@article{ZipfelEyrichSchlegeletal.2016,
  author    = {Zipfel, Julian and Eyrich, Matthias and Schlegel, Paul-Gerhardt and Wiegering, Verena},
  title     = {Disturbed B cell and DC-Homeostasis in Pediatric cGVHD Patients-Cocultivation Experiments and Review of the Literature},
  series = {Clinics in Oncology},
  volume    = {1},
  journal   = {Clinics in Oncology},
  number    = {1097},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-147914},
  year      = {2016},
  abstract  = {B cells and DCs are suspected to play an important role in the pathogenesis of cGvHD, which is a serious complication of HSCT with high morbidity. It is characterized by immune responses of donor immune cells against recipient-derived antigens. athogenesis is not yet fully understood, however reconstitution of B cells after HSCT has similarities to physiologic ontogeny. Immunophenotyping and co-cultivation-experiments of B cells and DCs from pediatric patients with cGvHD as well as healthy donors were conducted. Significant differences between patients and healthy donors were observed with increased memory, transitional, CD69+ and CD86+ phenotype and lower levels of na{\"i}ve B cells due to apoptosis. Co-cultivation revealed this to be primarily B cell-dependent without major effects of and with DCs. There was a decreased CD11c- phenotype in patients and less apoptosis of DCs. Our data suggest a disturbed homeostasis in B cells with increased memory phenotype in patients, whereas DCs could not influence these differences, therefore DCs are not imposing as promising targets. B cell-dependent approaches should be further investigated.},
  language  = {en}
}
@article{StraussMoskalenkoTiurbeetal.2012,
  author    = {Strauss, Armin and Moskalenko, Vasily and Tiurbe, Christian and Chodnevskaja, Irina and Timm, Stephan and Wiegering, Verena A. and Germer, Chrioph Thomas and Ulrichs, Karin},
  title     = {Goettingen Minipigs (GMP): Comparison of Two Different Models for Inducing Diabetes},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75119},
  year      = {2012},
  abstract  = {Purpose: Preclinical experiments on large animals are indispensable for evaluating the effectiveness of diabetes therapies. Miniature swine are well suited for such studies due to their physiological and pathophysiological responses. Methods: We compare two methods for inducing diabetes in Goettingen minipigs (GMP), in five with the beta cell toxin streptozotocin (STZ) and in five other GMP by total pancreatectomy (PE). Glucose homeostasis was assessed with the intravenous glucose-tolerance test (IVGTT) and continual monitoring of interstitial glucose levels. At conclusion of the observation period, the pancreata were examined histologically. Three non-diabetic GMP served as control group. Results: The IVGTT revealed markedly diabetic profiles in both GMP groups. STZ-GMP were found to harbor residual C-peptides and scattered insulin-positive cells in the pancreas. PE-GMP survived the total pancreatectomy only with intensive postoperative care. Conclusions: Although both methods reliably induced diabetes in GMP, the PE-GMP clearly had more health problems and required a greater expenditure of time and resources. The PE-GMP model, however, was better at eliminating endogenous insulin and C-peptide than the STZ-GMP model.},
  subject      = {G{\"o}ttingen},
  language  = {en}
}
@article{WiegeringSchickBeeretal.2011,
  author    = {Wiegering, Verena and Schick, Judith and Beer, Meinrad and Gattenl{\"o}hner, Stefan and Girschick, Hermann and Liese, Johannes and Schlegel, Paul and Eyrich, Matthias},
  title     = {Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68723},
  year      = {2011},
