TY - JOUR A1 - Hofrichter, Michaela A. H. A1 - Doll, Julia A1 - Habibi, Haleh A1 - Enayati, Samaneh A1 - Mehrjardi, Mohammad Yahya Vahidi A1 - Müller, Tobias A1 - Dittrich, Marcus A1 - Haaf, Thomas A1 - Vona, Barbara T1 - Exome-wide copy number variation analysis identifies a COL9A1 in frame deletion that is associated with hearing loss JF - European Journal of Medical Genetics N2 - Pathogenic variants in COL9A1 are primarily associated with autosomal recessive Stickler syndrome. Patients with COL9A1-associated Stickler syndrome (STL) present hearing loss (HL), ophthalmic manifestations and skeletal abnormalities. However, the clinical spectrum of patients with COL9A1 variants can also include multiple epiphyseal dysplasia, as well as non-syndromic HL that was observed in one previously reported proband. Exome sequencing was performed on the genomic DNA of an Iranian patient and his affected brother who both report non-syndromic HL. A 44.6 kb homozygous in-frame deletion spanning exons 6 to 33 of COL9A1 was detected via exome-based copy number variation analysis. The deleted exons were confirmed by PCR in the patient and his affected brother, who both have non-syndromic HL. Segregation analysis via qPCR confirmed the parents as heterozygous deletion carriers. Breakpoint analysis mapped the homozygous deletion spanning introns 5 to 33 (g.70,948,188_70,997,277del, NM_001851.4(COL9A1):c.697–3754_2112+769del, p.(Phe233_Ser704del), with an additional 67 bp of inserted intronic sequence that may have originated due to a fork stalling and template switching/microhomology-mediated break-induced replication (FoSTeS/MMBIR) mechanism. This mechanism has not been previously implicated in HL or STL. This is also the first reported copy number variation in COL9A1 that was identified through an exome data set in an Iranian family with apparent non-syndromic HL. The present study emphasizes the importance of exome-wide copy number variation analysis in molecular diagnosis and provides supporting evidence to associate COL9A1 with autosomal recessive non-syndromic HL. KW - COL9A1 KW - copy number variation KW - FoSTeS/MMBIR mechanism KW - non-syndromic hearing loss KW - Stickler syndrome Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-322008 VL - 62 ER - TY - JOUR A1 - Elliot, Perry M. A1 - Germain, Dominique P. A1 - Hilz, Max J. A1 - Spada, Marco A1 - Wanner, Christoph A1 - Falissard, Bruno T1 - Why systematic literature reviews in Fabry disease should include all published evidence JF - European Journal of Medical Genetics N2 - Fabry disease is an X-linked inherited, progressive disorder of lipid metabolism resulting from the deficient activity of the enzyme α-galactosidase. Enzyme replacement therapy (ERT) with recombinant agalsidase, with intravenous infusions of either agalsidase beta or agalsidase alfa, is available and clinical experience now exceeds 15 years. There are very few randomised, placebo-controlled clinical trials evaluating the outcomes of ERT. Data are often derived from observational, registry-based studies and case reports. Pooled analysis of data from different sources may be limited by the heterogeneity of the patient populations, outcomes and treatment. Therefore, comprehensive systematic literature reviews of unpooled data are needed to determine the effects of ERT on disease outcomes. A systematic literature search was conducted in the Embase and PubMed (MEDLINE) databases to retrieve original articles that evaluated outcomes of ERT in patients with Fabry disease; the outcome data were analysed unpooled. The literature analysis included the full range of published literature including observational studies and case series/case reports. Considerable heterogeneity was found among the studies, with differences in sample size, statistical methods, ERT regimens and patient demographic and clinical characteristics. We have demonstrated the value of performing an unpooled systematic literature review of all published evidence of ERT outcomes in Fabry disease, highlighting that in a rare genetic disorder like Fabry disease, which is phenotypically diverse, different patient populations can require different disease management and therapeutic goals depending on age, genotype, and disease severity/level of organ involvement. In addition, these findings are valuable to guide the design and reporting of new clinical studies. KW - Fabry disease KW - enzyme replacement therapy KW - systematic literature review Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226654 VL - 62 ER - TY - JOUR A1 - Sondermann, Wiebke A1 - Utikal, Jochen Sven A1 - Enk, Alexander H. A1 - Schadendorf, Dirk A1 - Klode, Joachim A1 - Hauschild, Axel A1 - Weichenthal, Michael A1 - French, Lars E. A1 - Berking, Carola A1 - Schilling, Bastian A1 - Haferkamp, Sebastian A1 - Fröhling, Stefan A1 - von Kalle, Christof A1 - Brinker, Titus J. T1 - Prediction of melanoma evolution in melanocytic nevi via artificial intelligence: A call for prospective data JF - European Journal of Cancer