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Bucksch-Beudt, Cornelia ; Büchel, Anna ; Berkhoff, Stefan ; Janko, Steffi ; Kirchhoff, Andreas ; Kompatscher, Julia ; Kraft, Hans-Georg ; Kujumdshiev, Sandy ; Nürnberger, Frank ; Ochsendorf, Falk ; Rehner, Moritz ; Schulze, Johannes B.
Mit der Neuregelung der Studienplatzverteilung von 2005 haben die Universitäten in Deutschland die Möglichkeit, bis zu 60% der Studienplätze nach universitätseigenen Kriterien zu vergeben. Implizit wird vom Gesetzgeber und der öffentlichen Meinung gefordert, nicht-leistungsbezogene Kriterien und Persönlichkeitsmerkmale verstärkt zur Bewerberauswahl einzusetzen (Motivation, Identifikation, Vermeidung von Fehlvorstellungen). Da in Anbetracht der Bewerberzahlen mündliche Auswahlgespräche als ungeeignet erscheinen, wurde vom Fachbereich Medizin der Johann Wolfgang Goethe Universität ein Fragebogen entworfen, um nichtschulische Leistungen zu erfassen. Dieser Fragebogen wurde am Beginn des Wintersemesters 2005/2006 von allen Studienanfängern der JWG-Universität Frankfurt und der Medizinischen Universität Innsbruck ausgefüllt. Entgegen der initialen Erwartungen der Verfasser gaben nur etwa 15% Prozent Medizin-spezifische berufliche Vorerfahrungen an (Rettungsdienst, Ausbildung als Krankenschwester/pfleger oder ähnliches); dagegen wurden von etwa 60% angegeben, mindestens ein Musikinstrument zu spielen oder länger sportlich aktiv gewesen zu sein. Die Zusammenstellung der Selbstangaben zeigt, dass Medizin-relevante Vorkenntnisse nur bei einem kleinen Anteil der Studienbewerber in größerem Umfang vorhanden sind. Aufgrund der großen Streuung in der Art und Dauer der angegebenen Vorleistungen sollte die Erhebung von Parametern zur Beurteilung von soft skills, z.B. durch Online-Fragebogen, als (Vor)Selektionsinstrument nur sehr vorsichtig eingesetzt werden.
Schulze, Johannes B. ; Drolshagen, Stefan ; Nürnberger, Frank ; Ochsendorf, Falk ; Schäfer, Volker ; Brandt, Claudia
Multiple choice (MC)-Klausuren sind im deutschen Medizinstudium trotz weitgehend fehlender Daten zur Validität dieser Prüfungsform zur Regelprüfung geworden. Darüber hinaus ist unklar, in welchem Ausmaß die Studierenden - auch solche mit guten Prüfungsergebnissen - den geprüften Lernstoff tatsächlich beherrschen. Am Fachbereich Medizin der Johann-Wolfgang-Goethe-Universität Frankfurt wurde am Ende des SS 2003 im Fach Mikrobiologie für die Studierenden des 2. klinischen Semesters eine MC-basierte Abschlussprüfung geschrieben. Die Studierenden des 1. klinischen Semesters hatten - bedingt durch Umstellungen des Curriculums - eine identische Ausbildung. Diese wurde durch eine inhaltlich weitgehend identische, im Format aber andere Klausur abgeschlossen, in der sowohl offene Fragen enthalten waren als auch Fragen, bei denen die Studierenden jede Aussage einzeln auf Korrektheit bewerten mussten. Der Vergleich der Ergebnisse für inhaltlich gleiche Fragen zeigt, dass die Studierenden im MC-Format eine hohe Quote richtiger Antworten erzielen, diese jedoch durch ein geändertes Fragenformat stark reduziert wird. So erreichten nur 20 - 30% der Studierenden ein vollständig richtiges Ergebnis, wenn jede Aussage einzeln bewertet werden musste, während die inhaltlich gleiche Frage im MC-Format 80 - 90% richtige Ergebnisse erzielte. In freien Fragen konnten nur 30 - 40% der Studierenden die richtige Antwort aktiv niederschreiben, während 90 -99% der Studierenden die richtige Lösung passiv erkannten. Wir interpretieren diese Ergebnisse dahin, dass der Entscheidungszwang in MC-basierten Fragen einen starken Einfluss auf die Quote richtiger Antworten hat, und die Prüfungsergebnisse damit wesentlich durch das Format beeinflusst werden, das Wissen dagegen nicht beherrscht wird. Die Ergebnisse dieser Studie legen nahe, Sorgfalt bei der Auswahl des Prüfungsverfahrens walten zu lassen und der Steuerung des studentischen Lernverhaltens durch das Prüfungsformat wesentlich mehr Aufmerksamkeit zu widmen als bisher.
Zeiner, Kim Nikola ; Schreckenbach, Teresa ; Gruber-Rouh, Tatjana ; Roos, Frederik ; Frank, Johannes ; Kaufmann, Roland ; Meissner, Markus ; Valesky, Eva Maria
Haungs, Andreas ; Apel, Wolf-Dieter ; Arteaga-Velázquez, Juan Carlos ; Bekk, Klaus ; Bertaina, Mario Edoardo ; Blümer, Johannes ; Bozdog, Horia ; Brâncuş, Iliana M. ; Cantoni, Elena ; Chiavassa, Andrea ; Cossavella, Fabiana ; Daumiller, Kai ; Souza, Vitor de ; Di Pierro, Federico ; Doll, Paul ; Engel, Ralph ; Fuhrmann, Daniel ; Gherghel-Lascu, Alexandru ; Gils, Hans J. ; Glasstetter, Ralph ; Grupen, Claus ; Heck, Dieter ; Hörandel, Jörg R. ; Huege, Tim ; Kampert, Karl-Heinz ; Kang, Donghwa ; Klages, Hans Otto ; Link, Katrin ; Luczak, Pawel ; Mathes, Hermann-Josef ; Mayer, Hans-Jürgen ; Milke, Jens-Michael ; Mitrica, Bogdan ; Morello, Carlo ; Oehlschläger, Jürgen ; Ostapchenko, Sergey ; Pierog, Tanguy ; Rebel, Heinrich ; Roth, Markus ; Schieler, Harald ; Schoo, Sven ; Schröder, Frank Gerhard ; Sima, Octavian ; Toma, Gabriel ; Trinchero, Gian Carlo ; Ulrich, Holger ; Weindl, Andreas ; Wochele, Jürgen ; Zabierowski, Janusz
The KASCADE-Grande experiment has significantly contributed to the current knowledge about the energy spectrum and composition of cosmic rays for energies between the knee and the ankle. Meanwhile, post-LHC versions of the hadronic interaction models are available and used to interpret the entire data set of KASCADE-Grande. In addition, a new, combined analysis of both arrays, KASCADE and Grande, was developed significantly increasing the accuracy of the shower observables. First results of the new analysis with the entire data set of the KASCADE-Grande experiment will be the focus of this contribution.