  abstract  = {Background: Infection with varicella-zoster virus (VZV) contemporaneously with malignant disease or immunosuppression represents a particular challenge and requires individualized decisions and treatment. Although the increasing use of varicella-vaccines in the general population and rapid initiation of VZVimmunoglobulins and acyclovir in case of exposure has been beneficial for some patients, immunocompromised individuals are still at risk for unfavourable courses. Methods: In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZVinfections in our center and compare them to published data. Furthermore, we report three instructive cases. Results: Hospitalization rate of referred children with VZV-infections was 45\%, among these 17\% with malignancies and 9\% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroiddependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h. Conclusion: Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.},
  subject      = {Varizellen-Virus},
  language  = {en}
}
@article{WiegeringAndresSchlegeletal.2013,
  author    = {Wiegering, Verena and Andres, Oliver and Schlegel, Paul G. and Deinlein, Frank and Eyrich, Matthias and Sturm, Alexander},
  title     = {Hyperfibrinolysis and acquired factor XIII deficiency in newly diagnosed pediatric malignancies},
  series = {Haematologica},
  volume    = {98},
  journal   = {Haematologica},
  number    = {8},
  doi       = {10.3324/haematol.2013.089045},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130569},
  pages     = {E90-E91},
  year      = {2013},
  abstract  = {No abstract available},
  language  = {en}
}
@article{WiegeringSchmidAndresetal.2014,
  author    = {Wiegering, Verena and Schmid, Sophie and Andres, Oliver and Wirth, Clemens and Wiegering, Armin and Meyer, Thomas and Winkler, Beate and Schlegel, Paul G. and Eyrich, Matthias},
  title     = {Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience},
  doi       = {10.1186/2052-1839-14-18},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110476},
  year      = {2014},
  abstract  = {Background Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins—e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring—can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage. Methods Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation. Results Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20\%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis. Conclusions We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.},
  language  = {en}
}
@article{HendricksMuellerFassnachtetal.2022,
  author    = {Hendricks, Anne and M{\"u}ller, Sophie and Fassnacht, Martin and Germer, Christoph-Thomas and Wiegering, Verena A. and Wiegering, Armin and Reibetanz, Joachim},
  title     = {Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma — a systematic review and meta-analysis},
  series = {Cancers},
  volume    = {14},
  journal   = {Cancers},
  number    = {2},
  issn      = {2072-6694},
  doi       = {10.3390/cancers14020291},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254798},
  year      = {2022},
  abstract  = {(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I-III) and those including all tumor stages (I-IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001-2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I-III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95\% confidence interval (95\% CI): 0.26-0.68). Based on results of studies including patients with ACC stage I-IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95\% CI: 0.70-1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I-III).},
  language  = {en}
}
@phdthesis{Wiegering2010,
  author    = {Wiegering, Verena},
  title     = {Immunfunktion unter ALL-Therapie : prospektive Studie an 23 Kindern: Untersuchungen der Zytokinproduktion und der T-Zellregeneration mittels Durchflußzytometrie, TRECS, Immunoscope und ELISA},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-43834},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2010},
