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  • 1
    Language: English
    In: BJU International, Sept, 2012, p.E222(6)
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.10938.x/abstract Byline: Roman Mayr(1), Matthias May(2), Thomas Martini(1), Michele Lodde(1), Armin Pycha(1), Evi Comploj(1), Wolf F. Wieland(3), Stefan Denzinger(3), Wolfgang Otto(3), Maximilian Burger(3), Hans-Martin Fritsche(3) Keywords: comorbidity; cystectomy; ACE-27; ASA; urothelial carcinoma; perioperative mortality Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The degree of comorbidity significantly affects the course of patients with bladder cancer undergoing radical cystectomy (RC). To our knowledge this is the first study comparing four different comorbidity indices in patients undergoing RC for urothelial carcinoma to assess the best clinical predictors for 90-day perioperative mortality. We concluded that the ASA score should be the method of choice, as it showed a predictive ability superior to that of ECOG and CCI, and is much easier to generate than the ACE-27. OBJECTIVE * To evaluate which of the following among the Adult Comorbidity Evaluation-27 (ACE-27), the Charlson Comorbidity Index (CCI), the Eastern Cooperative Oncology Group performance status (ECOG) and the American Society of Anesthesiologists (ASA) comorbidity scores correlate best with perioperative mortality after radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. PATIENTS AND METHODS * A study was carried out on 555 unselected consecutive patients without neoadjuvant chemotherapy who underwent RC for UC of the bladder from 2000 to 2010 at one of two institutions. * Patients' medical records were reviewed retrospectively. * We established a defined binary linear progression model based on clinical variables to predict perioperative mortality 90 days after RC (90PM). To this model we added, individually, the comorbidity indices ACE-27, CCI, ECOG, and ASA to assess their predictive capacity regarding 90PM. RESULTS * The overall 90PM was 7.9%. * Age (P= 0.01) and clinical distant metastatic tumour stage (P= 0.002) were independent predictors for 90PM in the multivariate analysis. * Each of the four investigated comorbidity indices was able to significantly increase the predictive capacity of the basic model: ECOG +13.5%, (odds ratio [OR]: 1.61, P= 0.036; area under the curve [AUC] 74.7), ASA Score +28.3% (OR: 2.19, P= 0.004; AUC 76.1), Charlson Index +12.3% (OR: 1.31, P= 0.047; AUC 73.8) and ACE-27 + 29.8% (OR: 1.72, P= 0.004; AUC 76.1). CONCLUSIONS * ASA and ACE-27 show a nearly identical clinical predictive value for perioperative mortality. Both scores could be considered for clinical practice. * With regard to ease of generation and availability, the ASA score can be regarded as the best instrument. Author Affiliation: (1)Department of Urology, Central Hospital of Bolzano, Bolzano, Italy (2)Department of Urology, St. Elisabeth Hospital, Straubing (3)Department of Urology, University of Regensburg, Regensburg, Germany Correspondence: (*) Hans-Martin Fritsche, Department of Urology, University of Regensburg, Caritas-St.Josef Medical Centre, Landshuter Str. 65, 93053 Regensburg, Germany. e-mail: hans-martin.fritsche@klinik.uni-regensburg.de Accepted for publication 9 November 2011
    Keywords: Comorbidity -- Health Aspects ; Mortality
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 2
    Language: English
    In: BJU International, Sept, 2012, p.E222(6)
    Keywords: Comorbidity -- Health Aspects ; Mortality
    ISSN: 1464-4096
    Source: Cengage Learning, Inc.
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  • 3
    Language: English
    In: The Journal of Urology, April 2017, Vol.197(4), pp.e250-e250
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2017.02.3270 Byline: Maximilian Haider, Roman Mayr, Hans-Martin Fritsche Author Affiliation: Regensburg, Germany Article Note: (footnote) Source of Funding: none
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 4
    Language: English
    In: Journal of Hepatology, September 2011, Vol.55(3), pp.731-732
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jhep.2011.01.023 Byline: Roman Mayr, Heinz Zoller Author Affiliation: Medical University of Innsbruck, Department of Medicine II, Gastroenterology, and Hepatology, Anichstrasse 35, A-6020 Innsbruck, Austria Article History: Received 21 January 2011; Accepted 23 January 2011
    Keywords: Medicine
    ISSN: 0168-8278
    E-ISSN: 1600-0641
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  • 5
    Language: English
    In: European Urology, January 2013, Vol.63(1), pp.e10-e10
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.eururo.2012.09.044 Byline: Roman Mayr (a), Matthias May (b), Hans-Martin Fritsche (c) Author Affiliation: (a) Department of Urology, Central Hospital of Bolzano, Bolzano, Italy (b) Department of Urology, St. Elisabeth Hospital, Straubing, Germany (c) Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany Article History: Accepted 19 September 2012
    Keywords: Medicine
    ISSN: 0302-2838
    E-ISSN: 1873-7560
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  • 6
    Language: English
    In: Current Urology Reports, 2013, Vol.14(2), pp.90-93
    Description: Photodynamic Diagnosis (PDD), an adjunct to white light cystoscopy, has been shown to improve detection and thoroughness of resection of bladder cancer by enhancing visualisation of malign lesions during transurethral resection of bladder tumours (TURBT) compared to the sole use of standard white light cystoscopy. The PDD also has been shown to improve recurrence of free survival in non-muscle invasive bladder cancer. Little data on its impact on outcome in non-muscle invasive bladder cancer of high risk of progression is available however. The few trials and studies available demonstrate improved accuracy of diagnosis especially of flat malign lesions. In addition, improved recurrence rates have been suggested without an impact on progression rates in early invasive bladder cancer indicating little influence of thoroughness of resection on the tumour biology in those tumour stages. While no specific and larger data on impact of PDD on cancer specific survival exist to date and the few long-term data suggest little impact, improved accuracy of diagnosis is suggested to be beneficial for clinical decision making and thus a value of PDD is postulated in the management of high-risk non-muscle invasive bladder cancer.
