Thilo Gambichler

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany

Are you Thilo Gambichler?

Claim your profile

Publications (277)738.27 Total impact

  • T. Gambichler, L. Reininghhaus, J. Schaller
    Journal of the European Academy of Dermatology and Venereology 11/2014; · 2.69 Impact Factor
  • Journal of Biophotonics 10/2014; 9999. · 3.86 Impact Factor
  • Source
    Thilo Gambichler, Sarah Terras, Marina Skrygan
    Annals of Dermatology 10/2014; 26(5):666-8. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background High-definition optical coherence tomography scanners have recently been developed.Objectives To assess the diagnostic performance of HD-OCT in the differentiation of benign melanocytic skin lesions (MSL) and cutaneous melanoma (CM).Methods Patients with MSL were assessed by HD-OCT. All diagnoses were histopathologically confirmed. One blinded observer evaluated both slice and en-face HD-OCT images and diagnosed MLS on the basis of an algorithm adopted from reflectance confocal microscopy, recent HD-OCT reports, and conventional OCT.ResultsA total of 93 MSL were studied comprising 66 benign MSL and 27 CM. The sensitivity of HD-OCT was 74.1% [95% confidence interval (CI) 53.7–88.8%)], specificity was 92.4% (95% CI 83.2–97.5%). The positive predictive value was 80%, the negative predictive value 89.7%. The performance of HD-OCT depended on tumour thickness and the presence of borderline lesions indicated by high false negative rates in very thin melanomas and high false positive rates in dysplastic naevi.Conclusions In the distinction of MSL, HD-OCT applied in an investigator blinded fashion has a moderate diagnostic performance. The diagnostic performance of HD-OCT of MSL should be reassessed in other clinical settings.
    Journal of the European Academy of Dermatology and Venereology 07/2014; · 2.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recurrence rates following conventional surgery for lentigo maligna (LM) - a form of in situ melanoma - and lentigo maligna melanoma (LMM) - the invasive form of LM have previously been reported to be between 7% and 15%.(1,2) We aimed to present our single-center experience with LM and LMM focusing on clinical and pathological characteristics including recurrence and survival analysis. This mono-center study was performed in the Skin Cancer Center Ruhr-University (Bochum, North-Rhine-Westphalia, Germany). The study was approved by the ethics review board of the Ruhr-University Bochum. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 06/2014; · 3.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: IMPORTANCE Topical corticosteroids are the current first-line therapy for vulvar lichen sclerosus (VLS). UV-A1 phototherapy may be a promising alternative treatment option, but controlled studies are lacking. OBJECTIVE To compare the efficacy of high-potent topical corticosteroids with UV-A1 phototherapy in the treatment of VLS. DESIGN, SETTING, AND PARTICIPANTS A 2-arm randomized clinical trial was conducted at a university hospital dermatology department according to the intention-to-treat principle with last observation carried forward. The study population comprised 30 female patients with VLS. INTERVENTIONS Treatment of VLS with clobetasol propionate, 0.05%, ointment applied once daily for 3 months or medium-dose UV-A1 (50 J/cm2) home-based phototherapy, performed 4 times weekly for 3 months. MAIN OUTCOMES AND MEASURES Mean relative reduction of the total clinician's score (TCS) was considered the primary outcome measure. Secondary outcome measures included the reduction of pruritus and burning and/or pain according to a visual analog scale (VAS), a health-related quality of life score (Skindex-29), 20-MHz ultrasonography, and histopathological analysis before and after 3 months of therapy. RESULTS Fifteen patients were randomized in each treatment arm, and 2 patients dropped out in both treatment arms. After therapy, both therapies resulted in a significant decrease in mean TCS (51.4% [95% CI, 39.7% to 63.0%] for clobetasol ointment [P < .001] and 35.6% [95% CI, 18.2% to 53.1%] for UV-A1 phototherapy [P = .006]). No significant difference was found between both treatments (P > .05). The Skindex-29 (mean difference [MD], 29.6 [95% CI, 7.9 to 51.2] [P = .009]) and the VAS score for pruritus (MD, 4.6 [95% CI, 1.5 to 7.7] [P = .005]) and burning and/or pain (MD, 4.2 [95% CI, 1.9 to 6.6] [P = .001]) significantly decreased after clobetasol treatment. After UV-A1 phototherapy, the VAS score for burning and/or pain (MD, 3.2 [95% CI, 0.7 to 5.7] [P = .01]) was also significantly reduced; however, there was no significant reduction in pruritus (MD, 2.1 [95% CI, 0.5 to 3.7] [P = .16]) and in the Skindex-29 score (MD, 4.9 [95% CI, -12.6 to 22.4] [P > .99]). A significant reduction of the corium thickness and a significant increase in dermal density in 20-MHz ultrasonography as well as significant histopathological reduction of the inflammatory infiltrate was observed after clobetasol treatment but not after UV-A1 phototherapy. CONCLUSIONS AND RELEVANCE Although resulting in a significant clinical improvement, UV-A1 phototherapy was inferior to the current gold standard treatment with topical high-potent corticosteroids with respect to practicability, relief of itch, and improvement in quality of life. UV-A1 phototherapy may be considered a potential second-line treatment for VLS. TRIAL REGISTRATION Identifier: NCT01400022.
