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Background and Objectives: Development of hepatitis-B is considered a serious complication after liver transplantation. HBV de novo infection is a rather rare phenomenon, however it deserves attention in the era of donor organ shortage. The aim of the present analysis was to examine its course in liver transplant patients. Materials and Methods: Prevalence of de novo HBV-infections was extracted from our local transplant data base. Analysis focused on the moment of HBV-detection and on the long-term follow-up in terms of biochemical and histological changes over 30 years. Results: 46 patients were identified with the diagnosis of de novo hepatitis B. Median time from liver transplantation to diagnosis was 397 days (7–5505). 39 patients received antiviral therapy. No fibrosis progression could be detected, whereas the grade of inflammation significantly lessened from the moment of HBV detection to the end of histological follow-up over a median of 4344 days (range 123–9490). Patients with a poor virological control demonstrated a significantly poorer overall survival. Conclusions: De novo hepatitis B in liver transplant patients is a condition that can be controlled very well without significant fibrosis progression or graft loss if recognized on time within a regular transplant follow-up schedule.
Ramin Raul Ossami Saidy; Franziska Eurich; Maximilian Paul Postel; Eva Maria Dobrindt; Jasper Feldkamp; Selina Johanna Schaper; Johann Pratschke; Brigitta Globke; Dennis Eurich. Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation. Medicina 2021, 57, 767 .
AMA StyleRamin Raul Ossami Saidy, Franziska Eurich, Maximilian Paul Postel, Eva Maria Dobrindt, Jasper Feldkamp, Selina Johanna Schaper, Johann Pratschke, Brigitta Globke, Dennis Eurich. Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation. Medicina. 2021; 57 (8):767.
Chicago/Turabian StyleRamin Raul Ossami Saidy; Franziska Eurich; Maximilian Paul Postel; Eva Maria Dobrindt; Jasper Feldkamp; Selina Johanna Schaper; Johann Pratschke; Brigitta Globke; Dennis Eurich. 2021. "Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation." Medicina 57, no. 8: 767.
Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.
Ramin Ossami Saidy; Irina Sud; Franziska Eurich; Mustafa Aydin; Maximilian Postel; Eva Dobrindt; Johann Pratschke; Dennis Eurich. Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection. Viruses 2021, 13, 904 .
AMA StyleRamin Ossami Saidy, Irina Sud, Franziska Eurich, Mustafa Aydin, Maximilian Postel, Eva Dobrindt, Johann Pratschke, Dennis Eurich. Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection. Viruses. 2021; 13 (5):904.
Chicago/Turabian StyleRamin Ossami Saidy; Irina Sud; Franziska Eurich; Mustafa Aydin; Maximilian Postel; Eva Dobrindt; Johann Pratschke; Dennis Eurich. 2021. "Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection." Viruses 13, no. 5: 904.
Introduction: Recurrence of hepatocellular carcinoma (rHCC) after liver transplantation (LT) is associated with limited survival. Therefore, identification of factors that prolong survival in these patients is of great interest. Surgical resection, radiotherapy, and transarterial chemoembolization (TACE) are established interventions to improve outcomes in these patients; however, the impact of immunosuppression is unknown. Methods: All patients diagnosed with rHCC in the follow-up after LT were identified from a database of liver recipients transplanted between 1988 and 2019 at our institution (Charité Universitätsmedizin Berlin, Germany). Based on the immunosuppressive regimen following diagnosis of rHCC and the oncological treatment approach, survival analysis was performed. Results: Among 484 patients transplanted for HCC, 112 (23.1%) developed rHCC in the follow-up. Recurrent HCC was diagnosed at a median interval of 16.0 months (range 1.0–203.0), with the majority presenting early after transplantation (63.0%, <2 years). Median survival after rHCC diagnosis was 10.6 months (0.3–228.7). Reduction of immunosuppression was associated with improved survival, particularly in patients with palliative treatment (8.4 versus 3.0 months). In addition, greater reduction of immunosuppression seemed to be associated with greater prolongation of survival. Graft rejection after reduction was uncommon (n = 7, 6.8%) and did not result in any graft loss. Patients that underwent surgical resection showed improved survival rates (median 19.5 vs. 8.7 months). Conclusion: Reduction of immunosuppressive therapy after rHCC diagnosis is associated with prolonged survival in LT patients. Therefore, reduction of immunosuppression should be an early intervention following diagnosis. In addition, surgical resection should be attempted, if technically feasible and oncologically meaningful.
