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It has been recognized that molecular classifications will form the basis for neuropathological diagnostic work in the future. Consequently, in order to reach a diagnosis of Alzheimer's disease (AD), the presence of hyperphosphorylated tau (HP-tau) and beta-amyloid protein in brain tissue must be unequivocal. In addition, the stepwise progression of pathology needs to be assessed. This paper deals exclusively with the regional assessment of AD-related HP-tau pathology. The objective was to provide straightforward instructions to aid in the assessment of AD-related immunohistochemically (IHC) detected HP-tau pathology and to test the concordance of assessments made by 25 independent evaluators. The assessment of progression in 7-µm-thick sections was based on assessment of IHC labeled HP-tau immunoreactive neuropil threads (NTs). Our results indicate that good agreement can be reached when the lesions are substantial, i.e., the lesions have reached isocortical structures (stage V–VI absolute agreement 91%), whereas when only mild subtle lesions were present the agreement was poorer (I–II absolute agreement 50%). Thus, in a research setting when the extent of lesions is mild, it is strongly recommended that the assessment of lesions should be carried out by at least two independent observers.
Vasointestinal peptide metabolism plays a key physiological role in multimodular levels of vasodilatory, smooth muscle cell proliferative, parenchymal, and inflammatory lung reactions. In animal studies, vasointestinal peptide relaxes isolated pulmonary arterial segments from several mammalian species in vitro and neutralizes the pulmonary vasoconstrictor effect of endothelin. In some animal models, it reduces pulmonary vascular resistance in vivo and in monocrotaline-induced pulmonary hypertension. A 58-year-old woman presented with dyspnea and mild edema of the lower extremities. A bronchoscopy was performed without any suspicious findings suggesting a central tumor or other infiltrative disease. Endobronchial ultrasound revealed enlarged pulmonary arteries containing thrombi, a few enlarged lymph nodes, and enlarged mediastinal tissue anatomy with suspicion for mediastinal infiltration of a malignant process. We estimated that less than 10% of the peripheral vascular bed of the lung was involved in direct consolidated fibrosis as demonstrated in the left upper lobe apex. Further, direct involvement of fibrosis around the main stems of the pulmonary arteries was assumed to be low from positron emission tomography and magnetic resonance imaging scans. Assuming a positive influence of low-dose radiation, it was not expected that this could have reduced pulmonary vascular resistance by over two thirds of the initial result. However; it was noted that this patient had idiopathic pulmonary arterial hypertension mixed with "acute" (mediastinal) fibrosis which could have contributed to the unexpected success of reduction of pulmonary vascular resistance. To the best of our knowledge, this is the first report of successful treatment of idiopathic pulmonary arterial hypertension, probably as a result of low-dose radiation to the pulmonary arterial main stems. The patient continues to have no specific complaints concerning her idiopathic pulmonary arterial hypertension.
Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.
Introduction: Currently there are several advanced guiding techniques for pathoanatomical diagnosis of incidental solitary pulmonary nodules (iSPN): Electromagnetic navigation (EMN) with or without endobronchial ultrasound (EBUS) with miniprobe, transthoracic ultrasound (TTUS) for needle approach to the pleural wall and adjacent lung and computed tomography (CT) -guidance for (seldom if ever used) endobronchial or (common) transthoracical approach. In several situations one technique is not enough for efficient diagnosis, therefore we investigated a new diagnostic technique of endobronchial guided biopsies by a Cone Beam Computertomography (CBCT) called DynaCT (SIEMENS AG Forchheim, Germany). Method and Material: In our study 33 incidental solitary pulmonary nodules (iSPNs) (28 malignant, 5 benign; mean diameter 25 +/-12mm, shortest distance to pleura 25+/-18mm) were eligible according to in- and exclusion criteria. Realtime and onsite navigation were performed according to our standard protocol.22 All iSPN were controlled with a second technique when necessary and clinical feasible in case of unspecific or unexpected histological result. In all cases common guidelines of treatment of different iSPNs were followed in a routine manner. Results: Overall navigational yield (ny) was 91% and diagnostic yield (dy) 70%, dy for all accomplished malignant cases (n=28) was 82%. In the subgroup analysis of the invisible iSPN (n=12, 11 malignant, 1 benign; mean diameter 15+/-3mm) we found an overall dy of 75%. For the first time we describe a significant difference in specifity of biopsy results in regards to the position of the forceps