TY - THES A1 - Svistunov, Andrey T1 - Langzeitergebnisse der Erhaltungstherapie mit Gemcitabin nach Cisplatin-basierter adjuvanter Chemotherapie des operativ behandelten muskelinfiltrierenden Urothelkarzinoms T1 - Long-term results of maintenance monotherapy with gemcitabine after cisplatin-based adjuvant chemotherapy in surgically treated muscle-invasive urothelial carcinoma N2 - Der Stellenwert der Erhaltungstherapie mit Gemcitabin (GEM), die im Anschluss an die Cisplatin-basierte Polychemotherapie (CBPC) bei den radikal operativ vorbehandelten Patienten mit fortgeschrittenem Urothelkarzinom (UC) erfolgt, bleibt bis dato unklar. In der vorliegenden Arbeit konnten die Ergebnisse der GEM-Erhaltungstherapie mittels retrospektiver Analyse evaluiert werden. Zwischen 1999 und 2013 erhielten 38 operativ vorbehandelte Patienten im Anschluss an die primäre CBPC zusätzlich im vierteljährlichen Intervall zwei konsekutive Infusionen von GEM (1 250 mg/m2) als Erhaltungstherapie. Dieses Kollektiv wurde durch ein ebenso operativ vorbehandeltes Kontrollkollektiv (n = 38), das lediglich eine primäre CBPC erhielt, mittels eines `Propensity Score Matching`-Verfahrens gematched. Mittels Kaplan-Meier-Schätzungen mitsamt dem Log-rank-Test wurden die Gesamtüberlebens- und tumorspezifische Überlebensraten sowie das progressionsfreie Überleben in beiden Kollektiven beurteilt. Die Analyse der Überlebensdaten erfolgte durch die Regressionsmethode nach Cox (proportionales Hazard Modell). Die mediane Follow-Up Zeit betrug 37 Monate bei einem Interquartilsabstand von 9 bis 148 Monaten. Die Patienten, die die GEM-Erhaltungstherapie erhielten, zeigten signifikant bessere Ergebnisse bezüglich der Gesamt-5-Jahres-Überlebensrate (49,2 vs. 26,5 %, p = 0,0314) sowie der tumorspezifischen 5-Jahres-Überlebensrate (61,3 vs. 33,4 %, p = 0,0386). Dabei ergab sich in beiden Kollektiven kein statistisch signifikanter Unterschied bezüglich des progressionsfreien 5-Jahres-Überlebens (10,3 vs. 16,1 %, p = 0,134). Es ist dargelegt, dass die zusätzliche GEM-Erhaltungschemotherapie nach Abschluss der primären CBPC bei operativ vorbehandelten Patienten mit fortgeschrittenem UC sowohl Gesamt- als auch tumorspezifisches Überleben (wenngleich an einem kleinen Patientenkollektiv) verbessern kann. Der Einfluss der GEM-Erhaltungstherapie auf das progressionsfreie Überleben sollte in prospektiven Studien mit großer Patientenanzahl künftig evaluiert werden. N2 - The role of maintenance monotherapy with Gemcitabine (GEM) following cisplatin-based polychemotherapy (CBPC) in patients with surgically treated advanced urothelial carcinoma (UC) remains unclear until now. In the present study, a retrospective analysis was performed to evaluate the results of maintenance monotherapy with GEM. Between 1999 and 2013, 38 patients were identified with surgically treated advanced UC after having completed CBPC who were additionally treated quarterly with two consecutive GEM (1,250 mg/m2) infusions on day 1 and 8 of each bout of maintenance chemotherapy. This collective was matched by propensity score matching to a control collective (n=38) with surgically treated advanced UC following primary CBPC alone. The overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) rates were determined for the two collectives using Kaplan-Meier estimates and the log-rank test. Regression analysis of the survival rates was performed using the Cox proportional hazards model. The median follow-up time was 37 months (interquartile range: 9-148). Patients treated with GEM following primary chemotherapy had a significantly improved outcome related to the 5-year OS (46.2 vs. 26.4%, p=0.0314) and 5-year CSS (61.3 vs. 33.4%, p=0.0386) rates. The 5-year PFS rate did not differ between the two groups (10.3 vs. 16.1%, p=0.134). It is proposed (albeit on a small