Ramin Ossami Saidy; Maximilian Postel; Michael Pflüger; Wenzel Schoening; Robert Öllinger; Safak Gül-Klein; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Dennis Eurich. Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma. Cancers 2021, 13, 1617 .
AMA StyleRamin Ossami Saidy, Maximilian Postel, Michael Pflüger, Wenzel Schoening, Robert Öllinger, Safak Gül-Klein, Moritz Schmelzle, Frank Tacke, Johann Pratschke, Dennis Eurich. Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma. Cancers. 2021; 13 (7):1617.
Chicago/Turabian StyleRamin Ossami Saidy; Maximilian Postel; Michael Pflüger; Wenzel Schoening; Robert Öllinger; Safak Gül-Klein; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Dennis Eurich. 2021. "Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma." Cancers 13, no. 7: 1617.
Background A self‐limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end stage liver diseases (ESLD) unrelated to HBV are unknown and recommendations on HBV prophylaxis remain unclear. Patients and methods Among 1273 liver transplants, 168 patients with a self‐limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti‐HBc‐positive liver were not included in the analysis. Demographic, laboratory, serological and virological data were analyzed retrospectively. Appearance of HBsAg or HBV‐DNA were defined as reactivation. Results The median follow‐up after LT was 12.0 years (0.6‐30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n=7; 4.2%), the etiology of ESLD, hepatitis C treatment or the anti‐HBs concentration. The overall patient survival with a history of a self‐limited HBV infection before LT did not significantly differ from the rest of the cohort. Conclusion Antiviral treatment with nucleos(t)ide analogues post liver transplantation in order to prevent HBV reactivation in patients with a resolved self‐limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self‐limited hepatitis B prior to LT.
Ramin Raul Ossami Saidy; Muenevver Demir; Pauline Nibbe; Eva‐Maria Dobrindt; Robert Oellinger; Wenzel Schoening; Johann Pratschke; Dennis Eurich. Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program. Transplant Infectious Disease 2020, 23, 1 .
AMA StyleRamin Raul Ossami Saidy, Muenevver Demir, Pauline Nibbe, Eva‐Maria Dobrindt, Robert Oellinger, Wenzel Schoening, Johann Pratschke, Dennis Eurich. Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program. Transplant Infectious Disease. 2020; 23 (1):1.
Chicago/Turabian StyleRamin Raul Ossami Saidy; Muenevver Demir; Pauline Nibbe; Eva‐Maria Dobrindt; Robert Oellinger; Wenzel Schoening; Johann Pratschke; Dennis Eurich. 2020. "Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program." Transplant Infectious Disease 23, no. 1: 1.
Background Immunosuppressed liver transplant (LT) patients are considered to be at high risk for any kind of infection. What the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) means for the transplant cohort is a question that, as of now, cannot easily be answered. Data on prevalence, relevance of the novel virus, and clinical course of the infection in stable LT patients are limited. Methods Nasopharyngeal swabs were performed in our outpatient department during the shutdown between March and April 2020 in Germany. Results The prevalence of SARS‐CoV‐2 was 3%. Three out of a cohort of 101 LT patients were asymptomatic for respiratory diseases. Respiratory complaints were common and not associated with SARS‐CoV‐2 infection. The overall monthly mortality rate was 0.22% and did not show alterations during the shutdown in Germany. Conclusions If preventive measures are applied, LT patients do not seem to be at a higher risk for SARS‐CoV‐2 infection. Telemedicine in the outpatient setting may help to maintain distance and to reduce direct patient contact. However, standard of care must be guaranteed for patients with relevant comorbidities in spite of pandemics, because complications may arise from preexisting conditions.