    JAMA dermatology. 04/2014;
  • Clinical and Experimental Dermatology 03/2014; 39(2):216-8. · 1.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: High-definition optical coherence tomography (HD-OCT) scanners have recently been developed providing significantly higher resolution than conventional OCT. To assess the relationship between recently defined histopathological HD-OCT correlates of basal cell carcinomas (BCC) and possible predictors for the most common tumour subtypes. For HD-OCT imaging, we used the Skintell(®) device (Agfa Healthcare, Mortsel, Belgium). Twenty-five BCCs were histopathologically (including vertical as well horizontal haematoxylin and eosin and Alcian blue sectioning) confirmed and correlated with HD-OCT images. In the en-face mode, lobulated nodules were seen in 21 of the 25 lesions (84%), peripheral rimming in 18 (25/72%), epidermal disarray also in 18 (25/72%) and variably refractile stroma in 22 BCC (25/88%). In the slice imaging mode, we observed in 19 of 25 (76%) a BCC destruction of layering. Both in the slice and en-face mode a significant correlation was observed between peritumoural rimming and grey/dark oval structures and lobulated nodules. Alcian blue stains showed peritumoural mucin deposits correlating with peripheral rimming around the tumour nodules. In a logistic regression model, we neither observed for solid BCC nor for superficial BCC subtypes significant independent micromorphological HD-OCT predictors. In agreement with recent studies we have demonstrated that HD-OCT using slice and en-face imaging modes can visualize histopathological correlates of BCC, and potentially aid non-invasive diagnostics. However, using HD-OCT correlates assessed it was not possible to predict superficial or solid BCC subtypes. For the first time we have shown that peripheral rimming is a HD-OCT correlate of peritumoural mucin deposition. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 12/2013; · 3.76 Impact Factor
  • T Gambichler, S Terras, M Skrygan
    [Show abstract] [Hide abstract]
    ABSTRACT: Combined treatment using salt water baths and artificial ultraviolet (UV) radiation (balneophototherapy, BPT) is a common therapeutic option for conditions such as psoriasis. However, it remains unknown whether pre-treatment with salt water soaks alter inflammatory and/or carcinogenic effects of UVB phototherapy. We aimed to investigate the impact of BPT on COX-2 gene expression and apoptosis in normal and psoriatic keratinocytes. Normal epidermis models (NEM) and psoriatic epidermis models (PEM) were treated using different salt water soaks (3% NaCl, 30% NaCl, 30% Dead Sea salt; DSS) and subsequent narrowband ultraviolet B (NB-UVB) for three consecutive days. RT-PCR was performed for cyclooxygenase 2 (COX-2), survivin, and caspase-3. Compared with untreated controls COX-2 mRNA was significantly increased in NB-UVB irradiated NEM and PEM. NB-UVB-exposed and non-exposed 30% NaCl and 30% DSS-treated NEM and PEM (except for NB-UVB-exposed and non-irradiated 30% DSS) showed significantly higher COX-2 mRNA when compared with controls and 3% NaCl. In NB-UVB-exposed 30% NaCl and 30% DSS-treated NEM and PEM survivin mRNA was significantly decreased when compared with controls and 3% NaCl. Compared with NB-UVB-exposed controls mRNA of caspase-3 was significantly increased in NB-UVB-exposed 30% NaCl and 30% DSS-treated PEM. Although BPT using high-concentrated salt water solutions is associated with increased epidermal COX-2 mRNA expression, apoptosis of keratinocytes is enhanced possibly due to the down-regulation of survivin mRNA expression. If confirmed in larger studies these observations have important implications for BPT efficacy as well as safety, particularly with regard to the risk of early carcinogenesis.