Huckins, Laura M. ; Hatzikotoulas, Konstantinos ; Southam, Lorraine ; Thornton, Laura M. ; Steinberg, Julia ; Mckay Aguilera, Fernando Riveros ; Treasure, Janet ; Schmidt, Ulrike ; Gunasinghe, Cerisse ; Romero, Anibal ; Curtis, Charles ; Rhodes, Daniel ; Moens, Julie ; Kalsi, Gursharan ; Dempster, David ; Leung, Rufina ; Keohane, Aoife ; Burghardt, Roland ; Ehrlich, Stefan ; Hebebrand, Johannes ; Hinney, Anke ; Ludolph, Anja ; Walton, Esther ; Deloukas, Panos ; Hofman, Albert ; Palotie, Aarno ; Palta, Priit ; Rooij, Frank J. A. van ; Stirrups, Kathleen ; Adan, Roger ; Boni, Claudette ; Cone, Roger ; Dedoussis, George ; Furth, Eric van ; Gonidakis, Fragiskos ; Gorwood, Philip ; Hudson, James I. ; Kaprio, Jaakko ; Kas, Martien ; Keski-Rahkonen, Anna ; Kiezebrink, Kirsty ; Knudsen, Gun Peggy ; Slof-Op ‘t Landt, Margarita C. T. ; Maj, Mario ; Monteleone, Alessio Maria ; Monteleone, Palmiero ; Raevuori, Anu ; Reichborn-Kjennerud, Ted ; Tozzi, Federica ; Tsitsika, Artemis ; Elburg, Annemarie van ; Collier, David A. ; Sullivan, Patrick F. ; Breen, Gerome ; Bulik, Cynthia M. ; Zeggini, Eleftheria
Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified. We performed an exome-chip based genome-wide association studies (GWAS) in 2158 cases from nine populations of European origin and 15 485 ancestrally matched controls. Unlike previous studies, this GWAS also probed association in low-frequency and rare variants. Sixteen independent variants were taken forward for in silico and de novo replication (11 common and 5 rare). No findings reached genome-wide significance. Two notable common variants were identified: rs10791286, an intronic variant in OPCML (P=9.89 × 10−6), and rs7700147, an intergenic variant (P=2.93 × 10−5). No low-frequency variant associations were identified at genome-wide significance, although the study was well-powered to detect low-frequency variants with large effect sizes, suggesting that there may be no AN loci in this genomic search space with large effect sizes.
Mühlenfeld, Nils ; Berthold, Daniel P. ; Münch, Lukas Nawid ; Störmann, Philipp ; Hörauf, Jason-Alexander ; Leiblein, Maximilian ; Sander, Anna Lena ; Frank, Johannes ; Marzi, Ingo ; Wagner, Nils
Introduction: Current classifications of complete knee dislocations do not capture the extent of the complex concomitant ligamentous and bony injuries, which may have an impact on future outcomes. The purpose of this retrospective study was to evaluate the epidemiology of complete knee dislocations as well as to present an updated classification system based on the author’s experience at a Level-I trauma center.
Materials and methods: Only patients with complete loss of contact of the articulating bones and ≥ 18 years of age who admitted in our level-I trauma center between 2002 and 2019 were included. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG).
Results: Final data included 80 patients, with the majority of patients being male (n = 64; 80.0%). Mean age was 34.9 years (range: 18–70 years). External protective fixation was applied in 32 patients (40.0%). Reconstruction of the posterior cruciate ligament and the anterior cruciate ligament were performed in 56.3% (n = 45) and 55.0% (n = 44) of cases, respectively. The lateral collateral ligament complex was surgically addressed in 47.5% (n = 38), while the medial collateral ligament complex was reconstructed in 40% (n = 32). Surgery of the lateral meniscus and the medial meniscus was needed in 31.1% (n = 25) and 30.0% (n = 24). Neurovascular surgery occurred in 13.8% (n = 11). From the characteristic injury-patterns the authors of this study present a new classification system that ranks the injuries from Grade-A to Grade-D according to their severity.
Conclusion: This retrospective study demonstrates that the historically used classification systems for dislocations of the knee are insufficient for these severe injuries. Concomitant ligamentous, neurovascular, bony, and meniscal injuries were frequent, and required several staged procedures. Consequently, an updated classification system is proposed.
Wilde, Anne-Christin ; Lieb, Charlotte ; Leicht, Elise ; Greverath, Lena Maria ; Steinhagen, Lara Marleen ; Wald de Chamorro, Nina ; Petersen, Jörg ; Hofmann, Wolf-Peter ; Hinrichsen, Holger ; Heyne, Renate ; Berg, Thomas ; Naumann, Uwe ; Schwenzer, Jeannette ; Vermehren, Johannes ; Geier, Andreas ; Tacke, Frank ; Müller, Tobias
Background: Clinical practice guidelines for patients with primary biliary cholangitis (PBC) have been recently revised and implemented for well-established response criteria to standard first-line ursodeoxycholic acid (UDCA) therapy at 12 months after treatment initiation for the early identification of high-risk patients with inadequate treatment responses who may require treatment modification. However, there are only very limited data concerning the real-world clinical management of patients with PBC in Germany. Objective: The aim of this retrospective multicenter study was to evaluate response rates to standard first-line UDCA therapy and subsequent Second-line treatment regimens in a large cohort of well-characterized patients with PBC from 10 independent hepatological referral centers in Germany prior to the introduction of obeticholic acid as a licensed second-line treatment option. Methods: Diagnostic confirmation of PBC, standard first-line UDCA treatment regimens and response rates at 12 months according to Paris-I, Paris-II, and Barcelona criteria, the follow-up cut-off alkaline phosphatase (ALP) ≤ 1.67 × upper limit of normal (ULN) and the normalization of bilirubin (bilirubin ≤ 1 × ULN) were retrospectively examined between June 1986 and March 2017. The management and hitherto applied second-line treatment regimens in patients with an inadequate response to UDCA and subsequent response rates at 12 months were also evaluated. Results: Overall, 480 PBC patients were included in this study. The median UDCA dosage was 13.2 mg UDCA/kg bodyweight (BW)/d. Adequate UDCA treatment response rates according to Paris-I, Paris-II, and Barcelona criteria were observed in 91, 71.3, and 61.3% of patients, respectively. In 83.8% of patients, ALP ≤ 1.67 × ULN were achieved. A total of 116 patients (24.2%) showed an inadequate response to UDCA according to at least one criterion. The diverse second-line treatment regimens applied led to significantly higher response rates according to Paris-II (35 vs. 60%, p = 0.005), Barcelona (13 vs. 34%, p = 0.0005), ALP ≤ 1.67 × ULN and bilirubin ≤ 1 × ULN (52.1 vs. 75%, p = 0.002). The addition of bezafibrates appeared to induce the strongest beneficial effect in this cohort (Paris II: 24 vs. 74%, p = 0.004; Barcelona: 50 vs. 84%, p = 0.046; ALP < 1.67 × ULN and bilirubin ≤ 1 × ULN: 33 vs. 86%, p = 0.001). Conclusion: Our large retrospective multicenter study confirms high response rates following UDCA first-line standard treatment in patients with PBC and highlights the need for close monitoring and early treatment modification in high-risk patients with an insufficient response to UDCA since early treatment modification significantly increases subsequent response rates of these patients.