in the 3-dimensional volume (3DV) of the iSPN in the whole sample group. Comparing the specifity of biopsies of a 3D-uncentered but inside the outer one third of an iSPN-3DV with the specifity of biopsies of centered forceps position (meaning the inner two third of an iSPN-3DV) reveals a significant (p=0,0375 McNemar) difference for the size group (>1cm) of 0,9 for centered biopsies vs. 0,3 for uncentered biopsies. Therefore only 3D-centered biopsies should be relied on especially in case of a benign result. Conclusion:The diagnostic yield of DynaCT navigation guided transbronchial biopsies (TBB) only with forceps is at least up to twofold higher than conventional TBB for iSPNs <2cm. The diagnostic yield of DynaCT navigation guided forceps TBB in invisible SPNs is at least in the range of other navigation studies which were performed partly with multiple navigation tools and multiple instruments. For future diagnostic and therapeutic approaches it is so far the only onsite and realtime extrathoracic navigation approach (except for computed tomography (CT)-fluoroscopy) in the bronchoscopy suite which keeps the working channel open. The system purchase represents an important investment for hospitals but it is a multidisciplinary and multinavigational tool with possible access via bronchial airways, transthoracical or vascular approach at the same time and on the same table without the need for an expensive disposable instrument use.
Um zu überprüfen, ob sich die Artenzusammensetzung alpiner Kalk-Magerrasen (Blaugras-Horstseggenrasen, Polsterseggenrasen) im Nationalpark Berchtesgaden während der letzten drei Jahrzehnte geändert hat, wurden Vegetationsaufnahmen aus den 1980er Jahren 2013/14 zum zweiten Mal wiederholt vegetationskundlich erfasst.
Ziel der Arbeit war es, durch den Vergleich der Aufnahmenkollektive Vegetationsveränderungen während der letzten drei Jahrzehnte aufzuzeigen und diese als allogene oder autogene Prozesse zu interpretieren. Dabei wurde insbesondere der Frage nachgegangen, ob anthropogene Stickstoff-Einträge als Hauptursache für mögliche Veränderungen angesehen werden können.
Tatsächlich konnten ausgeprägte floristische Veränderungen im Vergleichszeitraum aufgezeigt werden. So hat sich seit den 1980er Jahre die mittlere Artenzahl sowohl im Polsterseggenrasen als auch im Horstseggenrasen um mehr als 10 Arten pro Aufnahmefläche erhöht. Im Polsterseggenrasen wurde ferner eine signifikante Abnahme der mittleren Kontinentalitätszahlen nachgewiesen.
Die dokumentierten floristischen Veränderungen könnten auf die globale Erwärmung und die damit verbundenen Klimaeffekte zurückzuführen sein. Auch natürlich ablaufende Sukzessionsprozesse könnten die aufgezeigten Änderungen in der Artenzusammensetzung erklären, allerdings ist die Zeitspanne von 30 Jahren zu kurz, als dass eine autogene Sukzession als der Hauptfaktor angesehen werden kann. Denkbar ist aber, dass Sukzessionsprozesse durch die globale Erwärmung heutzutage beschleunigt ablaufen. Stickstoffeinträge oder Landnutzungsänderungen spielen als Erklärungsmodell für die Vegetationsveränderungen dagegen wohl eher eine untergeordnete Rolle.
Intensive land use is a driving force for biodiversity decline in many ecosystems. In semi-natural grasslands, land-use activities such as mowing, grazing and fertilization affect the diversity of plants and arthropods, but the combined effects of different drivers and the chain of effects are largely unknown. In this study we used structural equation modelling to analyse how the arthropod communities in managed grasslands respond to land use and whether these responses are mediated through changes in resource diversity or resource quantity (biomass). Plants were considered resources for herbivores which themselves were considered resources for predators. Plant and arthropod (herbivores and predators) communities were sampled on 141 meadows, pastures and mown pastures within three regions in Germany in 2008 and 2009. Increasing land-use intensity generally increased plant biomass and decreased plant diversity, mainly through increasing fertilization. Herbivore diversity decreased together with plant diversity but showed no response to changes in plant biomass. Hence, land-use effects on herbivore diversity were mediated through resource diversity rather than quantity. Land-use effects on predator diversity were mediated by both herbivore diversity (resource diversity) and herbivore quantity (herbivore biomass), but indirect effects through resource quantity were stronger. Our findings highlight the importance of assessing both direct and indirect effects of land-use intensity and mode on different trophic levels. In addition to the overall effects, there were subtle differences between the different regions, pointing to the importance of regional land-use specificities. Our study underlines the commonly observed strong effect of grassland land use on biodiversity. It also highlights that mechanistic approaches help us to understand how different land-use modes affect biodiversity.