N2 - Recent research revealed the superiority of artificial intelligence over dermatologists to diagnose melanoma from images. However, 30–50% of all melanomas and more than half of those in young patients evolve from initially benign lesions. Despite its high relevance for melanoma screening, neither clinicians nor computers are yet able to reliably predict a nevus’ oncologic transformation. The cause of this lies in the static nature of lesion presentation in the current standard of care, both for clinicians and algorithms. The status quo makes it difficult to train algorithms (and clinicians) to precisely assess the likelihood of a benign skin lesion to transform into melanoma. In addition, it inhibits the precision of current algorithms since ‘evolution’ image features may not be part of their decision. The current literature reveals certain types of melanocytic nevi (i.e. ‘spitzoid’ or ‘dysplastic’ nevi) and criteria (i.e. visible vasculature) that, in general, appear to have a higher chance to transform into melanoma. However, owing to the cumulative nature of oncogenic mutations in melanoma, a more fine-grained early morphologic footprint is likely to be detectable by an algorithm. In this perspective article, the concept of melanoma prediction is further explored by the discussion of the evolution of melanoma, the concept for training of such a nevi classifier and the implications of early melanoma prediction for clinical practice. In conclusion, the authors believe that artificial intelligence trained on prospective image data could be transformative for skin cancer diagnostics by (a) predicting melanoma before it occurs (i.e. pre-in situ) and (b) further enhancing the accuracy of current melanoma classifiers. Necessary prospective images for this research are obtained via free mole-monitoring mobile apps. KW - melanoma KW - skin cancer KW - artificial Intelligence KW - deep learning KW - prediction Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239263 VL - 119 ER - TY - JOUR A1 - Brinker, Titus J. A1 - Hekler, Achim A1 - Enk, Alexander H. A1 - Berking, Carola A1 - Haferkamp, Sebastian A1 - Hauschild, Axel A1 - Weichenthal, Michael A1 - Klode, Joachim A1 - Schadendorf, Dirk A1 - Holland-Letz, Tim A1 - von Kalle, Christof A1 - Fröhling, Stefan A1 - Schilling, Bastian A1 - Utikal, Jochen S. T1 - Deep neural networks are superior to dermatologists in melanoma image classification JF - European Journal of Cancer N2 - Background Melanoma is the most dangerous type of skin cancer but is curable if detected early. Recent publications demonstrated that artificial intelligence is capable in classifying images of benign nevi and melanoma with dermatologist-level precision. However, a statistically significant improvement compared with dermatologist classification has not been reported to date. Methods For this comparative study, 4204 biopsy-proven images of melanoma and nevi (1:1) were used for the training of a convolutional neural network (CNN). New techniques of deep learning were integrated. For the experiment, an additional 804 biopsy-proven dermoscopic images of melanoma and nevi (1:1) were randomly presented to dermatologists of nine German university hospitals, who evaluated the quality of each image and stated their recommended treatment (19,296 recommendations in total). Three McNemar's tests comparing the results of the CNN's test runs in terms of sensitivity, specificity and overall correctness were predefined as the main outcomes. Findings The respective sensitivity and specificity of lesion classification by the dermatologists were 67.2% (95% confidence interval [CI]: 62.6%–71.7%) and 62.2% (95% CI: 57.6%–66.9%). In comparison, the trained CNN achieved a higher sensitivity of 82.3% (95% CI: 78.3%–85.7%) and a higher specificity of 77.9% (95% CI: 73.8%–81.8%). The three McNemar's tests in 2 × 2 tables all reached a significance level of p < 0.001. This significance level was sustained for both subgroups. Interpretation For the first time, automated dermoscopic melanoma image classification was shown to be significantly superior to both junior and board-certified dermatologists (p < 0.001). KW - deep learning KW - melanoma KW - skin cancer KW - artificial intelligence Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220539 VL - 119 ER - TY - JOUR A1 - Brinker, Titus J. A1 - Hekler, Achim A1 - Hauschild, Axel A1 - Berking, Carola A1 - Schilling, Bastian A1 - Enk, Alexander H. A1 - Haferkamp, Sebastian A1 - Karoglan, Ante A1 - von Kalle, Christof A1 - Weichenthal, Michael A1 - Sattler, Elke A1 - Schadendorf, Dirk A1 - Gaiser, Maria R. A1 - Klode, Joachim A1 - Utikal, Jochen S. T1 - Comparing artificial intelligence algorithms to 157 German dermatologists: the melanoma classification benchmark JF - European Journal of Cancer N2 - Background Several recent publications have demonstrated the use of convolutional neural networks to classify images of melanoma at par with board-certified dermatologists. However, the non-availability of