    Journal of the European Academy of Dermatology and Venereology 12/2013; · 2.69 Impact Factor
  • T Gambichler, M Skrygan
    [Show abstract] [Hide abstract]
    ABSTRACT: The molecular mechanisms of action of salt water soaks combined with ultraviolet (UV) irradiation - balneophototherapy (BPT) - are unknown. We aimed to investigate the effect of BPT on the expression of human β-defensin-2 (hBD2) using a psoriatic epidermis model (PEM). Using real-time RT-PCR and ELISA, we studied the expression patterns of hBD2 in PEM which were treated over three consecutive days with differently concentrated salt water solutions [(3% NaCl; 30% NaCl, 30% Dead Sea salt (DSS)] and consecutive narrowband UVB exposure. mRNA of hBD2 was significantly reduced in irradiated 3% NaCl, 30% NaCl and 30% DSS soaked PEM when compared with non-irradiated PEM. ELISA for hBD2 revealed significantly reduced protein expression in irradiated 3% NaCl, 30% NaCl and 30% DSS soaked PEM when compared with non-irradiated PEM. Compared with irradiated controls and 3% NaCl soaked and irradiated PEM, BPT using 30% NaCl and 30% DSS revealed significantly decreased hBD2 protein levels. Both mono-treatment with salt water soaks and BPT of PEM result in altered expression of hBD2, whereas the effects observed are most prominent after BPT. hBD2 gene and protein expression is predominantly down-regulated following BPT indicating that this combined phototherapeutic regimen is superior to mono-UVB or salt water soaks alone with respect to normalization of hBD2 expression in psoriatic epidermis.
    Journal of the European Academy of Dermatology and Venereology 11/2013; · 2.69 Impact Factor
  • Source
    T Gambichler, S Terras, A Kreuter, M Skrygan
    [Show abstract] [Hide abstract]
    ABSTRACT: Epigenetics refers to functionally relevant changes in the genome other than those of DNA sequence that can lead to changes in gene expression or cellular phenotype. There is evidence that epigenetics is relevant in the pathogenesis of autoimmune diseases such as vulvar lichen sclerosus (VLS) as well as cancer, including cutaneous squamous cell carcinoma frequently associated with VLS. We aimed to study the global methylation and hydroxymethylation status in healthy controls and VLS lesions before and after long-term UVA1 treatment. We studied 12 controls and 10 patients with VLS who were treated with medium-dose UVA1 4-times weekly for 3 months. Immunohistochemistry and mutation analyses (PCR) were performed for 5-methylcytosin (5mc), 5-hydroxymethylcytosin (5hmc), isocitrate dehydrogenases (IDH), and ten-eleven translocation 2 (TET2) enzyme, respectively. After 3-month treatment, 5mc was significantly increased in VLS when compared to baseline and controls. When compared to controls, however, 5hmc levels were significantly reduced in baseline-VLS but normalised after UVA1. Compared to controls, IDH1 expression was significantly higher in treated as well as baseline-VLS. By contrast, IDH2 levels were significantly reduced in baseline-VLS as compared to controls and UVA1-treated VLS. However, gene sequencing of IDH1, IDH2, and TET2 genes did not reveal evidence for mutations. VLS is associated with altered expression of IDH enzymes and aberrant hydroxymethylation indicating an epigenetic background for the pathogenesis of VLS. UVA1 phototherapy may cause normalisation of 5hmc patterns but also global DNA hypermethylation in VLS lesions raising concerns with respect to an increased risk of photocarcinogenesis. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 10/2013; · 3.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: With great interest, we read the article of Mogensen and co-workers, which was published in this journal.(1) They studied 11 actinic keratoses and 23 basal cell carcinomas (< 2 mm thickness) using conventional optical coherence tomography (OCT, 20 μm lateral resolution) and 20-MHz ultrasound. OCT and 20-MHz ultrasound were compared with routine histology. The authors concluded that systematic comparison between mean OCT and 20-MHz ultrasound lesion thickness demonstrated that OCT is more accurate and less biased than 20-MHz ultrasound, even though both methods tended to overestimate the thickness of the lesion. Recently, high-definition OCT (HD-OCT) scanners have been developed providing significantly higher lateral resolution (1 μm to 3 μm) than conventional OCT with lateral resolution of about 10 μm to 20 μm.(2-4) Hence, HD-OCT is a new non-invasive technique for morphological investigation of tissue with cellular resolution filling the imaging gap between reflectance confocal microscopy and conventional optical coherence tomography. The paper of Mogenson and colleagues (1) prompted us to report our data on HD-OCT measurements for the determination of ET in actinic keratoses and psoriasis. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 10/2013; · 3.