Potentilla heptaphylla gehört in Hessen zu den oft verkannten Arten. Durch Herbarbelege bestätigt sind Vorkommen bei Niederkleen, Münzenberg sowie in Nordhessen um Korbach und Waldeck. Für diese Vorkommen konnte die diploide Chromosomenzahl von 2n = 14 bestätigt werden. Ein Vorkommen im Frankfurter Wald ist erloschen. In Nordhessen wurden außerdem tetraploide Pflanzen festgestellt, bei denen es sich eventuell um Bastarde zwischen Potentilla heptaphylla und P. neumanniana handelt.
Mittels molekulargenetischer Elternschaftsanalyse wurde eine niedrige Rate gemischter Mutterschaften in Bruten der sozial monogamen Tannenmeise nachgewiesen, einer Art, die sich durch hohe Fremdvaterschaftsraten auszeichnet. Gemischte Mutterschaften wurden in vier (= 0,8 %) von 483 Bruten entdeckt und nur für zehn (= 0,3 %) von 3563 erfolgreich genotypisierten Nachkommen wurde die Putativmutter von der genetischen Mutterschaft ausgeschlossen. In Anbetracht dieser sehr niedrigen Rate kann in evolutionsbiologischen Studien der soziale Fortpflanzungserfolg mit dem genetischen Fortpflanzungserfolg für Weibchen der Tannenmeise ohne weiteres gleichgesetzt werden. Die Putativväter wurden ebenfalls in allen Fällen von der genetischen Elternschaft ausgeschlossen, was Quasiparasitismus als Erklärung für gemischte Mutterschaften ausschließt. In einem Fall konnten die Partner eines Brutpaares, das zeitgleich in der Nähe eine eigene Brut aufzog, zweifelsfrei als die genetischen Eltern eines einzelnen Nachkommen identifiziert werden. Mögliche
Ursachen für das Auftreten gemischter Mutterschaften bei der Tannenmeise schließen die Übernahme von
Nistkästen samt begonnenen Gelegen nach dem Tod oder Abwandern der Vorbesitzer und innerartlichen
Brutparasitismus ein.
From 12.12.2010 to 17.12.2010, the Dagstuhl Seminar 10501 "Advances and Applications of Automata on Words and Trees" was held in Schloss Dagstuhl - Leibniz Center for Informatics. During the seminar, several participants presented their current research, and ongoing work and open problems were discussed. Abstracts of the presentations given during the seminar as well as abstracts of seminar results and ideas are put together in this paper. The first section describes the seminar topics and goals in general. Links to extended abstracts or full papers are provided, if available.
Seminar: 10501 - Advances and Applications of Automata on Words and Trees. The aim of the seminar was to discuss and systematize the recent fast progress in automata theory and to identify important directions for future research. For this, the seminar brought together more than 40 researchers from automata theory and related fields of applications. We had 19 talks of 30 minutes and 5 one-hour lectures leaving ample room for discussions. In the following we describe the topics in more detail.
Analgesia is a well-documented effect of acupuncture. A critical role in pain sensation plays the nervous system, including the GABAergic system and opioid receptor (OR) activation. Here we investigated regulation of GABA transporter GAT1 by δOR in rats and in Xenopus oocytes. Synaptosomes of brain from rats chronically exposed to opiates exhibited reduced GABA uptake, indicating that GABA transport might be regulated by opioid receptors. For further investigation we have expressed GAT1 of mouse brain together with mouse δOR and μOR in Xenopus oocytes. The function of GAT1 was analyzed in terms of Na(+)-dependent [(3)H]GABA uptake as well as GAT1-mediated currents. Coexpression of δOR led to reduced number of fully functional GAT1 transporters, reduced substrate translocation, and GAT1-mediated current. Activation of δOR further reduced the rate of GABA uptake as well as GAT1-mediated current. Coexpression of μOR, as well as μOR activation, affected neither the number of transporters, nor rate of GABA uptake, nor GAT1-mediated current. Inhibition of GAT1-mediated current by activation of δOR was confirmed in whole-cell patch-clamp experiments on rat brain slices of periaqueductal gray. We conclude that inhibition of GAT1 function will strengthen the inhibitory action of the GABAergic system and hence may contribute to acupuncture-induced analgesia.