a public human benchmark restricts the comparability of the performance of these algorithms and thereby the technical progress in this field. Methods An electronic questionnaire was sent to dermatologists at 12 German university hospitals. Each questionnaire comprised 100 dermoscopic and 100 clinical images (80 nevi images and 20 biopsy-verified melanoma images, each), all open-source. The questionnaire recorded factors such as the years of experience in dermatology, performed skin checks, age, sex and the rank within the university hospital or the status as resident physician. For each image, the dermatologists were asked to provide a management decision (treat/biopsy lesion or reassure the patient). Main outcome measures were sensitivity, specificity and the receiver operating characteristics (ROC). Results Total 157 dermatologists assessed all 100 dermoscopic images with an overall sensitivity of 74.1%, specificity of 60.0% and an ROC of 0.67 (range = 0.538–0.769); 145 dermatologists assessed all 100 clinical images with an overall sensitivity of 89.4%, specificity of 64.4% and an ROC of 0.769 (range = 0.613–0.9). Results between test-sets were significantly different (P < 0.05) confirming the need for a standardised benchmark. Conclusions We present the first public melanoma classification benchmark for both non-dermoscopic and dermoscopic images for comparing artificial intelligence algorithms with diagnostic performance of 145 or 157 dermatologists. Melanoma Classification Benchmark should be considered as a reference standard for white-skinned Western populations in the field of binary algorithmic melanoma classification. KW - benchmark KW - artificial intelligence KW - deep learning KW - melanoma Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220569 VL - 111 ER - TY - JOUR A1 - Tesfamariam, Y. A1 - Jakob, T. A1 - Wöckel, A. A1 - Adams, A. A1 - Weigl, A. A1 - Monsef, I. A1 - Kuhr, K. A1 - Skoetz, N. T1 - Adjuvant bisphosphonates or RANK-ligand inhibitors for patients with breast cancer and bone metastases: A systematic review and network meta-analysis JF - Critical Reviews in Oncology / Hematology N2 - Bone-modifying agents like bisphosphonates and receptor activator of nuclear factor kappaβ ligand (RANK-L) inhibitors are used as supportive treatments in breast cancer patients with bone metastases to prevent skeletal-related events (SREs). Due to missing head-to-head comparisons, a network meta-analysis was performed to provide a hierarchy of these therapeutic options. Through a systematic literature search, 21 randomized controlled trials (RCTs) that fulfilled the inclusion criteria were identified. To prevent SREs, the ranking through P-scores showed denosumab (RR: 0.62; 95%CI: 0.50-0.76), zoledronic acid (RR: 0.72; 95%CI: 0.61-0.84) and pamidronate (RR: 0.76; 95%CI: 0.67-0.85) to be significantly superior to placebo. Due to insufficient or heterogeneous data, overall survival, quality of life, pain response and adverse events were not able to be analyzed within the network. Although data were sparse on adverse events, the risk of significant adverse events appeared low. The results of this review can therefore be used to formulate clinical studies more precisely in order to standardise and focus on patient-relevant outcomes. KW - bisphosphonates KW - RANK-L inhibitors KW - SREs KW - RCTs Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240827 VL - 137 ER - TY - JOUR A1 - Mooij, Wolf M A1 - van Wijk, Dianneke A1 - Beusen, Arthur HW A1 - Brederveld, Robert J A1 - Chang, Manqi A1 - Cobben, Marleen MP A1 - DeAngelis, Don L A1 - Downing, Andrea S A1 - Green, Pamela A1 - Gsell, Alena S A1 - Huttunen, Inese A1 - Janse, Jan H A1 - Janssen, Annette BG A1 - Hengeveld, Geerten M A1 - Kong, Xiangzhen A1 - Kramer, Lilith A1 - Kuiper, Jan J A1 - Langan, Simon J A1 - Nolet, Bart A A1 - Nuijten, Rascha JM A1 - Strokal, Maryna A1 - Troost, Tineke A A1 - van Dam, Anne A A1 - Teurlincx, Sven T1 - Modeling water quality in the Anthropocene: directions for the next-generation aquatic ecosystem models JF - Current Opinion in Environmental Sustainability N2 - “Everything changes and nothing stands still” (Heraclitus). Here we review three major improvements to freshwater aquatic ecosystem models — and ecological models in general — as water quality scenario analysis tools towards a sustainable future. To tackle the rapid and deeply connected dynamics characteristic of the Anthropocene, we argue for the inclusion of eco-evolutionary, novel ecosystem and social-ecological dynamics. These dynamics arise from adaptive responses in organisms and ecosystems to global environmental change and act at different integration levels and different time scales. We provide reasons and means to incorporate each improvement into aquatic ecosystem models. Throughout this study we refer to Lake Victoria as a microcosm of the evolving novel social-ecological systems of the Anthropocene. The Lake Victoria case clearly shows how interlinked eco-evolutionary, novel ecosystem and social-ecological dynamics are, and demonstrates the need for transdisciplinary research approaches towards global sustainability. Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224173 VL - 36 ER - TY - JOUR A1 - Kiefer, Markus A1 - Trumpp, Natalie M. A1 - Schaitz, Caroline A1 - Reuss, Heiko A1 - Kunde, Wilfried T1 - Attentional modulation of masked semantic priming by visible and masked task cues JF - Cognition N2 - In contrast to classical theories of cognitive control, recent evidence suggests that cognitive control and unconscious automatic processing influence each other. First, masked semantic priming, an index of unconscious automatic processing, depends on attention to semantics induced by a previously executed task. Second, cognitive control operations (e.g., implementation of task sets indicating how to process a particular stimulus) can be activated by masked task cues, presented outside awareness. In this study, we combined both lines of research. We investigated in three experiments whether induction tasks and presentation of visible or masked task cues, which signal subsequent semantic or perceptual tasks but do not require induction task execution, comparably modulate masked semantic priming. In line with previous research, priming was consistently larger following execution of a semantic rather than a perceptual induction task. However, we observed in experiment 1 (masked letter cues) a reversed priming pattern following task cues (larger priming following cues signaling perceptual tasks) compared to induction tasks. Experiment 2 (visible letter cues) and experiment 3 (visible color cues) showed that this reversed priming pattern depended only on apriori associations between task cues and task elements (task set dominance), but neither on awareness nor on the verbal or non-verbal format of the cues. These results indicate that task cues have the power to modulate subsequent masked semantic priming through attentional mechanisms. Task-set dominance conceivably affects the time course of task set activation and inhibition in response to task cues and thus the direction of their modulatory effects on priming. KW - automatic processes KW - unconscious cognition KW - attentional control KW - semantic priming KW - task cue KW - task switching Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-325751 VL - 187 ER - TY - JOUR A1 - Gerber, Bertram A1 - König, Christian A1 - Fendt, Markus A1 - Andreatta, Marta A1 - Romanos, Marcel A1 - Pauli, Paul A1 - Yarali, Ayse T1 - Timing-dependent valence reversal: a principle of reinforcement processing and its possible implications JF - Current Opinion in Behavioral Sciences N2 - Punishment feels bad, but relief upon its termination feels good. As a consequence of such timing-dependent valence reversal, memories of opposite valence can result from associating stimulus A with, for example, the occurrence of punishment (A-) versus punishment termination (-A): A- training results in aversive memory, but -A training in appetitive memory (corresponding effects exist for reward occurrence and termination). Whereas learning through the occurrence of punishment is well studied, much less is known about learning through its termination. Current research investigates how dopaminergic system function contributes to these processes in Drosophila, rats and humans. We argue that dopamine-related psychopathology may entail distortions in learning through punishment termination, and that this may contribute, for example, to non-suicidal self-injury or post-traumatic stress disorder. Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232933 VL - 26 ER - TY - JOUR A1 - Colunga, Thomas A1 - Hayworth, Miranda A1 - Kreß, Sebastian A1 - Reynolds, David M. A1 - Chen, Luoman A1 - Nazor, Kristopher L. A1 - Baur, Johannes A1 - Singh, Amar M. A1 - Loring, Jeanne F. A1 - Metzger, Marco A1 - Dalton, Stephen T1 - Human Pluripotent Stem Cell-Derived Multipotent Vascular Progenitors of the Mesothelium Lineage Have Utility in Tissue Engineering and Repair JF - Cell Reports N2 - In this report we describe a human pluripotent stem cell-derived vascular progenitor (MesoT) cell of the mesothelium lineage. MesoT cells are multipotent and generate smooth muscle cells, endothelial cells, and pericytes and self-assemble into vessel-like networks in vitro. MesoT cells transplanted into mechanically damaged neonatal mouse heart migrate into the injured tissue and contribute to nascent coronary vessels in the repair zone. When seeded onto decellularized vascular scaffolds, MesoT cells differentiate into the major vascular lineages and self-assemble into vasculature capable of supporting peripheral blood flow following transplantation. These findings demonstrate in vivo functionality and the potential utility of MesoT cells in vascular engineering applications. KW - stem cells KW - mesothelium KW - vascular progenitor KW - tissue engineering KW - regenerative medicine Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-223217 VL - 26 ER -