  abstract  = {Einleitung: Eine nicht ad{\"a}quate Funktion des Immunsystems ist ein großes klinisches Problem, welches Chemotherapien durch schwere bakterielle oder mykotische Infektionen komplikationsreich macht. W{\"a}hrend einer Immunantwort spielen Zytokine, die von T-Zellen produziert werden, eine wichtige Rolle f{\"u}r die Effektivit{\"a}t der Antwort. Um zu verstehen, welche Ver{\"a}nderungen w{\"a}hrend der Therapie im Immunsystem auftreten, untersuchten wir die Subpopulationen und Funktionen (Zytokine , Immunglobuline) der Lymphozyten. Patienten: 23 Kinder (medianes Alter 5y; 2m-14y; 15 weiblich, 8 m{\"a}nnlich) mit B-ALL behandelt nach dem ALL-BFM 2000-Protokoll. Blutproben wurden gesammelt bei Diagnosestellung und an den Tagen 8, 15, 33, 64 sowie vor Protokoll M, vor Protokoll 2 und w{\"a}hrend der Erhaltungstherapie. Methoden: Wir analysierten die Lymphozyten-Subpopulation mittels Durchflußzytometrie. Die Bestimmung intrazellul{\"a}re Zytokine (IFN\&\#947;, IL2, TNF\&\#945;, IL4, IL5, and IL10) erfolgte durch FACS-Analysen nach in vitro Stimulation mit PMA, Ionomycin und Brefeldin f{\"u}r 24h. Zus{\"a}tzlich untersuchten wir verschiedene Zytokine im unstimulierten Serum mittels ELISA und studierten TRECs und Spectratypes sowie die Immunglobulinlevels. Ergebnisse: Die B-Zellen verringerten sich schnell von einem Medianen Wert von 301+120/mm³ vor Chemotherapie auf 85+138/mm³ am Tag 33 und stiegen nicht mehr bis zum Ende der Therapie an. Die T-Zellzahl fiel zu Beginn der Therapie ab, allerdings konnten wir partielle Erholungen, die proportional zur Therapieintensit{\"a}t waren detektieren. Zudem fiel eine Verschiebung zugunsten der CD8+-Zellen auf. NK-Zellen zeigten keine signifikanten Ver{\"a}nderungen. Bei den von CD3+ -Zellen produzierten Zytokinen fiel eine Expressionssteigerung von IFN\&\#947; auf. Wir konnten eine Korrelation zwischen \&\#947;\&\#948;-TCR und IFN\&\#947; -Produktion(FACS) sowie IFN\&\#947; -Werte(ELISA) und hohe Anzahl von Ged{\"a}chtniszellen finden. Außerdem korrelieren CD45RA+Zellen mit CD4IL2+Zellen. TGF\&\#946; im unstimulierten Sera korrelierte signifikant (p<0,01) mit CD19+Zellen. TGF\&\#946; wurde auch von Blasten exprimiert. Wir stellten Unterschiede im Zytokinprofil zwischen dem mit Dexamethason bzw Prednison behandelten Patienten fest; insbesondere die IFN\&\#947;-Sekretion war sehr viel gr{\"o}ßer unter Prednisonbehandlung (p<0,01). TREC-Werte waren h{\"o}her unter Dexamethason, aber das mag mit beeinflusst sein durch das Alter, da j{\"u}ngere Kinder signifikant h{\"o}here TREC-Werte haben. Bei der Analyse des TZR-Repertoire zeigte sich eine h{\"o}here Komplexit{\"a}t im Prednisonzweig. Wir konnten V\&\#946;-Genfamilien mit h{\"o}herer Komplexit{\"a}t (BV22, BV23) und mit niedrigerer Komplexit{\"a}t (BV13b, BV6a) detektieren. Die Komplexit{\"a}t des TZR korrelierte positiv mit der Anzahl der naiven T-Zellen und dem Alter(p<0,01). Bis d15 nahm die Komplexit{\"a}t des Repertoires ab und erholte sich langsam im Therapieverlauf. Zusammenfassung: Wir detektierten eine Verschiebung zu Gunsten der TH1-Zytokine. B-Zellen wurden durch die Therapie ausgel{\"o}scht. Dieses Ergebnis mag eine klinische Relevanz haben in der prophylaktischen Gabe von Immunglobulinen, um schwere Infektionen durch das Fehlen der B-Zellen zu vermeiden.},
  subject      = {Cytokine},
  language  = {de}
}
@article{GerhardHartmannWiegeringBenoitetal.2021,
  author    = {Gerhard-Hartmann, Elena and Wiegering, Verena and Benoit, Clemens and Meyer, Thomas and Rosenwald, Andreas and Maurus, Katja and Ernestus, Karen},
  title     = {A large retroperitoneal lipoblastoma as an incidental finding: a case report},
  series = {BMC Pediatrics},
  volume    = {21},
  journal   = {BMC Pediatrics},
  doi       = {10.1186/s12887-021-02628-w},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260173},
  year      = {2021},
  abstract  = {Background Lipoblastoma is a rare benign mesenchymal neoplasm of infancy that most commonly occurs on the extremities and trunk but can arise at variable sites of the body. Retroperitoneal lipoblastomas are particularly rare but can grow to enormous size, and preoperative diagnosis is difficult with diverse, mostly malignant differential diagnoses that would lead to aggressive therapy. Since lipoblastoma is a benign tumor that has an excellent prognosis after resection, correct diagnosis is crucial. Case presentation A case of a large retroperitoneal tumor of a 24-month old infant that was clinically suspicious of a malignant tumor is presented. Due to proximity to the right kidney, clinically