Ramin Raul Ossami Saidy; Brigitta Globke; Johann Pratschke; Wenzel Schoening; Dennis Eurich. Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department. Transplant Infectious Disease 2020, 22, 1 .
AMA StyleRamin Raul Ossami Saidy, Brigitta Globke, Johann Pratschke, Wenzel Schoening, Dennis Eurich. Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department. Transplant Infectious Disease. 2020; 22 (6):1.
Chicago/Turabian StyleRamin Raul Ossami Saidy; Brigitta Globke; Johann Pratschke; Wenzel Schoening; Dennis Eurich. 2020. "Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department." Transplant Infectious Disease 22, no. 6: 1.
The efficacy of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has recently been proven. Till today, very few works evaluated the role of uniportal-VATS (U-VATS) approach in the treatment of pleural empyema even if it currently represents the most innovative and less invasive thoracoscopic approach. We report our experience with U-VATS in the treatment of pleural empyema. A retrospective bicentric analysis of 35 consecutive patients who underwent surgical treatment of stage II and stage III pleural empyema was performed, from January 2015 to May 2017. The mean age of patients was 57.26±18.29 years and 54.3% of them were males. In 85.7% of the cases, empyema was related to a complicated parapneumonic effusion; in only 5 cases it was a post-surgical consequence. All patients were treated with broad-spectrum antibiotics and subsequent target therapy for 14.62±21.76 days prior to operation and 23 patients needed the placement of a chest tube. Twenty patients (57.1%) presented with stage III, 11 patients (31.4%) stage II and 4 patients (11.4%) stage I empyema. Complete debridement and decortication were obtained in all patients through U-VATS approach and no conversion or further access was needed for any reason. No major complication was recorded. Only 2 cases of trapped lung were not responsive to surgical treatment. At a mean follow-up of 247.42±306.29 days, 33 patients (94.3%) were alive with no recurrence, 2 patients died for causes unrelated to the operation. According to our experience, we consider U-VATS as an adequate procedure in the treatment of “stages II and III” empyemas when the necessary surgical expertise has been achieved. Indeed, U-VATS permits an easier performance and complete debridement and decortication, with a very low risk for conversion and excellent postoperative outcomes in terms of less pain, fast recovery and cosmetic results.
Mahmoud Ismail; Dania Nachira; Elisa Meacci; Gian Maria Ferretti; Marc Swierzy; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Svea Faber; Maria Teresa Congedo; Marco Chiappetta; Leonardo Petracca Ciavarella; Stefano Margaritora; Jens C. Rueckert. Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. Journal of Thoracic Disease 2018, 10, S3696 -S3703.
AMA StyleMahmoud Ismail, Dania Nachira, Elisa Meacci, Gian Maria Ferretti, Marc Swierzy, Julianna Paulina Englisch, Ramin Raul Ossami Saidy, Svea Faber, Maria Teresa Congedo, Marco Chiappetta, Leonardo Petracca Ciavarella, Stefano Margaritora, Jens C. Rueckert. Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. Journal of Thoracic Disease. 2018; 10 (1):S3696-S3703.
Chicago/Turabian StyleMahmoud Ismail; Dania Nachira; Elisa Meacci; Gian Maria Ferretti; Marc Swierzy; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Svea Faber; Maria Teresa Congedo; Marco Chiappetta; Leonardo Petracca Ciavarella; Stefano Margaritora; Jens C. Rueckert. 2018. "Uniportal video-assisted thoracic surgery in the treatment of pleural empyema." Journal of Thoracic Disease 10, no. 1: S3696-S3703.