    Keywords: Bladder cancer ; High risk ; Progression ; Photodynamic diagnosis ; Fluorescence cystoscopy ; TURBT
    ISSN: 1527-2737
    E-ISSN: 1534-6285
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  • 7
    Language: English
    In: The Journal of Urology, April 2018, Vol.199(4), pp.e191-e191
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 8
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e639-e639
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 9
    Language: English
    In: World Journal of Urology, 2018, Vol.36(8), pp.1201-1207
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00345-018-2259-x Byline: Roman Mayr (1), Hans-Martin Fritsche (2), Florian Zeman (3), Marieke Reiffen (1), Leopold Siebertz (1), Christoph Niessen (4), Armin Pycha (5,6), Bas W. G. Rhijn (1,7), Maximilian Burger (1), Michael Gierth (1) Keywords: Frailty; Skeletal muscle mass; Bladder cancer; Prognosis; Urinary bladder neoplasm Abstract: Purpose A single-center study was conducted to investigate the impact of sarcopenia as a predictor for 90-day mortality (90 dM) and complications within 90 days after radical cystectomy for bladder cancer. Methods In total, 327 patients with preoperative available digital computed tomography (CT) scans of the abdomen and pelvis were identified. The lumbar skeletal muscle index was measured using preoperative abdominal CT to assess sarcopenia. Complications were recorded and graded according to Clavien--Dindo (CD). Predictors of 90 dM and complications within 90 days were analyzed by uni- and multivariable logistic regression. Results Of the 327 patients, 262 (80%) were male and 108 (33%) patients were classified as sarcopenic. Within 90 days, 28 (7.8%) patients died, of whom 15 patients were sarcopenic and 13 were not. In multivariable logistic regression analysis, sarcopenia (OR 2.59 95% CI 1.13--5.95 p=0.025), ASA 3--4 (OR 2.53 95% CI 1.10--5.82 p=0.029) and cM+(OR 7.43 95% CI 2.34--23.64 p=0.001) were independent predictors of 90-day mortality. Sarcopenic patients experienced significantly more complications, i.e., CD 4a--5 (p=0.003), compared to non-sarcopenic patients. In multivariable logistic regression analysis, sarcopenia was independently associated with CDa[yen]3b complications corrected for age, BMI, ASA-Score and type of urinary diversion. Conclusions We reported that sarcopenia proved an independent predictor for 90 dM and complications in patients undergoing RC for bladder cancer. Author Affiliation: (1) 0000 0001 2190 5763, grid.7727.5, Department of Urology, St. Josef Medical Centre, University of Regensburg, Landshuterstr. 65, 93053, Regensburg, Germany (2) Department of Urology, Surgical Clinic Munich-Bogenhausen, Munich, Germany (3) 0000 0000 9194 7179, grid.411941.8, Centre of Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany (4) 0000 0000 9194 7179, grid.411941.8, Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany (5) grid.415844.8, Department of Urology, Central Hospital of Bolzano, Bolzano, Italy (6) 0000 0004 0367 8888, grid.263618.8, Sigmund Freud University, Medical School of Vienna, Vienna, Austria (7) grid.430814.a, Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Article History: Registration Date: 05/03/2018 Received Date: 19/01/2018 Accepted Date: 05/03/2018 Online Date: 08/03/2018
    Keywords: Frailty ; Skeletal muscle mass ; Bladder cancer ; Prognosis ; Urinary bladder neoplasm
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 10
    Language: English
    In: Gastroenterology, 2011, Vol.140(7), pp.2056-2063.e1
    Description: Patients with ferroportin iron overload due to loss-of-function mutations in have macrophage iron overload, hyperferritinemia, and normal transferrin saturation. In contrast, hepatocellular iron storage, hyperferritinemia, and increased saturation of transferrin are a distinct clinical presentation of ferroportin iron overload that results from mutations that confer resistance of ferroportin to hepcidin-mediated inactivation. was sequenced in patients from 2 independent pedigrees affected by hepatic iron overload unrelated to HFE. Functions of the ferroportin variants were tested in vitro. A patient heterozygous for the variant p.W158C in presented with macrophage iron overload, hyperferritinemia, and normal transferrin saturation. A patient with hepatocellular iron storage, hyperferritinemia, and increased transferrin saturation was heterozygous for p.H507R. Expression of the p.W158C form of ferroportin in 293T cells resulted in defective trafficking to the plasma membrane and reduced iron export activity; the iron export activity of cells that expressed the p.H507R form of ferroportin did not differ from cells that expressed ferroportin without this mutation. The p.H507R of ferroportin localizes normally to the plasma membrane but is resistant to hepcidin-mediated inactivation. Addition of a synthetic peptide derived from ferroportin without these mutations (amino acids 500–518) decreased the inhibitory activity of hepcidin in cells, whereas a peptide from the same region, with p.H507R, had no effect on hepcidin activity. The variant p.W158C in impairs intracellular trafficking of ferroportin, resulting in reduced iron export. The variant p.H507R does not bind hepcidin in vitro and results in apparent hepcidin resistance.
    Keywords: Hyperferritinemia ; Non-Hfe Hemochromatosis ; Bioinformatics ; Slc11a3 ; Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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