Eckardt, Jan-Niklas ; Stasik, Sebastian ; Kramer, Michael ; Röllig, Christoph ; Krämer, Alwin ; Scholl, Sebastian ; Hochhaus, Andreas ; Crysandt, Martina ; Brümmendorf, Tim Henrik ; Naumann, Ralph ; Steffen, Björn ; Kunzmann, Volker ; Einsele, Hermann ; Schaich, Markus ; Burchert, Andreas ; Neubauer, Andreas ; Schäfer-Eckart, Kerstin ; Schliemann, Christoph ; Krause, Stefan W. ; Herbst, Regina ; Hänel, Mathias ; Frickhofen, Norbert ; Noppeney, Richard ; Kaiser, Ulrich ; Baldus, Claudia ; Kaufmann, Martin ; Rácil, Zdenek ; Platzbecker, Uwe ; Berdel, Wolfgang E. ; Mayer, Jiří ; Serve, Hubert ; Müller-Tidow, Carsten ; Ehninger, Gerhard ; Stölzel, Friedrich ; Kroschinsky, Frank ; Schetelig, Johannes ; Bornhäuser, Martin ; Thiede, Christian ; Middeke, Jan Moritz
Simple Summary: Acute myeloid leukemia (AML) is a genetically heterogeneous disease. Clinical phenotypes of frequent mutations and their impact on patient outcome are well established. However, the role of rare mutations often remains elusive. We retrospectively analyzed 1529 newly diagnosed and intensively treated AML patients for mutations of BCOR and BCORL1. We report a distinct co-mutational pattern that suggests a role in disease progression rather than initiation, especially affecting mechanisms of DNA-methylation. Further, we found loss-of-function mutations of BCOR to be independent markers of poor outcomes in multivariable analysis. Therefore, loss-of-function mutations of BCOR need to be considered for AML management, as they may influence risk stratification and subsequent treatment allocation.
Abstract: Acute myeloid leukemia (AML) is characterized by recurrent genetic events. The BCL6 corepressor (BCOR) and its homolog, the BCL6 corepressor-like 1 (BCORL1), have been reported to be rare but recurrent mutations in AML. Previously, smaller studies have reported conflicting results regarding impacts on outcomes. Here, we retrospectively analyzed a large cohort of 1529 patients with newly diagnosed and intensively treated AML. BCOR and BCORL1 mutations were found in 71 (4.6%) and 53 patients (3.5%), respectively. Frequently co-mutated genes were DNTM3A, TET2 and RUNX1. Mutated BCORL1 and loss-of-function mutations of BCOR were significantly more common in the ELN2017 intermediate-risk group. Patients harboring loss-of-function mutations of BCOR had a significantly reduced median event-free survival (HR = 1.464 (95%-Confidence Interval (CI): 1.005–2.134), p = 0.047), relapse-free survival (HR = 1.904 (95%-CI: 1.163–3.117), p = 0.01), and trend for reduced overall survival (HR = 1.495 (95%-CI: 0.990–2.258), p = 0.056) in multivariable analysis. Our study establishes a novel role for loss-of-function mutations of BCOR regarding risk stratification in AML, which may influence treatment allocation.
Grillari, Johannes ; Ajuh, Paul ; Stadler, Guido ; Löscher, Marlies ; Voglauer, Regina ; Ernst, Wolfgang ; Chusainow, Janet ; Eisenhaber, Frank ; Pokar, Marion ; Fortschegger, Klaus ; Grey, Martin ; Lamond, Angus I. ; Katinger, Hermann
We have isolated the human protein SNEV as downregulated in replicatively senescent cells. Sequence homology to the yeast splicing factor Prp19 suggested that SNEV might be the orthologue of Prp19 and therefore might also be involved in pre-mRNA splicing. We have used various approaches including gene complementation studies in yeast using a temperature sensitive mutant with a pleiotropic phenotype and SNEV immunodepletion from human HeLa nuclear extracts to determine its function. A human–yeast chimera was indeed capable of restoring the wild-type phenotype of the yeast mutant strain. In addition, immunodepletion of SNEV from human nuclear extracts resulted in a decrease of in vitro pre-mRNA splicing efficiency. Furthermore, as part of our analysis of protein–protein interactions within the CDC5L complex, we found that SNEV interacts with itself. The self-interaction domain was mapped to amino acids 56–74 in the protein's sequence and synthetic peptides derived from this region inhibit in vitro splicing by surprisingly interfering with spliceosome formation and stability. These results indicate that SNEV is the human orthologue of yeast PRP19, functions in splicing and that homo-oligomerization of SNEV in HeLa nuclear extract is essential for spliceosome assembly and that it might also be important for spliceosome stability.