most probably a nephroblastoma or clear cell sarcoma of the kidney was suspected. Radiological findings were ambiguous. Therefore, the mass was biopsied, and histology revealed an adipocytic lesion. Although mostly composed of mature adipocytes, in view of the age of the patient, the differential diagnosis of a (maturing) lipoblastoma was raised, which was supported by molecular analysis demonstrating a HAS2-PLAG1 fusion. The tumor was completely resected, and further histopathological workup led to the final diagnosis of a 13 cm large retroperitoneal maturing lipoblastoma. The child recovered promptly from surgery and showed no evidence of recurrence so far. Conclusion Although rare, lipoblastoma should be included in the differential diagnoses of retroperitoneal tumors in infants and children, and molecular diagnostic approaches could be a helpful diagnostic adjunct in challenging cases.},
  language  = {en}
}
@article{UttingerRiedmeierReibetanzetal.2022,
  author    = {Uttinger, Konstantin L. and Riedmeier, Maria and Reibetanz, Joachim and Meyer, Thomas and Germer, Christoph Thomas and Fassnacht, Martin and Wiegering, Armin and Wiegering, Verena},
  title     = {Adrenalectomies in children and adolescents in Germany - a diagnose related groups based analysis from 2009-2017},
  series = {Frontiers in Endocrinology},
  volume    = {13},
  journal   = {Frontiers in Endocrinology},
  issn      = {1664-2392},
  doi       = {10.3389/fendo.2022.914449},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282280},
  year      = {2022},
  abstract  = {Background Adrenalectomies are rare procedures especially in childhood. So far, no large cohort study on this topic has been published with data on to age distribution, operative procedures, hospital volume and operative outcome. Methods This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes) of patients between the age 0 and 21 years in Germany were included. Results A total of 523 patient records were identified. The mean age was 8.6 ± 7.7 years and 262 patients were female (50.1\%). The majority of patients were between 0 and 5 years old (52\% overall), while 11.1\% were between 6 and 11 and 38.8\% older than 12 years. The most common diagnoses were malignant neoplasms of the adrenal gland (56\%, mostly neuroblastoma) with the majority being younger than 5 years. Benign neoplasms in the adrenal gland (D350) account for 29\% of all cases with the majority of affected patients being 12 years or older. 15\% were not defined regarding tumor behavior. Overall complication rate was 27\% with a clear higher complication rate in resection for malignant neoplasia of the adrenal gland. Bleeding occurrence and transfusions are the main complications, followed by the necessary of relaparotomy. There was an uneven patient distribution between hospital tertiles (low volume, medium and high volume tertile). While 164 patients received surgery in 85 different "low volume" hospitals (0.2 cases per hospital per year), 205 patients received surgery in 8 different "high volume" hospitals (2.8 cases per hospital per year; p<0.001). Patients in high volume centers were significant younger, had more extended resections and more often malignant neoplasia. In multivariable analysis younger age, extended resections and open procedures were independent predictors for occurrence of postoperative complications. Conclusion Overall complication rate of adrenalectomies in the pediatric population in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a very uneven distribution of patient volume among hospitals.},
  language  = {en}
}
@article{RiedmeierDecarolisHaubitzetal.2021,
  author    = {Riedmeier, Maria and Decarolis, Boris and Haubitz, Imme and M{\"u}ller, Sophie and Uttinger, Konstantin and B{\"o}rner, Kevin and Reibetanz, Joachim and Wiegering, Armin and H{\"a}rtel, Christoph and Schlegel, Paul-Gerhardt and Fassnacht, Martin and Wiegering, Verena},
  title     = {Adrenocortical carcinoma in childhood: a systematic review},
  series = {Cancers},
  volume    = {13},
  journal   = {Cancers},
  number    = {21},
  issn      = {2072-6694},