Radical lymph node dissection (LND) plays a major role in the treatment of non-small cell lung cancer (NSCLC). This study presents the analysis of the results after uniportal video-assisted thoracoscopy (VATS) lymphadenectomy during anatomical lung resections for NSCLC, focusing on pathological nodal upstaging. Any possible risk factor affecting nodal upstaging was also investigated. The prospectively collected clinical data of 136 patients undergone uniportal VATS anatomical lung resections, from June 2012 to September 2017, were reviewed. In particular, all details inherent the clinical and pathological node stage and any possible risk factor affecting nodal upstaging were analyzed. The patient population consisted of 90 males and 46 females; their mean age was 67.42±10.64 years. The mean number of lymph nodes retrieved during uniportal VATS lymphadenectomy was 20.14±10.73 (7.27±5.90 and 12.60±7.96 in N1 and N2 stations, respectively). The incidence of nodal upstaging was 13.3% (18 cases). In particular there was a N0–1 upstaging in 10 cases (7.4%), a N1–2 upstaging in 3 (2.2%) and a N0–2 in 4 (3%). The ROC analysis showed that the resection of 18 lymph nodes was the best predictor of a general upstaging with an AUC-ROC of 0.595, while the resection of 7 hilar lymph nodes was the best predictor of N1 upstaging (AUC-ROC: 0.554) and 11 mediastinal nodes was the best predictor of N2 upstaging (AUC-ROC: 0.671). The number of positive lymph nodes of stations 5-6 (OR: 2.035, 95% CI: 1.082–3.826, P=0.027) and stations 2–3–4 (OR: 6.198, 95% CI: 1.580–24.321, P=0.009) were confirmed to be the only independent risk factors for N2 upstaging by multivariate analysis. According to our experience, uniportal VATS allows a safe and effective radical lymphadenectomy, with a satisfactory pathological nodal upstaging, comparable to other minimally invasive techniques.
Mahmoud Ismail; Dania Nachira; Marc Swierzy; Gian Maria Ferretti; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Feng Li; Harun Badakhshi; Jens C. Rueckert. Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy. Journal of Thoracic Disease 2018, 10, S3648 -S3654.
AMA StyleMahmoud Ismail, Dania Nachira, Marc Swierzy, Gian Maria Ferretti, Julianna Paulina Englisch, Ramin Raul Ossami Saidy, Feng Li, Harun Badakhshi, Jens C. Rueckert. Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy. Journal of Thoracic Disease. 2018; 10 (1):S3648-S3654.
Chicago/Turabian StyleMahmoud Ismail; Dania Nachira; Marc Swierzy; Gian Maria Ferretti; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Feng Li; Harun Badakhshi; Jens C. Rueckert. 2018. "Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy." Journal of Thoracic Disease 10, no. 1: S3648-S3654.
The combination of neoadjuvant chemotherapy and surgery in lung cancer therapy is well established. The role of uniportal video assisted thoracoscopy (VATS) is still not described in literature. This study presents the preliminary short-term results of uniportal VATS after neoadjuvant therapy in our series. The prospectively collected data of 154 patients after uniportal VATS anatomical lung resection (18 patients after neoadjuvant chemotherapy and 136 surgeries alone) were retrospectively reviewed. The perioperative results and follow-up of patients after neoadjuvant therapy were analyzed and compared to those after surgery alone. The mean age of population was 67.51±10.63 years. The mean operative time was overlapping in both groups: 248.97±118.17 min in surgery group and 287.17±94.13 min in chemotherapy + surgery group (P=0.190), with no difference in terms of types of anatomical lung resections performed and number of lymph nodes retrieved. The intraoperative mortality was null in both groups. The incidence of all complications was the same in both groups and no correlations was found with any possible risk factor evaluated (age, gender, comorbidities, type of resection, histology, etc.). Among minor complications, the incidence of parenchymal fistula was significantly higher in the 18 patients underwent chemotherapy (22.2% vs. 5.1% respectively, P=0.013). The overall survival of the series was 93% at 1 year follow-up and 88% at 5-year. The 1- and 2-year survival in only surgery group was 94% and 89% respectively vs. 85% and 85% in Chemotherapy + surgery, without any significant difference (P=0.324). According to our experience, uniportal VATS after neoadjuvant therapy is feasible and quite safe. The oncological results and postoperative complications are comparable to those of other techniques. Uniportal VATS can be performed even for complicated cases in experienced centers.