Barucca, Gianni ; Davì, F. ; Lancioni, G. ; Mengucci, P. ; Montalto, L. ; Natali, P. P. ; Paone, N. ; Rinaldi, D. ; Scalise, L. ; Erni, W. ; Krusche, B. ; Steinacher, M. ; Walford, N. ; Cao, N. ; Liu, Z. ; Liu, C. ; Liu, B. ; Shen, X. ; Sun, S. ; Tao, J. ; Xiong, X. A. ; Zhao, G. ; Zhao, J. ; Albrecht, Malte ; Alkakhi, W. ; Bökelmann, S. ; Coen, S. ; Feldbauer, Florian ; Fink, M. ; Frech, J. ; Freudenreich, V. ; Fritsch, Miriam ; Grochowski, J. ; Hagdorn, R. ; Heinsius, Fritz-Herbert ; Held, T. ; Holtmann, Tobias ; Keshk, Iman ; Koch, H. ; Kopf, Bertram ; Kuhlmann, M. ; Kümmel, M. ; Küßner, M. ; Li, J. ; Linzen, L. ; Maldaner, Stephan ; Oppotsch, J. ; Pankonin, S. ; Pelizäus, Marc ; Pflüger, S. ; Pitka, A. ; Reher, J. ; Reicherz, G. ; Schnier, Claudius ; Steinke, M. ; Triffterer, T. ; Wenzel, C. ; Wiedner, Ulrich ; Denizli, H. ; Er, N. ; Keskin, U. ; Olgun, A. T. ; Yerlikaya, S. ; Yilmaz, A. ; Beck, R. ; Hammann, C. ; Hartmann, J. ; Ketzer, Bernhard ; Müllers, J. ; Rossbach, M. ; Salisbury, B. ; Schmidt, Christian Joachim ; Thoma, U. ; Urban, M. ; Bianconi, A. ; Bragadireanu, Mario ; Pantea, D. ; Domagala, M. ; Filo, G. ; Lisowski, E. ; Lisowski, F. ; Michałek, M. ; Poznański, P. ; Płażek, J. ; Korcyl, K. ; Kozela, A. ; Lebiedowicz, P. ; Pysz, K. ; Schäfer, W. ; Szczurek, A. ; Firlej, M. ; Fiutowski, T. ; Idzik, M. ; Moron, J. ; Swientek, K. ; Terlecki, P. ; Korcyl, G. ; Lalik, R. ; Malige, A. ; Moskal, P. ; Nowakowski, K. ; Przygoda, W. ; Rathod, N. ; Rudy, Z. ; Salabura, P. ; Smyrski, J. ; Augustin, I. ; Böhm, R. ; Lehmann, I. ; Schmitt, L. ; Varentsov, V. ; Al-Turany, Mohammad ; Belias, A. ; Deppe, H. ; Dzhygadlo, R. ; Flemming, H. ; Gerhardt, A. ; Götzen, Klaus ; Heinz, Andreas ; Jiang, P. ; Karabowicz, R. ; Koch, S. ; Kurilla, U. ; Lehmann, D. ; Lühning, J. ; Lynen, U. ; Orth, H. ; Peters, Klaus ; Saito, T. ; Schepers, G. ; Schmidt, C. J. ; Schwarz, C. ; Schwiening, J. ; Täschner, Alexander ; Traxler, M. ; Voss, B. ; Wieczorek, P. ; Abazov, V. ; Alexeev, G. ; Arefiev, V. A. ; Astakhov, V. ; Barabanov, M. Yu. ; Batyunya, B. V. ; Dodokhov, V. Kh. ; Efremov, A. ; Fechtchenko, A. ; Galoyan, A. ; Golovanov, G. ; Koshurnikov, E. K. ; Lobanov, Y. Yu. ; Olshevskiy, A. G. ; Piskun, A. A. ; Samartsev, A. ; Shimanski, S. ; Skachkov, N. B. ; Skachkova, A. N. ; Strokovsky, E. A. ; Tokmenin, V. ; Uzhinsky, V. ; Verkheev, A. ; Vodopianov, A. ; Zhuravlev, N. I. ; Branford, D. ; Watts, D. ; Böhm, M. ; Eyrich, W. ; Lehmann, A. ; Miehling, D. ; Pfaffinger, M. ; Quin, N. ; Robison, L. ; Seth, K. ; Xiao, T. ; Bettoni, Diego ; Ali, A. ; Hamdi, A. ; Himmelreich, Mathilde ; Krebs, M. ; Nakhoul, S. ; Nerling, Frank ; Belousov, A. ; Kisel, Ivan ; Kozlov, Grigory ; Pugach, M. ; Zyzak, Maksym ; Bianchi, Nicola ; Gianotti, Paola ; Lucherini, V. ; Bracco, G. ; Bettner, Y. ; Bodenschatz, S. ; Brinkmann, K. T. ; Brück, L. ; Diehl, S. ; Dormenev, V. ; Düren, M. ; Erlen, T. ; Föhl, K. ; Hahn, C. ; Hayrapetyan, A. ; Hofmann, J. ; Kegel, S. ; Kesselkaul, M. ; Köseoglu, I. ; Kripko, A. ; Kühn, Wolfgang ; Lange, Jens Sören ; Metag, V. ; Moritz, M. ; Nanova, M. ; Novotny, R. ; Orsich, P. ; Pereira-de-Lira, J. ; Peter, M. ; Sachs, M. ; Schmidt, M. ; Schubert, R. ; Stenzel, H. ; Straube, M. ; Strickert, M. ; Thöring, U. ; Wasem, T. ; Wohlfahrt, B. ; Zaunick, H. G. ; Tomasi-Gustafsson, E. ; Glazier, D. ; Ireland, D. ; Seitz, B. ; Deepak, P. N. ; Kulkarni, A. ; Kappert, R. ; Kavatsyuk, Myroslav O. ; Loehner, H. ; Messchendorp, Johannes Gerhardus ; Rodin, Viktor ; Schakel, P. ; Vejdani, S. ; Dutta, K. ; Kalita, K. ; Huang, G. ; Liu, D. ; Peng, H. ; Qi, H. ; Sun, Y. ; Zhou, X. ; Kunze, M. ; Azizi, K. ; Tavukoglu, Z. ; Derichs, A. ; Dosdall, R. ; Esmail, W. ; Gillitzer, A. ; Goldenbaum, F. ; Grunwald, D. ; Jokhovets, L. ; Kannika, J. ; Kulessa, P. ; Orfanitski, S. ; Pérez Andrade, G. ; Prasuhn, D. ; Prencipe, E. ; Pütz, J. ; Ritman, J. ; Rosenthal, E. ; Schadmand, S. ; Schmitz, R. ; Scholl, A. ; Sefzick, T. ; Serdyuk, V. ; Stockmanns, T. ; Veretennikov, D. ; Wintz, P. ; Wüstner, P. ; Xu, H. ; Zhou, Y. ; Cao, X. ; Hu, Q. ; Li, Z. ; Li, H. ; Liang, Y. ; Ma, X. ; Rigato, V. ; Isaksson, L. ; Achenbach, P. ; Corell, O. ; Denig, Achim ; Distler, M. ; Hoek, M. ; Lauth, W. ; Leithoff, H. H. ; Liu, Z. ; Merkel, H. ; Müller, U. ; Pochodzalla, J. ; Schlimme, S. ; Sfienti, C. ; Thiel, M. ; Zambrana, M. ; Ahmed, Samer ; Bleser, S. ; Bölting, M. ; Capozza, L. ; Dbeyssi, A. ; Ehret, A. ; Klasen, R. ; Kliemt, Ralf ; Maas, F. ; Motzko, C. ; Noll, O. ; Piñeiro, D. Rodríguez ; Schupp, F. ; Steinen, M. ; Wolff, S. ; Zimmermann, I. ; Fedorov, A. ; Kazlou, D. ; Korzhik, M. ; Missevitch, O. ; Balanutsa, P. ; Chernetsky, V. ; Demekhin, A. ; Dolgolenko, A. ; Fedorets, P. ; Gerasimov, A. ; Golubev, A. ; Goryachev, V. ; Kantsyrev, Alexey V. ; Kirin, D. Y. ; Kristi, N. ; Ladygina, E. ; Luschevskaya, E. ; Matveev, V. A. ; Panjushkin, V. ; Stavinskiy, A. V. ; Balashoff, A. ; Boukharov, A. ; Malyshev, O. ; Basant, K. N. ; Kumawat, H. ; Roy, B. ; Saxena, Alok ; Yogesh, S. ; Bonaventura, D. ; Brand, P. ; Fritzsch, C. ; Grieser, S. ; Hargens, C. ; Hergemöller, A. K. ; Hetz, B. ; Hüsken, Nils ; Kellers, J. ; Khoukaz, Alfons ; Mannweiler, C. ; Vestrick, S. ; Bumrungkoh, D. ; Herold, Christoph ; Khosonthongkee, K. ; Kobdaj, Chinorat ; Limphirat, A. ; Manasatitpong, K. ; Nasawad, T. ; Pongampai, S. ; Simantathammakul, T. ; Srisawad, P. ; Wongprachanukul, N. ; Yan, Y. ; Yu, C. ; Zhang, X. ; Zhu, W. ; Blinov, A. E. ; Kononov, S. ; Kravchenko, E. A. ; Antokhin, E. ; Barnyakov, A. Yu. ; Beloborodov, K. ; Blinov, V. E. ; Kuyanov, I. A. ; Pivovarov, S. ; Pyata, E. ; Tikhonov, Y. ; Hunter, G. ; Lattery, M. ; Pace, H. ; Boca, Gianluigi ; Duda, D. ; Finger, M. ; Finger, M. ; Kveton, A. ; Pesek, M. ; Peskova, M. ; Prochazka, I. ; Slunecka, M. ; Volf, M. ; Gallus, P. ; Jary, V. ; Korchak, O. ; Marcisovsky, M. ; Neue, G. ; Novy, J. ; Tomasek, L. ; Tomasek, M. ; Virius, M. ; Vrba, V. ; Abramov, V. ; Bukreeva, S. ; Chernichenko, S. ; Derevschikov, A. ; Ferapontov, V. ; Goncharenko, Y. ; Levin, A. ; Maslova, E. ; Melnik, Y. ; Meščanin, Aleksei P. ; Minaev, N. ; Mochalov, V. ; Moiseev, V. ; Morozov, D. ; Nogach, L. ; Poslavskiy, S. ; Ryazantsev, A. ; Ryzhikov, S. ; Semenov, P. ; Shein, I. ; Uzunian, A. ; Vasiliev, Andrey ; Yakutin, A. ; Roy, U. ; Yabsley, B. ; Belostotski, S. ; Fedotov, G. ; Gavrilov, G. ; Izotov, A. ; Manaenkov, S. ; Miklukho, O. ; Zhdanov, A. ; Atac, A. ; Bäck, T. ; Cederwall, B. ; Makonyi, K. ; Preston, M. ; Tegner, P. E. ; Wölbing, D. ; Gandhi, K. ; Rai, A. K. ; Godre, S. ; Crede, V. ; Dobbs, S. ; Eugenio, P. ; Lersch, D. ; Calvo, D. ; De Remigis, P. ; Filippi, A. ; Mazza, G. ; Rivetti, Angelo ; Wheadon, R. ; Bussa, M. P. ; Spataro, Stefano ; Iazzi, F. ; Lavagno, A. ; Martin, A. ; Akram, A. ; Calen, H. ; Ikegami Andersson, Walter ; Johansson, Tord ; Kupsc, Andrzej ; Marciniewski, P. ; Papenbrock, Michael ; Regina, J. ; Rieger, J. ; Schönning, K. ; Wolke, M. ; Pothodi Chackara, V. ; Chlopik, A. ; Kesik, G. ; Melnychuk, D. ; Tarasiuk, J. ; Wojciechowski, M. ; Wronka, S. ; Zwieglinski, B. ; Amsler, C. ; Bühler, Paul ; Marton, J. ; Nalti, W. ; Steinschaden, D. ; Widmann, Eberhard ; Zimmermann, S. ; Zmeskal, Johann
This paper reports on Monte Carlo simulation results for future measurements of the moduli of time-like proton electromagnetic form factors, |GE | and |GM|, using the ¯pp → μ+μ− reaction at PANDA (FAIR). The electromagnetic form factors are fundamental quantities parameterizing the electric and magnetic structure of hadrons. This work estimates the statistical and total accuracy with which the form factors can be measured at PANDA, using an analysis of simulated data within the PandaRoot software framework. The most crucial background channel is ¯pp → π+π−,due to the very similar behavior of muons and pions in the detector. The suppression factors are evaluated for this and all other relevant background channels at different values of antiproton beam momentum. The signal/background separation is based on a multivariate analysis, using the Boosted Decision Trees method. An expected background subtraction is included in this study, based on realistic angular distribuations of the background contribution. Systematic uncertainties are considered and the relative total uncertainties of the form factor measurements are presented.