As second part of a series focusing on the Pannonian grasslands of Austria, we present a detailed classification of the grasslands of the Vienna Woods (Wienerwald). This region, although geographically belonging to the Alps, has strong floristic affinities to the Pannonian Basin. The eastern slopes of the Vienna Woods are a hotspot of xero-thermophytic vegetation and exhibit the highest vascular plant species richness in Austria at a scale of 3' x 5'. We used the TWINSPAN classification of a large data set reported in the first part of this series as starting point. Relevés that were considered as misclassified at the level of alliances were manually re-arranged. From this table, an excerpt containing only the relevés of the Vienna Woods was used for the present study (1055 plots). We re-classified the relevés preliminary labelled as Arrhenatherion with another TWINSPAN run. Clusters for which no ecological difference could be detected were merged. The final delimitation of associations and subassociations was achieved by adjusting their diagnostic species so as to get units that were most informative in terms of environmental conditions. All re-arrangements were based on the summarised cover of diagnostic species within individual relevés. As a result, the grasslands of the Vienna Woods are classified within 22 associations (plus two subassociations) belonging to ten alliances and four classes. Within the Seslerio-Festucion pallentis, a new association Scorzonero austriacae-Caricetum humilis is described. The semi-dry grasslands of the study area previously classified as Onobrychido-Brometum are de-scribed as new association Filipendulo vulgaris-Brometum erecti and assigned to the Cirsio-Brachypodion. The Anthoxantho-Agrostietum tenuis is reported for Austria for the first time, and its syntaxonomy is discussed within a broader geographical context.
Herausforderungen für die nationale, regionale und thematische Webarchivierung und deren Nutzung
(2015)
Das World Wide Web ist als weltweites Informations- und Kommunikationsmedium etabliert. Neue Technologien erweitern regelmäßig die Nutzungsformen und erlauben es auch unerfahrenen Nutzern, Inhalte zu publizieren oder an Diskussionen teilzunehmen. Daher wird das Web auch als eine gute Dokumentation der heutigen Gesellschaft angesehen. Aufgrund seiner Dynamik sind die Inhalte des Web vergänglich und neue Technologien und Nutzungsformen stellen regelmäßig neue Herausforderungen an die Sammlung von Webinhalten für die Webarchivierung. Dominierten in den Anfangstagen der Webarchivierung noch statische Seiten, so hat man es heute häufig mit dynamisch generierten Inhalten zu tun, die Informationen aus verschiedenen Quellen integrieren. Neben dem klassischen domainorientieren Webharvesting kann auch ein steigendes Interesse aus verschiedenen Forschungsdisziplinen an thematischen Webkollektionen und deren Nutzung und Exploration beobachtet werden. In diesem Artikel werden einige Herausforderungen und Lösungsansätze für die Sammlung von thematischen und dynamischen Inhalten aus dem Web und den sozialen Medien vorgestellt. Des Weiteren werden aktuelle Probleme der wissenschaftlichen Nutzung diskutiert und gezeigt, wie Webarchive und andere temporale Kollektionen besser durchsucht werden können.
Die Fundmeldungen in Band 33 von Botanik und Naturschutz in Hessen stammen von: Dirk Bönsel, Martin de Jong, Wolfgang Ehmke, Peter Emrich, Benjamin Feller, Brunhilde Göbel, Thomas Gregor, Arthur Händler, Sylvain Hodvina, Gerwin Kasperek, Egbert Korte, Ute Lange, Stefan Meyer, Hasko Friedrich Nesemann, Uwe Raabe, Bernd Sauerwein, Marco Schmidt, Christof Nikolaus Schröder, Antje Schwab, Rainer Stoodt und Michael Uebeler.