  doi       = {10.3390/cancers13215266},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-248507},
  year      = {2021},
  abstract  = {Adrenocortical tumors are rare in children. This systematic review summarizes the published evidence on pediatric adrenocortical carcinoma (ACC) to provide a basis for a better understanding of the disease, investigate new molecular biomarkers and therapeutic targets, and define which patients may benefit from a more aggressive therapeutic approach. We included 137 studies with 3680 ACC patients (~65\% female) in our analysis. We found no randomized controlled trials, so this review mainly reflects retrospective data. Due to a specific mutation in the TP53 gene in ~80\% of Brazilian patients, that cohort was analyzed separately from series from other countries. Hormone analysis was described in 2569 of the 2874 patients (89\%). Most patients were diagnosed with localized disease, whereas 23\% had metastasis at primary diagnosis. Only 72\% of the patients achieved complete resection. In 334 children (23\%), recurrent disease was reported: 81\% — local recurrence, 19\% (n = 65) — distant metastases at relapse. Patients < 4 years old had a different distribution of tumor stages and hormone activity and better overall survival (p < 0.001). Although therapeutic approaches are typically multimodal, no consensus is available on effective standard treatments for advanced ACC. Thus, knowledge regarding pediatric ACC is still scarce and international prospective studies are needed to implement standardized clinical stratifications and risk-adapted therapeutic strategies.},
  language  = {en}
}
@article{ManukjanWiegeringReindletal.2020,
  author    = {Manukjan, Georgi and Wiegering, Verena and Reindl, Tobias and Strauß, Gabriele and Klopocki, Eva and Schulze, Harald and Andres, Oliver},
  title     = {Novel variants in FERMT3 and RASGRP2 - Genetic linkage in Glanzmann-like bleeding disorders},
  series = {Pediatric Blood \& Cancer},
  volume    = {67},
  journal   = {Pediatric Blood \& Cancer},
  number    = {2},
  doi       = {10.1002/pbc.28078},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-208129},
  pages     = {e28078},
  year      = {2020},
  abstract  = {Defects of platelet intracellular signaling can result in severe platelet dysfunction. Several mutations in each of the linked genes FERMT3 and RASGRP2 on chromosome 11 causing a Glanzmann-like bleeding phenotype have been identified so far. We report on novel variants in two unrelated pediatric patients with severe bleeding diathesis—one with leukocyte adhesion deficiency type III due to a homozygous frameshift in FERMT3 and the other with homozygous variants in both, FERMT3 and RASGRP2 . We focus on the challenging genetic and functional variant assessment and aim to accentuate the risk of obtaining misleading results due to the phenomenon of genetic linkage.},
  language  = {en}
}
@article{KrakowCrescimoneBartelsetal.2019,
  author    = {Krakow, S{\"o}ren and Crescimone, Marie L. and Bartels, Charlotte and Wiegering, Verena and Eyrich, Matthias and Schlegel, Paul G. and W{\"o}lfl, Matthias},
  title     = {Re-expression of CD14 in response to a combined IL-10/TLR stimulus defines monocyte-derived cells with an immunoregulatory phenotype},
  series = {Frontiers in Immunology},
  volume    = {10},
  journal   = {Frontiers in Immunology},
  number    = {1484},
  doi       = {10.3389/fimmu.2019.01484},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201537},
  year      = {2019},