Hofmann, Wolf-Peter ; Buggisch, Peter ; Schubert, Lisa ; Dikopoulos, Nektarios ; Schwenzer, Jeannette ; Muche, Marion ; Felten, Gisela ; Heyne, Renate ; Ingiliz, Patrick Philipp ; Schmidt, Anna ; Stein, Kerstin ; Wedemeyer, Heiner ; Berg, Thomas ; Wiegand, Johannes ; Lammert, Frank ; Zeuzem, Stefan ; Schattenberg, Jörn Markus
Background & Aims: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care. Methods: The FLAG study is an observational real-world study in patients with NAFLD enrolled at 13 centres across Germany. Severity of disease was assessed by non-invasive surrogate scores and data recorded at baseline and 12 months. Results: In this study, 507 patients (mean age 53 years; 47% women) were enrolled. According to fibrosis-4 index, 64%, 26%, and 10% of the patients had no significant fibrosis, indeterminate stage, and advanced fibrosis, respectively. Patients with advanced fibrosis were older, had higher waist circumferences, and higher aspartate aminotransferase and gamma-glutamyltransferase as well as ferritin levels. The prevalence of obesity, arterial hypertension, and type 2 diabetes increased with fibrosis stages. Standard of care included physical exercise >2 times per week in 17% (no significant fibrosis), 19% (indeterminate), and 6% (advanced fibrosis) of patients. Medication with either vitamin E, silymarin, or ursodeoxycholic acid was reported in 5%. Approximately 25% of the patients received nutritional counselling. According to the FibroScan-AST score, 17% of patients presented with progressive non-alcoholic steatohepatitis (n = 107). On follow-up at year 1 (n = 117), weight loss occurred in 47% of patients, of whom 17% lost more than 5% of body weight. In the weight loss group, alanine aminotransferase activities were reduced by 20%. Conclusions: This is the first report on NAFLD from a secondary-care real-world cohort in Germany. Every 10th patient presented with advanced fibrosis at baseline. Management consisted of best supportive care and lifestyle recommendations. The data highlight the urgent need for systematic health agenda in NAFLD patients. Lay summary: FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease.
Kupka, Johannes Raphael ; Kohler, Annika ; El Bagdadi, Karima ; Bostelmann, Richard Klaus Ludwig ; Brenneis, Marco ; Fleege, Christoph ; Chan, Danny ; Zaucke, Frank ; Meurer, Andrea ; Rickert, Marcus ; Jenei-Lanzl, Zsuzsa
Healthy and degenerating intervertebral discs (IVDs) are innervated by sympathetic nerves, however, adrenoceptor (AR) expression and functionality have never been investigated systematically. Therefore, AR gene expression was analyzed in both tissue and isolated cells from degenerated human IVDs. Furthermore, human IVD samples and spine sections of wildtype mice (WT) and of a mouse line that develops spontaneous IVD degeneration (IVDD, in SM/J mice) were stained for ARs and extracellular matrix (ECM) components. In IVD homogenates and cells α1a-, α1b-, α2a-, α2b-, α2c-, β1-, and β2-AR genes were expressed. In human sections, β2-AR was detectable, and its localization parallels with ECM alterations. Similarly, in IVDs of WT mice, only β2-AR was expressed, and in IVDs of SM/J mice, β2AR expression was stronger accompanied by increased collagen II, collagen XII, decorin as well as decreased cartilage oligomeric matrix protein expression. In addition, norepinephrine stimulation of isolated human IVD cells induced intracellular signaling via ERK1/2 and PKA. For the first time, the existence and functionality of ARs were demonstrated in IVD tissue samples, suggesting that the sympathicus might play a role in IVDD. Further studies will address relevant cellular mechanisms and thereby help to develop novel therapeutic options for IVDD.
Phillips, Gavin J. ; Thieser, Jim ; Tang, Mingjin ; Sobanski, Nicolas ; Schuster, Gerhard ; Fachinger, Johannes ; Drewnick, Frank ; Borrmann, Stephan ; Bingemer, Heinz ; Lelieveld, Jos ; Crowley, John N.
We present an estimation of the uptake coefficient (γ) and yield of nitryl chloride (ClNO2) (f) for the heterogeneous processing of dinitrogen pentoxide (N2O5) using simultaneous measurements of particle and trace gas composition at a semi-rural, non-coastal, mountain site in the summer of 2011. The yield of ClNO2 varied between (0.035 ± 0.027) and (1.38 ± 0.60) with a campaign average of (0.49 ± 0.35). The large variability in f reflects the highly variable chloride content of particles at the site. Uptake coefficients were also highly variable with minimum, maximum and average γ values of 0.004, 0.11 and 0.028 ± 0.029, respectively, with no significant correlation with particle composition, but a weak dependence on relative humidity. The uptake coefficients obtained are compared to existing parameterizations based on laboratory datasets and with other values obtained by analysis of field data.
Phillips, Gavin J. ; Thieser, Jim ; Tang, Mingjin ; Sobanski, Nicolas ; Schuster, Gerhard ; Fachinger, Johannes ; Drewnick, Frank ; Borrmann, Stephan ; Bingemer, Heinz ; Lelieveld, Jos ; Crowley, John N.
We present an estimation of the uptake coefficient (γ) and yield of nitryl chloride (ClNO2) (f) for the heterogeneous processing of dinitrogen pentoxide (N2O5) using simultaneous measurements of particle and trace gas composition at a semi-rural, non-coastal, mountain site in the summer of 2011. The yield of ClNO2 varied between (0.035 ± 0.027) and (1.38 ± 0.60) with a campaign average of (0.49 ± 0.35). The large variability in f reflects the highly variable chloride content of particles at the site. Uptake coefficients were also highly variable with minimum, maximum and average γ values of 0.004, 0.11 and 0.028 ± 0.029, respectively, with no significant correlation with particle composition, but a weak dependence on relative humidity. The uptake coefficients obtained are compared to existing parameterisations based on laboratory datasets and with other values obtained by analysis of field data.