Mahmoud Ismail; Dania Nachira; Marc Swierzy; Gian Maria Ferretti; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Feng Li; Harun Badakhshi; Jens C. Rueckert. Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy. Journal of Thoracic Disease 2018, 10, S3655 -S3661.
AMA StyleMahmoud Ismail, Dania Nachira, Marc Swierzy, Gian Maria Ferretti, Julianna Paulina Englisch, Ramin Raul Ossami Saidy, Feng Li, Harun Badakhshi, Jens C. Rueckert. Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy. Journal of Thoracic Disease. 2018; 10 (1):S3655-S3661.
Chicago/Turabian StyleMahmoud Ismail; Dania Nachira; Marc Swierzy; Gian Maria Ferretti; Julianna Paulina Englisch; Ramin Raul Ossami Saidy; Feng Li; Harun Badakhshi; Jens C. Rueckert. 2018. "Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy." Journal of Thoracic Disease 10, no. 1: S3655-S3661.
The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.
Dania Nachira; Mahmoud Ismail; Elisa Meacci; Edoardo Zanfrini; Amedeo Iaffaldano; Marc Swierzy; Julianna Englisch; Svea Faber; Ramin Raul Ossami Saidy; Maria Letizia Vita; Venanzio Porziella; Jens C. Rueckert; Stefano Margaritora. Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax—a propensity matched bicentric study. Journal of Thoracic Disease 2018, 10, S3712 -S3719.
AMA StyleDania Nachira, Mahmoud Ismail, Elisa Meacci, Edoardo Zanfrini, Amedeo Iaffaldano, Marc Swierzy, Julianna Englisch, Svea Faber, Ramin Raul Ossami Saidy, Maria Letizia Vita, Venanzio Porziella, Jens C. Rueckert, Stefano Margaritora. Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax—a propensity matched bicentric study. Journal of Thoracic Disease. 2018; 10 (1):S3712-S3719.
Chicago/Turabian StyleDania Nachira; Mahmoud Ismail; Elisa Meacci; Edoardo Zanfrini; Amedeo Iaffaldano; Marc Swierzy; Julianna Englisch; Svea Faber; Ramin Raul Ossami Saidy; Maria Letizia Vita; Venanzio Porziella; Jens C. Rueckert; Stefano Margaritora. 2018. "Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax—a propensity matched bicentric study." Journal of Thoracic Disease 10, no. 1: S3712-S3719.
Natural killer (NK) cells comprise the main components of lymphocyte-mediated nonspecific immunity. Through their effector function they play a crucial role combating bacterial and viral challenges. They are also thought to be key contributors to the systemic spinal cord injury-induced immune-deficiency syndrome (SCI-IDS). SCI-IDS increases susceptibility to infection and extends to the post-acute and chronic phases after SCI. The prospective study of NK cell function after traumatic SCI was carried out in two centers in Berlin, Germany. SCI patients and control patients with neurologically silent vertebral fracture also undergoing surgical stabilization were enrolled. Furthermore healthy controls were included to provide reference data. The NK cell function was assessed at 7 (5–9) days, 14 days (11–28) days, and 10 (8–12) weeks post-trauma. Clinical documentation included the American Spinal Injury Association (ASIA) impairment scale (AIS), neurological level of injury, infection status, concomitant injury, and medications. The primary endpoint of the study is CD107a expression by NK cells (cytotoxicity marker) 8–12 weeks following SCI. Secondary endpoints are the NK cell’s TNF-α and IFN-γ production by the NK cells 8–12 weeks following SCI. The protocol of this study was developed to investigate the hypotheses whether i) SCI impairs NK cell function throughout the post-acute and sub-acute phases after SCI and ii) the degree of impairment relates to lesion height and severity. A deeper understanding of the SCI-IDS is crucial to enable strategies for prevention of infections, which are associated with poor neurological outcome and elevated mortality. DRKS00009855.