  abstract  = {Interleukin 10 is a central regulator of the antigen-presenting function of myeloid cells. It exerts immunomodulatory effects in vivo and induces a regulatory phenotype in monocyte-derived cells in vitro. We analyzed phenotype and function of monocytic cells in vitro in relation to the cytokine milieu and the timing of TLR-based activation. In GM-CSF/IL-4 cultured human monocytic cells, we identified two, mutually exclusive cell populations arising from undifferentiated cells: CD83\(^+\) fully activated dendritic cells and CD14\(^+\) macrophage like cells. Re-expression of CD14 occurs primarily after a sequential trigger with a TLR signal following IL-10 preincubation. This cell population with re-expressed CD14 greatly differs in phenotype and function from the CD83+ cells. Detailed analysis of individual subpopulations reveals that exogenous IL-10 is critical for inducing the shift toward the CD14\(^+\) population, but does not affect individual changes in marker expression or cell function in most cases. Thus, plasticity of CD14 expression, defining a subset of immunoregulatory cells, is highly relevant for the composition of cellular products (such as DC vaccines) as it affects the function of the total product.},
  language  = {en}
}
@article{RufBadranSiauwetal.2021,
  author    = {Ruf, Katharina and Badran, Alaa and Siauw, C{\´e}line and Haubitz, Imme and Schlegel, Paul-Gerhardt and Hebestreit, Helge and H{\"a}rtel, Christoph and Wiegering, Verena},
  title     = {Does allogeneic stem cell transplantation in survivors of pediatric leukemia impact regular physical activity, pulmonary function, and exercise capacity?},
  series = {Molecular and Cellular Pediatrics},
  volume    = {8},
  journal   = {Molecular and Cellular Pediatrics},
  doi       = {10.1186/s40348-021-00127-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265528},
  year      = {2021},
  abstract  = {Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved survival in high-risk childhood leukemia but is associated with long-term sequelae such as impaired pulmonary function and reduced exercise capacity impacting quality of life. Methods A convenience sample of 17 patients after allo-HSCT (HSCT—12 male, age 15.7±6.7 years, time after HSCT 5.3±2.8 years) underwent pulmonary function testing, echocardiography, and an incremental exercise test on a bike. Physical activity and health-related quality of life were assessed by questionnaires (7-day physical activity recall, PEDS-QL). Seventeen healthy age- and gender-matched controls served as control group (CG) for results of pulmonary function and exercise testing. Results HSCT showed reduced pulmonary function (HSCT vs. CG: FEV1 90.5±14.0 vs. 108.0±8.7\%pred; FVC 88.4±19.3 vs. 107.6±6.9\%pred, DLCO 75.3±23.6 vs. 104.9±12.8\%pred) and exercise capacity (VO2peak 89±30.8\%pred, CG 98±17.5\%pred; Wmax 84±21.7\%pred, CG 115±22.8\%pred), but no relevant cardiac dysfunction and a good quality of life (PEDS-QL mean overall score 83.3±10.7). Differences in peak oxygen uptake between groups were mostly explained by 5 adolescent patients who underwent total body irradiation for conditioning. They showed significantly reduced diffusion capacity and reduced peak oxygen uptake. Patients reported a mean time of inactivity of 777±159min/day, moderate activity of 110±107 min/day, hard activity of 35±36 min/day, and very hard activity of 23±22 min/day. A higher amount of inactivity was associated with a lower peak oxygen uptake (correlation coefficient tau -0.48, p=0.023). Conclusions This pilot study shows that although patients after allo-HSCT reported a good quality of life, regular physical activity and exercise capacity are reduced in survivors of stem cell transplantation, especially in adolescents who are treated with total body irradiation for conditioning. Factors hindering regular physical activity need to be identified and exercise counseling should be part of follow-up visits in these patients.},
  language  = {en}
}
@article{WiegeringRiedmeierThompsonetal.2022,
  author    = {Wiegering, Verena and Riedmeier, Maria and Thompson, Lester D. R. and Virgone, Calogero and Redlich, Antje and Kuhlen, Michaela and Gultekin, Melis and Yalcin, Bilgehan and Decarolis, Boris and H{\"a}rtel, Christoph and Schlegel, Paul-Gerhardt and Fassnacht, Martin and Timmermann, Beate},
  title     = {Radiotherapy for pediatric adrenocortical carcinoma - Review of the literature},
  series = {Clinical and Translational Radiation Oncology},
  volume    = {35},
  journal   = {Clinical and Translational Radiation Oncology},
  doi       = {10.1016/j.ctro.2022.05.003},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300472},