Almeida, Joao ; Schobesberger, Siegfried ; Kürten, Christoph Andreas ; Ortega, Ismael K. ; Kupiainen-Määttä, Oona ; Praplan, Arnaud Patrick ; Adamov, Alexey ; Amorim, Antonio ; Bianchi, Federico ; Breitenlechner, Martin ; David, André ; Dommen, Josef ; Donahue, Neil McPherson ; Downard, Andrew ; Dunne, Eimear M. ; Duplissy, Jonathan ; Ehrhart, Sebastian ; Flagan, Richard C. ; Franchin, Alessandro ; Guida, Roberto ; Hakala, Jani ; Hansel, Armin ; Heinritzi, Martin ; Henschel, Henning ; Jokinen, Tuija ; Junninen, Heikki ; Kajos, Maija ; Kangasluoma, Juha ; Keskinen, Helmi ; Kupc, Agnieszka ; Kurtén, Theo ; Kvashin, Alexander N. ; Laaksonen, Ari ; Lehtipalo, Katrianne ; Leiminger, Markus ; Leppä, Johannes ; Loukonen, Ville ; Makhmutov, Vladimir ; Mathot, Serge ; McGrath, Matthew J. ; Nieminen, Tuomo ; Olenius, Tinja ; Onnela, Antti ; Petäjä, Tuukka ; Riccobono, Francesco ; Riipinen, Ilona ; Rissanen, Matti P. ; Rondo, Linda ; Ruuskanen, Taina ; Santos, Filipe Duarte ; Sarnela, Nina ; Schallhart, Simon ; Schnitzhofer, Ralf ; Seinfeld, John H. ; Simon, Mario ; Sipilä, Mikko ; Stozhkov, Yuri ; Stratmann, Frank ; Tomé, Antonio ; Tröstl, Jasmin ; Tsagkogeorgas, Georgios ; Vaattovaara, Petri ; Viisanen, Yrjo ; Virtanen, Annele ; Vrtala, Aron ; Wagner, Paul E. ; Weingartner, Ernest ; Wex, Heike ; Williamson, Christina ; Wimmer, Daniela ; Ye, Penglin ; Yli-Juuti, Taina ; Carslaw, Kenneth S. ; Kulmala, Markku ; Curtius, Joachim ; Baltensperger, Urs ; Worsnop, Douglas R. ; Vehkamäki, Hanna ; Kirkby, Jasper
Nucleation of aerosol particles from trace atmospheric vapours is thought to provide up to half of global cloud condensation nuclei. Aerosols can cause a net cooling of climate by scattering sunlight and by leading to smaller but more numerous cloud droplets, which makes clouds brighter and extends their lifetimes. Atmospheric aerosols derived from human activities are thought to have compensated for a large fraction of the warming caused by greenhouse gases. However, despite its importance for climate, atmospheric nucleation is poorly understood. Recently, it has been shown that sulphuric acid and ammonia cannot explain particle formation rates observed in the lower atmosphere. It is thought that amines may enhance nucleation, but until now there has been no direct evidence for amine ternary nucleation under atmospheric conditions. Here we use the CLOUD (Cosmics Leaving Outdoor Droplets) chamber at CERN and find that dimethylamine above three parts per trillion by volume can enhance particle formation rates more than 1,000-fold compared with ammonia, sufficient to account for the particle formation rates observed in the atmosphere. Molecular analysis of the clusters reveals that the faster nucleation is explained by a base-stabilization mechanism involving acid–amine pairs, which strongly decrease evaporation. The ion-induced contribution is generally small, reflecting the high stability of sulphuric acid–dimethylamine clusters and indicating that galactic cosmic rays exert only a small influence on their formation, except at low overall formation rates. Our experimental measurements are well reproduced by a dynamical model based on quantum chemical calculations of binding energies of molecular clusters, without any fitted parameters. These results show that, in regions of the atmosphere near amine sources, both amines and sulphur dioxide should be considered when assessing the impact of anthropogenic activities on particle formation.
Altınçekiç, Nadide ; Korn, Sophie Marianne ; Qureshi, Nusrat Shahin ; Dujardin, Marie ; Ninot-Pedrosa, Martí ; Abele, Rupert ; Abi Saad, Marie Jose ; Alfano, Caterina ; Almeida, Fabio C. L. ; Alshamleh, Islam ; Amorim, Gisele Cardoso de ; Anderson, Thomas K. ; Anobom, Cristiane D. ; Anorma, Chelsea ; Bains, Jasleen Kaur ; Bax, Adriaan ; Blackledge, Martin ; Blechar, Julius ; Böckmann, Anja ; Brigandat, Louis ; Bula, Anna ; Bütikofer, Matthias ; Camacho-Zarco, Aldo R. ; Carlomagno, Teresa ; Caruso, Icaro Putinhon ; Ceylan, Betül ; Chaikuad, Apirat ; Chu, Feixia ; Cole, Laura ; Crosby, Marquise G. ; De Jesus, Vanessa ; Dhamotharan, Karthikeyan ; Felli, Isabella C. ; Ferner, Jan ; Fleischmann, Yanick ; Fogeron, Marie-Laure ; Fourkiotis, Nikolaos K. ; Fuks, Christin ; Fürtig, Boris ; Gallo, Angelo ; Gande, Santosh L. ; Gerez, Juan Atilio ; Ghosh, Dhiman ; Gomes-Neto, Francisco ; Gorbatyuk, Oksana ; Guseva, Serafima ; Hacker, Carolin ; Häfner, Sabine ; Hao, Bing ; Hargittay, Bruno ; Henzler-Wildman, Katherine ; Hoch, Jeffrey C. ; Hohmann, Katharina Felicitas ; Hutchison, Marie T. ; Jaudzems, Kristaps ; Jović, Katarina ; Kaderli, Janina ; Kalnins, Gints ; Kanepe, Iveta ; Kirchdoerfer, Robert N. ; Kirkpatrick, John ; Knapp, Stefan ; Krishnathas, Robin ; Kutz, Felicitas ; Zur Lage, Susanne ; Lambertz, Roderick ; Lang, Andras ; Laurents, Douglas ; Lecoq, Lauriane ; Linhard, Verena ; Löhr, Frank ; Malki, Anas ; Bessa, Luiza Mamigonian ; Martin, Rachel W. ; Matzel, Tobias ; Maurin, Damien ; McNutt, Seth W. ; Mebus-Antunes, Nathane Cunha ; Meier, Beat H. ; Meiser, Nathalie ; Mompeán, Miguel ; Monaca, Elisa ; Montserret, Roland ; Perez, Laura Mariño ; Moser, Celine ; Muhle-Goll, Claudia ; Neves-Martins, Thais Cristtina ; Ni, Xiamonin ; Norton-Baker, Brenna ; Pierattelli, Roberta ; Pontoriero, Letizia ; Pustovalova, Yulia ; Ohlenschläger, Oliver ; Orts, Julien ; Poian, Andrea T. da ; Pyper, Dennis Joshua ; Richter, Christian ; Riek, Roland ; Rienstra, Chad M. ; Robertson, Angus ; Pinheiro, Anderson S. ; Sabbatella, Raffaele ; Salvi, Nicola ; Saxena, Krishna ; Schulte, Linda ; Schiavina, Marco ; Schwalbe, Harald ; Silber, Mara ; Almeida, Marcius da Silva ; Sprague-Piercy, Marc A. ; Spyroulias, Georgios A. ; Sreeramulu, Sridhar ; Tants, Jan-Niklas ; Tars, Kaspars ; Torres, Felix ; Töws, Sabrina ; Trevino, Miguel A. ; Trucks, Sven ; Tsika, Aikaterini C. ; Varga, Krisztina ; Wang, Ying ; Weber, Marco E. ; Weigand, Julia E. ; Wiedemann, Christoph ; Wirmer-Bartoschek, Julia ; Wirtz Martin, Maria Alexandra ; Zehnder, Johannes ; Hengesbach, Martin ; Schlundt, Andreas
The highly infectious disease COVID-19 caused by the Betacoronavirus SARS-CoV-2 poses a severe threat to humanity and demands the redirection of scientific efforts and criteria to organized research projects. The international COVID19-NMR consortium seeks to provide such new approaches by gathering scientific expertise worldwide. In particular, making available viral proteins and RNAs will pave the way to understanding the SARS-CoV-2 molecular components in detail. The research in COVID19-NMR and the resources provided through the consortium are fully disclosed to accelerate access and exploitation. NMR investigations of the viral molecular components are designated to provide the essential basis for further work, including macromolecular interaction studies and high-throughput drug screening. Here, we present the extensive catalog of a holistic SARS-CoV-2 protein preparation approach based on the consortium’s collective efforts. We provide protocols for the large-scale production of more than 80% of all SARS-CoV-2 proteins or essential parts of them. Several of the proteins were produced in more than one laboratory, demonstrating the high interoperability between NMR groups worldwide. For the majority of proteins, we can produce isotope-labeled samples of HSQC-grade. Together with several NMR chemical shift assignments made publicly available on covid19-nmr.com, we here provide highly valuable resources for the production of SARS-CoV-2 proteins in isotope-labeled form.