Inês Laginha; Marcel A. Kopp; Claudia Druschel; Klaus-Dieter Schaser; Benedikt Brommer; Rick C. Hellmann; Ralf Watzlawick; Ramin-Raul Ossami-Saidi; Harald Prüss; Vieri Failli; Christian Meisel; Thomas Liebscher; Erik Prilipp; Andreas Niedeggen; Axel Ekkernkamp; Ulrike Grittner; Sophie K. Piper; Ulrich Dirnagl; Monica Killig; Chiara Romagnani; Jan M. Schwab. Natural Killer (NK) Cell Functionality after human Spinal Cord Injury (SCI): protocol of a prospective, longitudinal study. BMC Neurology 2016, 16, 1 -8.
AMA StyleInês Laginha, Marcel A. Kopp, Claudia Druschel, Klaus-Dieter Schaser, Benedikt Brommer, Rick C. Hellmann, Ralf Watzlawick, Ramin-Raul Ossami-Saidi, Harald Prüss, Vieri Failli, Christian Meisel, Thomas Liebscher, Erik Prilipp, Andreas Niedeggen, Axel Ekkernkamp, Ulrike Grittner, Sophie K. Piper, Ulrich Dirnagl, Monica Killig, Chiara Romagnani, Jan M. Schwab. Natural Killer (NK) Cell Functionality after human Spinal Cord Injury (SCI): protocol of a prospective, longitudinal study. BMC Neurology. 2016; 16 (1):1-8.
Chicago/Turabian StyleInês Laginha; Marcel A. Kopp; Claudia Druschel; Klaus-Dieter Schaser; Benedikt Brommer; Rick C. Hellmann; Ralf Watzlawick; Ramin-Raul Ossami-Saidi; Harald Prüss; Vieri Failli; Christian Meisel; Thomas Liebscher; Erik Prilipp; Andreas Niedeggen; Axel Ekkernkamp; Ulrike Grittner; Sophie K. Piper; Ulrich Dirnagl; Monica Killig; Chiara Romagnani; Jan M. Schwab. 2016. "Natural Killer (NK) Cell Functionality after human Spinal Cord Injury (SCI): protocol of a prospective, longitudinal study." BMC Neurology 16, no. 1: 1-8.
Infections are the leading cause of death in the acute phase following spinal cord injury and qualify as independent risk factor for poor neurological outcome (“disease modifying factor”). The enhanced susceptibility for infections is not stringently explained by the increased risk of aspiration in tetraplegic patients, neurogenic bladder dysfunction, or by high-dose methylprednisolone treatment. Experimental and clinical pilot data suggest that spinal cord injury disrupts the balanced interplay between the central nervous system and the immune system. The primary hypothesis is that the Spinal Cord Injury-induced Immune Depression Syndrome (SCI-IDS) is 'neurogenic’ including deactivation of adaptive and innate immunity with decreased HLA-DR expression on monocytes as a key surrogate parameter. Secondary hypotheses are that the Immune Depression Syndrome is i) injury level- and ii) severity-dependent, iii) triggers transient lymphopenia, and iv) causes qualitative functional leukocyte deficits, which may endure the post-acute phase after spinal cord injury. SCIentinel is a prospective, international, multicenter study aiming to recruit about 118 patients with acute spinal cord injury or control patients with acute vertebral fracture without neurological deficits scheduled for spinal surgery. The assessment points are: i) <31 hours, ii) 31–55 hours, iii) 7 days, iv) 14 days, and v) 10 weeks post-trauma. Assessment includes infections, concomitant injury, medication and neurological classification using American Spinal Injury Association impairment scale (AIS) and neurological