We apply seismic full waveform inversion to SH‐ and Love‐wave data for investigating the near‐surface lithology at an archaeological site. We evaluate the resolution of the applied full waveform inversion algorithm through ground truthing in the form of an excavation and sediment core studies. Thereby, we investigate the benefits of full waveform inversion in comparison with other established methods of near‐surface prospecting in terms of resolution capabilities and interpretation security. The study is performed in a presumed harbour area of the ancient Thracian city of Ainos. The exemplary target is the source of a linear magnetic anomaly oriented perpendicular to the coast, which was found in a previous magnetic gradiometry survey, suggesting a mole. The SH‐wave full waveform inversion recovered a subsurface SH‐wave velocity model with submeter resolution showing lateral and vertical velocity variation between 40 and 150 m/s. To tame the non‐linearity of the full waveform inversion, a sequential inversion of frequency bands has to be combined with time‐windowing in order to separate the Love wave from the reflected SH wavefield. We compare the full waveform inversion results with multichannel analysis of surface waves, standard seismic reflection imaging, electrical resistivity tomography and electromagnetic induction. It turns out that the respective depth sections are correlated to a certain degree with the full waveform inversion results. However, the structural resolution of the other geophysical methods is significantly lower than for the full waveform inversion. An exception is the reflection seismic imaging, which shows the same resolution as full waveform inversion but can only be interpreted together with the full waveform inversion–based velocity model. An archaeological excavation as well as coring data allows ground truthing and a direct understanding of the geophysical structures. The results show that the target was a sort of near‐surface trench of about 3–4 m width and 0.8 m to 1.0 m depth, filled with silty sediment, which differs from the layered surrounding in colour and composition. The ground truthing revealed that only SH‐wave full waveform inversion and seismic reflection imaging could image the trench and sediment structure with satisfying lateral and depth resolution. We emphasize that the velocity distribution from SH‐wave full waveform inversion agrees closely with the excavated subsurface structures, and that the discovered changes in seismic velocity correlate with changes in the sand content in the respective sediment facies sequences. The study demonstrated that SH‐wave full waveform inversion is capable to image structural and lithological changes in the near subsurface at scales as low as 0.5 m, thus providing the high resolution needed for archaeological and geoarchaeological prospection.
Throughout mankind’s history, the need to secure and protect the home settlement was an essential one. This holds especially true for the city of Ainos (modern Enez) in Turkish Thrace. Due to its continuous settlement history since the 7th/6th century BC, several different types of city walls were built—sometimes even on top of each other—several of which have been preserved over time. To decipher the construction style, the course and the age of a buried city wall segment in the southern part of the former city, a geoscientific multi-proxy approach including magnetic gradiometer (MG) and electrical resistivity tomography (ERT) measurements in combination with granulometrical, sedimentological and microfaunistical investigations on sediment cores was applied. We were able to (1) present reasonable arguments for its Hellenistic age; (2) reveal the course of this wall segment and extrapolate it further north into a less studied area; and (3) demonstrate that in this near-coastal area, the former swampy terrain had been consolidated for constructing the wall. Our multi-proxy approach serves as a valuable example for investigating buried structures in archaeological contexts, avoiding a less-economical, time-consuming, or even forbidden excavation.
Purpose: To determine the value of the 2D multiple-echo data image combination (MEDIC) sequence relative to the short-tau inversion recovery (STIR) sequence regarding the depiction of chondral lesions in the patellofemoral joint.
Materials and methods: During a period of 6 month patients with acute pain at the anterior aspect of the knee, joint effusion and suspected chondral lesion defect in the patellofemoral joint underwent MRI including axial MEDIC and STIR imaging. Patients with chondral lesions in the patellofemoral joint on at least one sequence were included. The MEDIC and STIR sequence were quantitatively compared regarding the patella cartilage-to-effusion contrast-to-noise ratio (CNR) and qualitatively regarding the depiction of chondral lesions independently scored by two radiologists on a 3-point scale (1 = not depicted; 2 = blurred depicted; 3 = clearly depicted) using the Wilcoxon-Mann-Whitney-Test. For the analysis of inter-observer agreement the Cohen's Weighted Kappa test was used.
Results: 30 of 58 patients (male: female, 21:9; age: 44 ± 12 yrs) revealed cartilage lesions (fissures, n = 5 including fibrillation; gaps, n = 15; delamination, n = 7; osteoarthritis, n = 3) and were included in this study. The STIR-sequence was significantly (p < 0.001) superior to the MEDIC-sequence regarding both, the patella cartilage-to-effusion CNR (mean CNR: 232 ± 61 vs. 40 ± 16) as well as the depiction of chondral lesion (mean score: 2.83 ± 0.4 vs. 1.75 ± 0.7) with substantial inter-observer agreement in the rating of both sequences (κ = 0.76–0.89).