Chang, Johannes ; Meinke, Jonathan ; Geck, Moritz ; Hebest, Marc ; Böhling, Nina ; Dolscheid, Ramona Christina ; Stoffel-Wagner, Birgit ; Kristiansen, Glen ; Overhaus, Marcus ; Peyman, Leon O. ; Klein, Sabine ; Uschner, Frank Erhard ; Brol, Maximilian ; Vilz, Tim Oliver ; Lingohr, Philipp ; Kalff, Jörg C. ; Jansen, Christian ; Straßburg, Christian P. ; Wehner, Sven ; Trebicka, Jonel ; Praktiknjo, Michael
Background: Liver cirrhosis is a relevant comorbidity with increasing prevalence. Postoperative decompensation and development of complications in patients with cirrhosis remains a frequent clinical problem. Surgery has been discussed as a precipitating event for decompensation and complications of cirrhosis, but the underlying pathomechanisms are still obscure. The aim of this study was to analyze the role of abdominal extrahepatic surgery in cirrhosis on portal pressure and fibrosis in a preclinical model. Methods: Compensated liver cirrhosis was induced using tetrachlormethane (CCL4) inhalation and bile duct ligation (BDL) models in rats, non-cirrhotic portal hypertension by partial portal vein ligation (PPVL). Intestinal manipulation (IM) as a model of extrahepatic abdominal surgery was performed. 2 and 7 days after IM, portal pressure was measured in-vivo. Hydroxyproline measurements, Sirius Red staining and qPCR measurements of the liver were performed for evaluation of fibrosis development and hepatic inflammation. Laboratory parameters of liver function in serum were analyzed. Results: Portal pressure was significantly elevated 2 and 7 days after IM in both models of cirrhosis. In the non-cirrhotic model the trend was the same, while not statistically significant. In both cirrhotic models, IM shows strong effects of decompensation, with significant weight loss, elevation of liver enzymes and hypoalbuminemia. 7 days after IM in the BDL group, Sirius red staining and hydroxyproline levels showed significant progression of fibrosis and significantly elevated mRNA levels of hepatic inflammation compared to the respective control group. A progression of fibrosis was not observed in the CCL4 model. Conclusion: In animal models of cirrhosis with continuous liver injury (BDL), IM increases portal pressure, and development of fibrosis. Perioperative portal pressure and hence inflammation processes may be therapeutic targets to prevent post-operative decompensation in cirrhosis.
Praktiknjo, Michael ; Simón-Talero, Macarena ; Römer, Julia ; Roccarina, Davide ; Martínez, Javier ; Lampichler, Katharina ; Baiges, Anna ; Low, Gavin ; Llop, Elba ; Maurer, Martin H. ; Zipprich, Alexander ; Triolo, Michela ; Maleux, Geert ; Fialla, Annette Dam ; Dam, Claus ; Vidal-González, Judit ; Majumdar, Avik ; Picón, Carmen ; Toth, Daniel ; Darnell, Anna ; Abraldes, Juan G. ; López, Marta ; Jansen, Christian ; Chang, Johannes ; Schierwagen, Robert ; Uschner, Frank Erhard ; Kukuk, Guido ; Meyer, Carsten ; Thomas, Daniel ; Wolter, Karsten ; Straßburg, Christian P. ; Laleman, Wim ; La Mura, Vincenzo ; Ripoll, Cristina ; Berzigotti, Annalisa ; Calleja, José Luis ; Tandon, Puneeta ; Hernández-Gea, Virginia ; Reiberger, Thomas ; Albillos, Agustin ; Tsochatzis, Emmanuel A. ; Krag, Aleksander ; Genescà, Joan ; Trebicka, Jonel
Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.
Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.
Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
Trebicka, Jonel ; Gu, Wenyi ; De Ledinghen, Victor ; Aubé, Christophe ; Krag, Aleksander ; Praktiknjo, Michael ; Castera, Laurent ; Dumortier, Jerome ; Bauer, David Josef Maria ; Friedrich-Rust, Mireen ; Pol, Stanislas ; Grgurevic, Ivica ; Zheng, Rongqin ; Francque, Sven ; Gottfriedovà, Halima ; Mustapic, Sanda ; Sporea, Ioan ; Berzigotti, Annalisa ; Uschner, Frank Erhard ; Simbrunner, Benedikt Michael ; Ronot, Maxime ; Cassinotto, Christophe ; Kjaergaard, Maria ; Andrade, Filipe ; Schulz, Martin ; Semmler, Georg ; Tjesic Drinkovic, Ida ; Chang, Johannes ; Brol, Maximilian ; Rautou, Pierre Emmanuel ; Vanwolleghem, Thomas ; Straßburg, Christian P. ; Boursier, Jerome ; Ferstl, Philip ; Rasmussen, Ditlev Nytoft ; Reiberger, Thomas ; Vilgrain, Valerie ; Guibal, Aymeric ; Guillaud, Olivier ; Zeuzem, Stefan ; Vassord, Camille ; Lu, Xue ; Vonghia, Luisa ; Senkerikova, Renata ; Popescu, Alina ; Margini, Cristina ; Wang, Wenping ; Thiele, Maja ; Jansen, Chrisitan
Objective: Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.
Design: This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.
Results: After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.
Conclusion: The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.