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Polymorphic light eruption (PLE) is considered an autoimmune-mediated skin condition in which the normally ultraviolet induced local immunosuppression appears to be absent leading to recognition of photo-induced auto-antigens and consecutive inflammation. We aimed to investigate T regulatory cells (Tregs) and related immunoregulatory factors in PLE lesions and controls. Skin biopsies were performed in 13 patients with UVA1-challenged PLE, 12 female patients with chronic discoid lupus erythematosus (CDLE), and 11 healthy controls who had UVA1 exposures (UVA1-controls). Immunohistochemistry and four-colour immunofluorescence studies were performed. CDLE patients and UVA1-controls showed significantly (P = 0.0001) decreased epidermal immunoreactivity for CD1a when compared to PLE. Four-colour immunofluorescence revealed a median CD4+CD25+FOXP3+ Tregs percentage of 7.6% (3.7 - 13.6%) in PLE, a median percentage of 11.7% (9.5 - 13.9%) in CDLE, and a median percentage of 3.4% (0 - 6.8%) in UVA1-controls. Compared to UVA1-controls, PLE and CDLE lesions showed significantly decreased transforming growth factor-ß1 (TGFß1) immunoreactivity in the epidermis (P = 0.0003). In PLE lesions, we observed significantly decreased interleukin 10 (IL10) expression when compared to CDLE (P = 0.022). In the dermis, nuclear factor-κB ligand (RANKL) expression was increased in UVA1-controls as compared to PLE and CDLE (P = 0.018). Similar to CDLE, UVA1-challenged PLE lesions display an altered immunoregulatory network as indicated by decreased epidermal or dermal expression of TGFß1, IL10, and RANKL and a relatively low number of Tregs particularly when compared to other inflammatory skin conditions reported in the literature. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 09/2013; · 3.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Regulatory T cells (Tregs) play an important role in autoimmune diseases. In skin, the presence of Tregs is thought to be mandatory for suppression of autoreactive T cells. Here, we assess the number of Tregs in skin of healthy subjects and patients with an autoimmune dermatosis. Immunohistochemical stainings for CD3 and FOXP3 on skin biopsies of healthy subjects and subjects with psoriasis, vitiligo, pemphigus vulgaris, bullous pemphigoid, and halo nevus to assess the number of T and regulatory T cells, respectively. Low numbers of CD3+ and FOXP3+ cells were seen in the skin of healthy controls (median = 0.5%). A significantly higher frequency of Tregs was seen in lesional skin of patients with psoriasis (median = 12.4%) and patients with bullous pemphigoid (median = 10.1%) as compared to controls. In vitiligo (median = 0.0%), pemphigus vulgaris (median = 5.2%), and halo nevi (median = 5.4%), no significant difference in number of FOXP3+ cells was observed when compared to controls. As confirmed in the literature, few Tregs were seen in healthy skin. A high number of Tregs were present in lesional skin from patients with psoriasis and bullous pemphigoid. These results support the hypothesis that not a decrease in number but rather a decrease in function of Tregs would be at the basis of autoimmune skin diseases, which could result in unrestrained activation autoreactive T cells in skin of patients with autoimmune dermatoses.
    International journal of dermatology 08/2013; · 1.23 Impact Factor
  • T Gambichler, S Terras, M Skrygan
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of transforming growth factor-β1 (TGFβ1) and Smad signalling has not been established in psoriasis treatment. We aimed to investigate the effect of combined treatment with salt water soaks and ultraviolet radiation on the expression of TGFβ1/Smad signalling proteins in a psoriatic model. We studied mRNA expression (real-time RT-PCR) of TGFβ1, TGFβ receptor type I (TGFβRI), Smad2, Smad3, Smad4, Smad7, minichromosome maintenance protein 7, and involucrin in normal as well as psoriatic epidermis models (PEM) which were treated for three consecutive days with differently concentrated salt water solutions [(3% NaCl; 30% NaCl, 30% Dead Sea salt water (DSSW)] and subsequent narrowband ultraviolet B (NB-UVB). In PEM, TGFβ1 and Smad3 was significantly increased as compared to normal epidermis models. By contrast, TGFβRI mRNA was significantly decreased in PEM. Significant increase of mRNA levels of TGFβ1, TGFβRI, Smad2 and Smad3 was predominantly observed in non-irradiated and irradiated PEM pre-treated with 30% NaCl and/or DSSW which was paralleled by increase of involucrin mRNA. In PEM pre-treated with DSSW, TGFβRI, Smad2, Smad3, Smad4, and Smad7 mRNA was significantly higher in irradiated PEM when compared to non-irradiated samples. It has been shown that TGFβ1/Smad signalling is altered in a psoriatic model and may play a role in the mode of action of salt water soaks and NB-UVB phototherapy of psoriasis.