Conclusion: For the depiction of chondral lesions in the patellofemoral joint, the axial STIR-sequence should be chosen in preference to the axial MEDIC-sequence.
Outcomes of SARS-CoV-2 infections in patients with neurodegenerative diseases in the LEOSS cohort
(2021)
The impact of preexisting neurodegenerative diseases on superimposed SARS-CoV-2 infections remains controversial. Here we examined the course and outcome of SARS-CoV-2 infections in patients affected by Parkinson's disease (PD) or dementia compared to matched controls without neurodegenerative diseases in the LEOSS (Lean European Open Survey on SARS-CoV-2-infected patients) cohort, a large-scale prospective multicenter cohort study...
Hereditary angioedema (HAE) in children and adolescents : a consensus on therapeutic strategies
(2012)
Hereditary angioedema due to C1 inhibitor (C1 esterase inhibitor) deficiency (types I and II HAE-C1-INH) is a rare disease that usually presents during childhood or adolescence with intermittent episodes of potentially life-threatening angioedema. Diagnosis as early as possible is important to avoid ineffective therapies and to properly treat swelling attacks. At a consensus meeting in June 2011, pediatricians and dermatologists from Germany, Austria, and Switzerland reviewed the currently available literature, including published international consensus recommendations for HAE therapy across all age groups. Published recommendations cannot be unconditionally adopted for pediatric patients in German-speaking countries given the current approval status of HAE drugs. This article provides an overview and discusses drugs available for HAE therapy, their approval status, and study results obtained in adult and pediatric patients. Recommendations for developing appropriate treatment strategies in the management of HAE in pediatric patients in German-speaking countries are provided.Conclusion Currently, plasma-derived C1 inhibitor concentrate is considered the best available option for the treatment of acute HAE-C1-INH attacks in pediatric patients in German-speaking countries, as well as for short-term and long-term prophylaxis.
Objectives: An increasing number of treatment-determining biomarkers has been identified in non-small cell lung cancer (NSCLC) and molecular testing is recommended to enable optimal individualized treatment. However, data on implementation of these recommendations in the “real-world” setting are scarce. This study presents comprehensive details on the frequency, methodology and results of biomarker testing of advanced NSCLC in Germany.
Patients and methods: This analysis included 3,717 patients with advanced NSCLC (2,921 non-squamous; 796 squamous), recruited into the CRISP registry at start of systemic therapy by 150 German sites between December 2015 and June 2019. Evaluated were the molecular biomarkers EGFR, ALK, ROS1, BRAF, KRAS, MET, TP53, RET, HER2, as well as expression of PD-L1.
Results: In total, 90.5 % of the patients were tested for biomarkers. Testing rates were 92.2 % (non-squamous), 70.7 % (squamous) and increased from 83.2 % in 2015/16 to 94.2% in 2019. Overall testing rates for EGFR, ALK, ROS1, and BRAF were 72.5 %, 74.5 %, 66.1 %, and 53.0 %, respectively (non-squamous). Testing rates for PD-L1 expression were 64.5 % (non-squamous), and 58.5 % (squamous). The most common testing methods were immunohistochemistry (68.5 % non-squamous, 58.3 % squamous), and next-generation sequencing (38.7 % non-squamous, 14.4 % squamous). Reasons for not testing were insufficient tumor material or lack of guideline recommendations (squamous). No alteration was found in 37.8 % (non-squamous), and 57.9 % (squamous), respectively. Most common alterations in non-squamous tumors (all patients/all patients tested for the respective biomarker): KRAS (17.3 %/39.2 %), TP53 (14.1 %/51.4 %), and EGFR (11.0 %/15.1 %); in squamous tumors: TP53 (7.0 %/69.1 %), MET (1.5 %/11.1 %), and EGFR (1.1 %/4.4 %). Median PFS (non-squamous) was 8.7 months (95 % CI 7.4–10.4) with druggable EGFR mutation, and 8.0 months (95 % CI 3.9–9.2) with druggable ALK alterations.
Conclusion: Testing rates in Germany are high nationwide and acceptable in international comparison, but still leave out a significant portion of patients, who could potentially benefit. Thus, specific measures are needed to increase implementation.