  pages     = {56-63},
  year      = {2022},
  abstract  = {Background and purpose Pediatric adrenocortical carcinoma (pACC) is a rare disease with poor prognosis. Publications on radiotherapy (RT) are scarce. This review summarizes the current data on RT for pACC and possibly provides first evidence to justify its use in this setting. Materials and methods We searched the PubMed and Embase database for manuscripts regarding RT for pACC. Results We included 17 manuscripts reporting on 76 patients treated with RT, after screening 2961 references and 269 full articles. In addition, we added data of 4 unreported pACC patients treated by co-authors. All reports based on retrospective data. Median age at first diagnosis was 11.1 years (70\% female); 78\% of patients presented with hormonal activity. RT was mostly performed for curative intent (78\%). 88\% of RT were administered during primary therapy. The site of RT was predominantly the local tumor bed (76\%). Doses of RT ranged from 15 to 62 Gy (median 50 Gy). Information on target volumes or fractionation were lacking. Median follow-up was 6,9 years and 64\% of the patients died of disease, with 33\% alive without disease. In 16 of 48 patients with available follow-up data after adjuvant RT (33\%) no recurrence was reported and in 3 of 9 patients palliative RT seemed to induce some benefit for the patient. Conclusions Our first systematic review on RT for pACC provides too few data for any general recommendation, but adjuvant RT in patients with high risk might be considered. International collaborative studies are urgently needed to establish better evidence on the role of RT in this rare malignancy.},
  language  = {en}
}
@article{vonLukowiczSchlegelHaerteletal.2021,
  author    = {von Lukowicz, Hannah and Schlegel, Paul-Gerhardt and H{\"a}rtel, Christoph and Morbach, Henner and Haubitz, Imme and Wiegering, Verena},
  title     = {ESPED survey on newly diagnosed immune thrombocytopenia in childhood: how much treatment do we give?},
  series = {Molecular and Cellular Pediatrics},
  volume    = {8},
  journal   = {Molecular and Cellular Pediatrics},
  doi       = {10.1186/s40348-021-00121-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261832},
  year      = {2021},
  abstract  = {Background Immune thrombocytopenia (ITP) is an autoimmune disease associated with isolated thrombocytopenia, which is caused by an imbalance between platelet production and platelet destruction. Petechial and mucous membrane hemorrhages are characteristic of ITP, but life-threatening bleeding rarely occurs. Depending on the bleeding symptoms, ITP can be treated with glucocorticoids (GC), intravenous immunoglobulins (IVIG), or in severe cases, platelet transfusions. Mild bleeding does not necessarily require therapy. Using the German Surveillance Unit for rare Pediatric Diseases (ESPED) we conducted a prospective survey on ITP patients in all German Children's Hospitals between September 2018 and August 2019. We collected data on ITP, including the clinical course, therapy implementation recommendations (according to the Association of German Scientific Medical Societies guidelines), outcome, and influence of treatment regimens depending on the treating physician´s experience with ITP patients. Results Of the 287 recorded cases of children with ITP, 268 questionnaires were sent to the authors. Two hundred seventeen of the questionnaires fulfilled the inclusion criteria. ITP affected boys and girls similarly, and the median age of manifestation was 3.5 years. The main reasons for hospitalization were thrombocytopenia, bleeding signs, hematomas, and/or petechiae. Bleeding scores were ≤ 3 in 96\% of children, which corresponded to a low-to-moderately low risk of bleeding. No life-threatening bleeding was documented. The most common therapies were IVIG (n = 59), GC (n = 33), or a combination of these (n = 17). Blood products (i.e., red blood cells, platelet concentrate, and fresh frozen plasma) were given to 13 patients. Compared to the established guidelines, 67 patients were over-treated, and 2 patients were under-treated. Conclusions Adherence to German ITP treatment guidelines is currently limited. To improve patient safety and medical care, better medical training and dissemination of the guidelines are required in line with targeted analyses of patients with serious bleeding events to identify potential risk constellations.},