group of patients) that maintenance monotherapy with GEM improves the OS rate as well the CSS rate following primary CBPC in surgically treated patients with advanced UC. Prospective studies should further determine the impact of maintenance monotherapy with GEM regard to PFS rates in groups comprising larger numbers of patients. KW - Gemcitabin KW - Blasenkrebs KW - Erhaltungstherapie KW - Urothelkarzinom KW - Gemcitabin Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-154666 ER - TY - JOUR A1 - de Munter, Johannes A1 - Pavlov, Dmitrii A1 - Gorlova, Anna A1 - Sicker, Michael A1 - Proshin, Andrey A1 - Kalueff, Allan V. A1 - Svistunov, Andrey A1 - Kiselev, Daniel A1 - Nedorubov, Andrey A1 - Morozov, Sergey A1 - Umriukhin, Aleksei A1 - Lesch, Klaus-Peter A1 - Strekalova, Tatyana A1 - Schroeter, Careen A. T1 - Increased Oxidative Stress in the Prefrontal Cortex as a Shared Feature of Depressive- and PTSD-Like Syndromes: Effects of a Standardized Herbal Antioxidant JF - Frontiers in Nutrition N2 - Major depression (MD) and posttraumatic stress disorder (PTSD) share common brain mechanisms and treatment strategies. Nowadays, the dramatically developing COVID-19 situation unavoidably results in stress, psychological trauma, and high incidence of MD and PTSD. Hence, the importance of the development of new treatments for these disorders cannot be overstated. Herbal medicine appears to be an effective and safe treatment with fewer side effects than classic pharmaca and that is affordable in low-income countries. Currently, oxidative stress and neuroinflammation attract increasing attention as important mechanisms of MD and PTSD. We investigated the effects of a standardized herbal cocktail (SHC), an extract of clove, bell pepper, basil, pomegranate, nettle, and other plants, that was designed as an antioxidant treatment in mouse models of MD and PTSD. In the MD model of “emotional” ultrasound stress (US), mice were subjected to ultrasound frequencies of 16–20 kHz, mimicking rodent sounds of anxiety/despair and “neutral” frequencies of 25–45 kHz, for three weeks and concomitantly treated with SHC. US-exposed mice showed elevated concentrations of oxidative stress markers malondialdehyde and protein carbonyl, increased gene and protein expression of pro-inflammatory cytokines interleukin (IL)-1β and IL-6 and other molecular changes in the prefrontal cortex as well as weight loss, helplessness, anxiety-like behavior, and neophobia that were ameliorated by the SHC treatment. In the PTSD model of the modified forced swim test (modFST), in which a 2-day swim is followed by an additional swim on day 5, mice were pretreated with SHC for 16 days. Increases in the floating behavior and oxidative stress markers malondialdehyde and protein carbonyl in the prefrontal cortex of modFST-mice were prevented by the administration of SHC. Chromatography mass spectrometry revealed bioactive constituents of SHC, including D-ribofuranose, beta-D-lactose, malic, glyceric, and citric acids that can modulate oxidative stress, immunity, and gut and microbiome functions and, thus, are likely to be active antistress elements underlying the beneficial effects of SHC. Significant correlations of malondialdehyde concentration in the prefrontal cortex with altered measures of behavioral despair and anxiety-like behavior suggest that the accumulation of oxidative stress markers are a common biological feature of MD and PTSD that can be equally effectively targeted therapeutically with antioxidant therapy, such as the SHC investigated here. KW - antioxidant nutrients KW - oxidative stress KW - depression KW - post-traumatic stress disorder KW - pro-inflammatory cytokines KW - prefrontal cortex KW - forced swimming KW - mice Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236326 SN - 2296-861X VL - 8 ER -