and Consumer Services, Gainesville, FL 32608
| | - T Schubert
- Division of Plant Industry, Florida Department of Agriculture and Consumer Services, Gainesville, FL 32608
| | - G Knox
- North Florida Research and Education Center, University of Florida, Quincy 32351
| | - M Paret
- North Florida Research and Education Center, University of Florida, Quincy 32351
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Schubert T, Danzig MR, Kotamarti S, Ghandour RA, Lascano D, Dubow BP, Decastro GJ, Benson MC, McKiernan JM. Mixed low- and high-grade non-muscle-invasive bladder cancer: a histological subtype with favorable outcome. World J Urol 2014; 33:847-52. [DOI: 10.1007/s00345-014-1383-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022] Open
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Stope MB, Stender C, Schubert T, Peters S, Weiss M, Ziegler P, Zimmermann U, Walther R, Burchardt M. Heat-shock protein HSPB1 attenuates microRNA miR-1 expression thereby restoring oncogenic pathways in prostate cancer cells. Anticancer Res 2014; 34:3475-3480. [PMID: 24982356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Heat-shock proteins (HSPs) as well as microRNAs have been identified to orchestrate crucial mechanisms in prostate cancer (PCa) progression and treatment resistance. Due to cytoprotective properties of HSPB1 we analyzed molecular mechanisms of drug resistance in PCa cell culture systems, and notably found HSPB1 functionality linked to microRNA miR-1 activities. MATERIALS AND METHODS HSPB1 and miR-1 levels were genetically modified in PCa cell lines and alterations in molecular and cellular responses were assessed by quantitative reverse transcription/polymerase chain reaction, western blotting, and proliferation assays. RESULTS Our data provided for the first time evidence that HSPB1 regulates miR-1 expression, and subsequently restores oncogenic signaling pathways of androgen receptor (AR) and transforming growth factor β1 (TGFB1). CONCLUSION Our data point towards HSPB1 and miR-1 involvement in development of castration-resistant PCa and therefore represent promising targets for anticancer therapy of advanced PCa.
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Affiliation(s)
- Matthias B Stope
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Stender
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Tina Schubert
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Stefanie Peters
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Martin Weiss
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Patrick Ziegler
- Department of Oncology, Hematology and Stem Cell Transplantation, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Uwe Zimmermann
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Reinhard Walther
- Department of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
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Gaschler R, Schwager S, Umbach VJ, Frensch PA, Schubert T. Expectation mismatch: differences between self-generated and cue-induced expectations. Neurosci Biobehav Rev 2014; 46 Pt 1:139-57. [PMID: 24971824 DOI: 10.1016/j.neubiorev.2014.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 09/01/2013] [Revised: 05/20/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
Expectation of upcoming stimuli and tasks can lead to improved performance, if the anticipated situation occurs, while expectation mismatch can lead to less efficient processing. Researchers have used methodological approaches that rely on either self-generated expectations (predictions) or cue-induced expectations to investigate expectation mismatch effects. Differentiating these two types of expectations for different contents of expectation such as stimuli, responses, task sets and conflict level, we review evidence suggesting that self-generated expectations lead to larger facilitating effects and conflict effects on the behavioral and neural level - as compared to cue-based expectations. On a methodological level, we suggest that self-generated as compared to cue-induced expectations allow for a higher amount of experimental control in many experimental designs on expectation effects. On a theoretical level, we argue for qualitative differences in how cues vs. self-generated expectations influence performance. While self-generated expectations might generally involve representing the expected event in the focus of attention in working memory, cues might only lead to such representations under supportive circumstances (i.e., cue of high validity and attended).
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Rieken M, Schubert T, Xylinas E, Kluth L, Rouprêt M, Trinh QD, Lee R, Al Hussein Al Awamlh B, Fajkovic H, Novara G, Margulis V, Lotan Y, Martinez-Salamanca J, Matsumoto K, Seitz C, Remzi M, Karakiewicz P, Scherr D, Briganti A, Bachmann A, Shariat S. MP77-05 ASSOCIATION OF PERIOPERATIVE BLOOD TRANSFUSION WITH ONCOLOGIC OUTCOMES AFTER RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2468] [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: 11/30/2022]
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Danzig M, Ghandour R, Kotamarti S, Schubert T, RoyChoudhury A, Pierorazio P, Badani K, Allaf M, McKiernan J. MP54-04 PARTIAL NEPHRECTOMY IS EQUIVALENT TO ACTIVE SURVEILLANCE IN PRESERVING RENAL FUNCTION FOR PATIENTS WITH SMALL RENAL MASSES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1593] [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: 10/25/2022]
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Peters RK, Schubert T, Clemmons R, Vickroy T. Levetiracetam rectal administration in healthy dogs. J Vet Intern Med 2014; 28:504-9. [PMID: 24417468 PMCID: PMC4857990 DOI: 10.1111/jvim.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/24/2013] [Accepted: 11/05/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Levetiracetam is used to manage status epilepticus (SE) and cluster seizures (CS) in humans. The drug might be absorbed after rectal administration and could offer a practical adjunct to rectal administration of diazepam in managing SE and CS. HYPOTHESIS Levetiracetam is rapidly absorbed after rectal administration in dogs and maintains target serum concentrations for at least 9 hours. ANIMALS Six healthy privately owned dogs between 2 and 6 years of age and weighing 10-20 kg. METHODS Levetiracetam (40 mg/kg) was administered rectally and blood samples were obtained immediately before (time zero) and at 10, 20, 40, 60, 90, 180, 360, and 540 minutes after drug administration. Dogs were observed for signs of adverse effects over a 24-hour period after drug administration. RESULTS CLEV at 10 minutes was 15.3 ± 5.5 μg/mL (mean, SD) with concentrations in the target range (5-40 μg/mL) for all dogs throughout the sampling period. Cmax (36.0 ± 10.7 μg/mL) and Tmax (103 ± 31 minutes) values were calculated and 2 disparate groups were appreciated. Dogs with feces in the rectum at the time of drug administration had lower mean Cmax values (26.7 ± 3.4 μg/mL) compared with those without (45.2 ± 4.4 μg/mL). Mild sedation was observed between 60 and 90 minutes without other adverse effects noted. CONCLUSIONS AND CLINICAL IMPORTANCE This study supports the use of rectally administered levetiracetam in future studies of clinical effectiveness in the management of epileptic dogs.
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Affiliation(s)
- R K Peters
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
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Schubert T, Rapp B, McCloskey M. Recognition of Oral Spelling is Diagnostic of the Integrity of the Central Reading Processes. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.09.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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