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1.
Dis Esophagus ; 32(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329831

RESUMO

Risk stratification in patients with Barrett's esophagus (BE) to prevent the development of esophageal adenocarcinoma (EAC) is an unsolved task. The incidence of EAC and BE is increasing and patients are still at unknown risk. BarrettNET is an ongoing multicenter prospective cohort study initiated to identify and validate molecular and clinical biomarkers that allow a more personalized surveillance strategy for patients with BE. For BarrettNET participants are recruited in 20 study centers throughout Germany, to be followed for progression to dysplasia (low-grade dysplasia or high-grade dysplasia) or EAC for >10 years. The study instruments comprise self-administered epidemiological information (containing data on demographics, lifestyle factors, and health), as well as biological specimens, i.e., blood-based samples, esophageal tissue biopsies, and feces and saliva samples. In follow-up visits according to the individual surveillance plan of the participants, sample collection is repeated. The standardized collection and processing of the specimen guarantee the highest sample quality. Via a mobile accessible database, the documentation of inclusion, epidemiological data, and pathological disease status are recorded subsequently. Currently the BarrettNET registry includes 560 participants (23.1% women and 76.9% men, aged 22-92 years) with a median follow-up of 951 days. Both the design and the size of BarrettNET offer the advantage of answering research questions regarding potential causes of disease progression from BE to EAC. Here all the integrated methods and materials of BarrettNET are presented and reviewed to introduce this valuable German registry.

2.
J Neurosurg Sci ; 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31190514

RESUMO

Enhanced Recovery After Surgery (ERAS) programs for spine surgery have been developed throughout Europe and the United States leading to reduced hospital stay lengths, reduced opioid consumption, and faster return to activities of daily living and exercise. Development and execution of an ERAS spine program require commitment from the physician practice and collaborative hospital along with commitments from the entire health care team. Navigating this process can be a daunting task for a surgeon, whose traditional training involves no project management. Here we review our experience in the development of an ERAS program at a major academic medical institution and tertiary-care hospital in the United States from a program management perspective. In this manuscript, we provide the language and an outline to educate a surgeon on the project management processes needed to develop and initiate a pilot spine ERAS program.

3.
Clin Cancer Res ; 25(17): 5260-5270, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227506

RESUMO

PURPOSE: Clinically aggressive meningiomas (MGMs) are rare but treatment-resistant tumors in need for more effective therapies. Because tumor-infiltrating T lymphocytes (TILs) are essential for successful immunotherapy, we assessed TIL numbers and their activation status in primary (p-) and recurrent (r-) meningiomas and their impact on survival. EXPERIMENTAL DESIGN: Presence of TILs was analyzed in 202 clinically well-annotated cases (n = 123 pMGMs and n = 79 rMGMs) focusing on higher-grade meningiomas [n = 97 World Health Organization (WHO) °II, n = 62 WHO°III]. TILs were quantified by a semiautomated analysis on whole-tissue sections stained by multicolor immunofluorescence for CD3, CD8, FOXP3, and programmed cell death protein 1 (PD-1). RESULTS: Median T-cell infiltration accounted for 0.59% TILs per total cell count. Although there were no significant WHO°-dependent changes regarding helper (CD3+CD8-FOXP3-) and cytotoxic (CD3+CD8+FOXP3-) TILs in pMGMs, higher number of cytotoxic TILs were associated with an improved progression-free survival (PFS) independent of prognostic confounders. rMGMs were characterized by lower numbers of TILs in general, helper, and cytotoxic TILs. The additional analysis of their activation status revealed that a proportion of PD-1+CD8+ TILs within the TIL population was significantly decreased with higher WHO grade and in rMGMs. Furthermore, lower proportions of PD-1+CD8+ TILs were associated with inferior PFS in multivariate analyses, arguing for PD-1 as activation rather than exhaustion marker. CONCLUSIONS: We identified higher numbers of CD3+CD8+FOXP3- TILs and proportions of PD-1-expressing CD3+CD8+FOXP3- TILs as novel biomarkers for better survival. These findings might facilitate the selection of patients who may benefit from immunotherapy and argue in favor of an intervention in primary rather than recurrent tumors.

5.
Arthroscopy ; 32(8): 1489-90, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27495852

RESUMO

Arthroscopy and Arthroscopy Techniques attract authors as a result of our large, innovative, and global audience. In addition, the journals attract authors because of our robust and rapid review process, our wide indexing and search availability, and our openness to diverse article types including Technical Notes with video.


