@article{KleinertRollBaumgaertneretal.2012, author = {Kleinert, Stefan and Roll, Petra and Baumgaertner, Christian and Himsel, Andrea and Burkhardt, Harald and Mueller, Adelheid and Fleck, Martin and Feuchtenberger, Martin and Janett, Manfred and Tony, Hans-Peter}, title = {Renal Perfusion in Scleroderma Patients Assessed by Microbubble-Based Contrast-Enhanced Ultrasound}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75207}, year = {2012}, abstract = {Abstract: Objectives: Renal damage is common in scleroderma. It can occur acutely or chronically. Renal reserve might already be impaired before it can be detected by laboratory findings. Microbubble-based contrast-enhanced ultrasound has been demonstrated to improve blood perfusion imaging in organs. Therefore, we conducted a study to assess renal perfusion in scleroderma patients utilizing this novel technique. Materials and Methodology: Microbubble-based contrast agent was infused and destroyed by using high mechanical index by Siemens Sequoia (curved array, 4.5 MHz). Replenishment was recorded for 8 seconds. Regions of interests (ROI) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California). Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE\%A) were calculated for different ROIs. Results: There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate. However, the other parameters did not reveal significant differences between scleroderma patients and healthy controls. Conclusion: Renal perfusion of scleroderma patients including the glomerular filtration rate can be assessed using microbubble-based contrast media.}, subject = {Medizin}, language = {en} } @article{ScharbatkeBehrensSchmalzingetal.2016, author = {Scharbatke, Eva C. and Behrens, Frank and Schmalzing, Marc and Koehm, Michaela and Greger, Gerd and Gnann, Holger and Burkhardt, Harald and Tony, Hans-Peter}, title = {Association of improvement in pain with therapeutic response as determined by individual improvement criteria in patients with rheumatoid arthritis}, series = {Arthritis Care \& Research}, volume = {68}, journal = {Arthritis Care \& Research}, number = {11}, doi = {10.1002/acr.22884}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-186817}, pages = {1607-1615}, year = {2016}, abstract = {Objective To use statistical methods to establish a threshold for individual response in patient-reported outcomes (PROs) in patients with rheumatoid arthritis. Methods We used an analysis of variance model in patients on stable therapy (discovery cohort) to establish critical differences (d(crit)) for the minimum change associated with a significant individual patient response (beyond normal variation) in the PRO measures of pain (0-10), fatigue (0-10), and function (Funktionsfragebogen Hannover questionnaire; 0-100). We then evaluated PRO responses in patients initiating adalimumab in a noninterventional study (treatment cohort). Results In the discovery cohort (n=700), PROs showed excellent long-term retest reliability. The minimum change that exceeded random fluctuation was conservatively determined to be 3 points for pain, 4 points for fatigue, and 16 points for function. In the treatment cohort (n=2,788), 1,483 patients (53.2\%) achieved a significant individual therapeutic response as assessed by Disease Activity Score in 28 joints (DAS28)-d(crit) (1.8 points) after 12 months of adalimumab treatment; 68.5\% of patients with a DAS28-d(crit) response achieved a significant improvement in pain, whereas approximately 40\% achieved significant improvements in fatigue or function. Significant improvements in all 3 PROs occurred in 22.7\% of patients; 22.8\% did not have any significant PRO responses. In contrast, significant improvements in all 3 PROs occurred in only 4.4\% of 1,305 patients who did not achieve a DAS28-d(crit) response at month 12, and 59.1\% did not achieve any significant PRO responses. Conclusion The establishment of critical differences in PROs distinguishes true responses from random variation and provides insights into appropriate patient management.}, language = {en} }