level. Laboratory analyses comprise haematological profiling, immunophenotyping, including HLA-DR expression on monocytes, cytokines and gene expression of immune modulators. We provide an administrative interim analysis of the recruitment schedule of the trial. The objectives are to characterize the dysfunction of the innate and adaptive immune system after spinal cord injury and to explore its proposed 'neurogenic’ origin by analyzing its correlation with lesion height and severity. The trial protocol considers difficulties of enrolment in an acute setting, and loss to follow up. The administrative interim analysis confirmed the feasibility of the protocol. Better understanding of the SCI-IDS is crucial to reduce co-morbidities and thereby to attenuate the impact of disease modifying factors to protect neurological “outcome at risk”. This putatively results in improved spinal cord injury medical care. DRKS-ID: DRKS00000122 (German Clinical Trials Registry)
Marcel A Kopp; Claudia Druschel; Christian Meisel; Thomas Liebscher; Erik Prilipp; Ralf Watzlawick; Paolo Cinelli; Andreas Niedeggen; Klaus-Dieter Schaser; Guido A Wanner; Armin Curt; Gertraut Lindemann; Natalia Nugaeva; Michael G Fehlings; Peter Vajkoczy; Mario Čabraja; Julius Dengler; Wolfgang Ertel; Axel Ekkernkamp; Peter Martus; Hans-Dieter Volk; Nadine Unterwalder; Uwe Kölsch; Benedikt Brommer; Rick C Hellmann; Ramin R Ossami Saidy; Ines Laginha; Harald Prüss; Vieri Failli; Ulrich Dirnagl; Jan M Schwab. The SCIentinel study - prospective multicenter study to define the spinal cord injury-induced immune depression syndrome (SCI-IDS) - study protocol and interim feasibility data. BMC Neurology 2013, 13, 168 -168.
AMA StyleMarcel A Kopp, Claudia Druschel, Christian Meisel, Thomas Liebscher, Erik Prilipp, Ralf Watzlawick, Paolo Cinelli, Andreas Niedeggen, Klaus-Dieter Schaser, Guido A Wanner, Armin Curt, Gertraut Lindemann, Natalia Nugaeva, Michael G Fehlings, Peter Vajkoczy, Mario Čabraja, Julius Dengler, Wolfgang Ertel, Axel Ekkernkamp, Peter Martus, Hans-Dieter Volk, Nadine Unterwalder, Uwe Kölsch, Benedikt Brommer, Rick C Hellmann, Ramin R Ossami Saidy, Ines Laginha, Harald Prüss, Vieri Failli, Ulrich Dirnagl, Jan M Schwab. The SCIentinel study - prospective multicenter study to define the spinal cord injury-induced immune depression syndrome (SCI-IDS) - study protocol and interim feasibility data. BMC Neurology. 2013; 13 (1):168-168.
Chicago/Turabian StyleMarcel A Kopp; Claudia Druschel; Christian Meisel; Thomas Liebscher; Erik Prilipp; Ralf Watzlawick; Paolo Cinelli; Andreas Niedeggen; Klaus-Dieter Schaser; Guido A Wanner; Armin Curt; Gertraut Lindemann; Natalia Nugaeva; Michael G Fehlings; Peter Vajkoczy; Mario Čabraja; Julius Dengler; Wolfgang Ertel; Axel Ekkernkamp; Peter Martus; Hans-Dieter Volk; Nadine Unterwalder; Uwe Kölsch; Benedikt Brommer; Rick C Hellmann; Ramin R Ossami Saidy; Ines Laginha; Harald Prüss; Vieri Failli; Ulrich Dirnagl; Jan M Schwab. 2013. "The SCIentinel study - prospective multicenter study to define the spinal cord injury-induced immune depression syndrome (SCI-IDS) - study protocol and interim feasibility data." BMC Neurology 13, no. 1: 168-168.