  language  = {en}
}
@article{ReibetanzKelmUttingeretal.2022,
  author    = {Reibetanz, Joachim and Kelm, Matthias and Uttinger, Konstantin L. and Reuter, Miriam and Schlegel, Nicolas and Hankir, Mohamed and Wiegering, Verena and Germer, Christoph-Thomas and Fassnacht, Martin and Lock, Johan Friso and Wiegering, Armin},
  title     = {Differences in morbidity and mortality between unilateral adrenalectomy for adrenal Cushing's syndrome and bilateral adrenalectomy for therapy refractory extra-adrenal Cushing's syndrome},
  series = {Langenbeck's Archives of Surgery},
  volume    = {407},
  journal   = {Langenbeck's Archives of Surgery},
  number    = {6},
  doi       = {10.1007/s00423-022-02568-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323947},
  pages     = {2481-2488},
  year      = {2022},
  abstract  = {Purpose In selected cases of severe Cushing's syndrome due to uncontrolled ACTH secretion, bilateral adrenalectomy appears unavoidable. Compared with unilateral adrenalectomy (for adrenal Cushing's syndrome), bilateral adrenalectomy has a perceived higher perioperative morbidity. The aim of the current study was to compare both interventions in endogenous Cushing's syndrome regarding postoperative outcomes. Methods We report a single-center, retrospective cohort study comparing patients with hypercortisolism undergoing bilateral vs. unilateral adrenalectomy during 2008-2021. Patients with adrenal Cushing's syndrome due to adenoma were compared with patients with ACTH-dependent Cushing's syndrome (Cushing's disease and ectopic ACTH production) focusing on postoperative morbidity and mortality as well as long-term survival. Results Of 83 patients with adrenalectomy for hypercortisolism (65.1\% female, median age 53 years), the indication for adrenalectomy was due to adrenal Cushing's syndrome in 60 patients (72.2\%; 59 unilateral and one bilateral), and due to hypercortisolism caused by Cushing's disease (n = 16) or non-pituitary uncontrolled ACTH secretion of unknown origin (n = 7) (27.7\% of all adrenalectomies). Compared with unilateral adrenalectomy (n = 59), patients with bilateral adrenalectomy (n = 24) had a higher rate of severe complications (0\% vs. 33\%; p < 0.001) and delayed recovery (median: 10.2\% vs. 79.2\%; p < 0.001). Using the MTL30 marker, patients with bilateral adrenalectomy fared worse than patients after unilateral surgery (MTL30 positive: 7.2\% vs. 25.0\% p < 0.001). Postoperative mortality was increased in patients with bilateral adrenalectomy (0\% vs. 8.3\%; p = 0.081). Conclusion While unilateral adrenalectomy for adrenal Cushing's syndrome represents a safe and definitive therapeutic option, bilateral adrenalectomy to control ACTH-dependent extra-adrenal Cushing's syndrome or Cushing's disease is a more complicated intervention with a mortality of nearly 10\%.},
  language  = {en}
}
@article{AugustinKertelsWiegeringetal.2022,
  author    = {Augustin, Anne Marie and Kertels, Olivia and Wiegering, Verena and Thurner, Annette and Kickuth, Ralph},
  title     = {Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients},
  series = {Pediatric Radiology},
  volume    = {52},
  journal   = {Pediatric Radiology},
  number    = {8},
  doi       = {10.1007/s00247-022-05321-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324947},
  pages     = {1550-1558},
  year      = {2022},
  abstract  = {Background Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. Objective To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. Materials and methods Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. Results Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1\%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. Conclusion Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.},
  language  = {en}
}