Assuntos
Artroscopia , Publicações Periódicas como Assunto , Humanos
6.
Oncotarget ; 7(12): 14551-68, 2016 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-26894859

RESUMO

Meningiomas are frequent central nervous system tumors. Although most meningiomas are benign (WHO grade I) and curable by surgery, WHO grade II and III tumors remain therapeutically challenging due to frequent recurrence. Interestingly, relapse also occurs in some WHO grade I meningiomas. Hence, we investigated the transcriptional features defining aggressive (recurrent, malignantly progressing or WHO grade III) meningiomas in 144 cases. Meningiomas were categorized into non-recurrent (NR), recurrent (R), and tumors undergoing malignant progression (M) in addition to their WHO grade. Unsupervised transcriptomic analysis in 62 meningiomas revealed transcriptional profiles lining up according to WHO grade and clinical subgroup. Notably aggressive subgroups (R+M tumors and WHO grade III) shared a large set of differentially expressed genes (n=332; p<0.01, FC>1.25). In an independent multicenter validation set (n=82), differential expression of 10 genes between WHO grades was confirmed. Additionally, among WHO grade I tumors differential expression between NR and aggressive R+M tumors was affirmed for PTTG1, AURKB, ECT2, UBE2C and PRC1, while MN1 and LEPR discriminated between NR and R+M WHO grade II tumors. Univariate survival analysis revealed a significant association with progression-free survival for PTTG1, LEPR, MN1, ECT2, PRC1, COX10, UBE2C expression, while multivariate analysis identified a prediction for PTTG1 and LEPR mRNA expression independent of gender, WHO grade and extent of resection. Finally, stainings of PTTG1 and LEPR confirmed malignancy-associated protein expression changes. In conclusion, based on the so far largest study sample of WHO grade III and recurrent meningiomas we report a comprehensive transcriptional landscape and two prognostic markers.


Assuntos
Biomarcadores Tumorais/genética , Perfilação da Expressão Gênica , Neoplasias Meníngeas/secundário , Meningioma/patologia , Recidiva Local de Neoplasia/patologia , Receptores para Leptina/genética , Securina/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Neoplasias Meníngeas/genética , Meningioma/genética , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia/genética , Taxa de Sobrevida , Adulto Jovem
7.
J Natl Cancer Inst ; 108(5)2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26668184

RESUMO

The World Health Organization (WHO) classification and grading system attempts to predict the clinical course of meningiomas based on morphological parameters. However, because of high interobserver variation of some criteria, more reliable prognostic markers are required. Here, we assessed the TERT promoter for mutations in the hotspot regions C228T and C250T in meningioma samples from 252 patients. Mutations were detected in 16 samples (6.4% across the cohort, 1.7%, 5.7%, and 20.0% of WHO grade I, II, and III cases, respectively). Data were analyzed by t test, Fisher's exact test, log-rank test, and Cox proportional hazard model. All statistical tests were two-sided. Within a mean follow-up time in surviving patients of 68.1 months, TERT promoter mutations were statistically significantly associated with shorter time to progression (P < .001). Median time to progression among mutant cases was 10.1 months compared with 179.0 months among wild-type cases. Our results indicate that the inclusion of molecular data (ie, analysis of TERT promoter status) into a histologically and genetically integrated classification and grading system for meningiomas increases prognostic power. Consequently, we propose to incorporate the assessment of TERT promoter status in upcoming grading schemes for meningioma.


Assuntos
Neoplasias Meníngeas/genética , Meningioma/genética , Mutação , Recidiva Local de Neoplasia/genética , Regiões Promotoras Genéticas , Telomerase/genética , Adulto , Idoso , Biomarcadores Tumorais/genética , Progressão da Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Prognóstico , Regiões Promotoras Genéticas/genética , Modelos de Riscos Proporcionais
8.
Psychother Res ; 20(6): 619-26, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20714970

RESUMO

The current study examined whether clients' perceptions of hope and therapists' hope in their clients were associated with therapy outcomes. The authors conducted a naturalistic study of brief therapy with 10 therapists and 43 adult clients. Client-rated hope significantly increased after one session of therapy. However, no significant relationship was found between pretherapy client-rated hope and first-session symptom change. Further, client-rated hope at any point in therapy was not significantly related to therapy outcomes. Therapists' hope in their clients after the first and last sessions was significantly related to client outcomes. Implications for therapy practice and research are offered.


Assuntos
Relações Médico-Paciente , Psicoterapia Breve , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Resultado do Tratamento , Adulto Jovem
9.
J Nurs Scholarsh ; 40(4): 349-54, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19094150

RESUMO

PURPOSE: To replicate research about confidence level in receiving health teaching from either an overweight or a weight-appropriate RN. METHODS: A quasi-experimental post-test only design was used. Participants were randomly assigned to be shown images of a nurse, either overweight or weight-appropriate, then asked to rate their confidence in health teaching received from that nurse. Descriptive statistics, t test for independent samples, and covariate analyses were performed. RESULTS: A significant difference in confidence p=0.000 was noted between participants who viewed the image of a weight-appropriate nurse and participants who viewed the image of an overweight nurse. CONCLUSIONS: Weight-appropriate nurses may inspire more confidence in their teaching. Further study is indicated to explore the implications of these findings for practice. CLINICAL RELEVANCE: Nurses need to be conscious of clients' perceptions of weight when planning teaching interventions.


Assuntos
Atitude , Educação em Saúde , Enfermeiras e Enfermeiros , Sobrepeso , Adulto , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto
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