    Cytokine 07/2013; · 2.87 Impact Factor
  • Thilo Gambichler, Sarah Terras, Alexander Kreuter
    [Show abstract] [Hide abstract]
    ABSTRACT: During the last three decades, ultraviolet A1 (UVA1) phototherapy has emerged as a specific phototherapeutic modality with distinct modes of action and some well established indications. Atopic dermatitis, localized scleroderma, and systemic lupus erythematosus seem to be the conditions with the best evidence regarding efficacy and safety of UVA1 phototherapy. Further indications for UVA1 include subacute prurigo, lichen sclerosus, dyshidrotic dermatitis, cutaneous T cell lymphoma, urticaria pigmentosa, and pityriasis rosea; nevertheless, there are some unknowns, uncertainties, and controversies concerning short- and long-term side effects, efficacy and dosage regimens of UVA1 phototherapy in some conditions. We describe and discuss treatment regimens, protocols, dosage, and indications for UVA1 phototherapy.
    Clinics in dermatology 07/2013; 31(4):438-454. · 3.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Histopathologic differentiation of nevus cell aggregates and metastatic melanoma in lymph nodes is challenging. Patients with melanoma who had undergone sentinel lymph node (SLN) biopsy were evaluated using univariate and multivariate analyses as well as Kaplan-Meier statistics. Of the 651 patients, 50 (7.7%) had a nodal nevus in the SLN. In the logistic regression model, primary melanoma on the lower extremities proved to be the strongest independent negative predictor of nodal nevi with an odds ratio of 0.11 (95% confidence interval, 0.034-0.36; P = .0002). Overall 5-year survival (P = .17) and 5-year disease-free survival (P = .45) of patients with nodal nevi did not significantly differ from that of patients with negative SLNs. The frequency and anatomic localization of nodal nevi observed in the present study are in line with previous studies. Our 5-year survival data clearly demonstrate that nevus cell aggregates in lymph nodes have to be considered a benign condition even though it occurs in patients with melanoma. This study provides an indirect proof of validity and accuracy of current histopathologic methods for differentiation between nodal nevi and melanoma metastasis.
    American Journal of Clinical Pathology 05/2013; 139(5):566-73. · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Glutathione S-transferases (GSTs) are involved in detoxification of xenobiotics such as fumaric acid esters (FAE). OBJECTIVES: To perform GSTT1 geno- and phenotyping in psoriasis patients treated with FAE to find out whether the responder status and/or occurrence of side-effects are associated with allelic variants and enzymatic activity of GSTT1. METHODS: We treated 106 psoriasis patients with FAE. GSTT1 genotyping was performed using PCR, phenotyping was carried out by means of a validated high performance liquid chromatography assay at baseline and under treatment. RESULTS: The distribution of GSTT1 genotypes was as follows: 31% *A/*A; 49% *A/*0; 20% *0/*0. GSTT1 phenotypes as expressed in enzyme activity significantly differed between conjugators classes. (P < 0.001). GSTT1 activity under treatment was significantly (P = 0.0001) increased when compared with baseline. There were no significant associations between the aforementioned GSTT1 pheno- and genotypes and clinical parameters such as psoriasis area and severity index (PASI)50, adverse effects and FAE dosage (P > 0.05), except for the frequent occurrence of reduction (>50%) of circulating lymphocytes in patients with *0/*0 GSTT1 status (P = 0.036; odds ratio: 6, 95% CI: 1.1-32). CONCLUSION: GSTT1 geno- and phenotypes significantly correlate in psoriasis patients and do not substantially differ from healthy controls. Response to FAE does likely not depend on GSTT1. However, *0/*0 GSTT1 status is a predictor for the occurrence of marked reduction of lymphocyte counts under FAE therapy. Notably, FAE seem to enhance GSTT1 enzyme activity in high and low conjugators.
    Journal of the European Academy of Dermatology and Venereology 03/2013; · 2.69 Impact Factor
  • Thilo Gambichler, Michael Sand, Marina Skrygan
    [Show abstract] [Hide abstract]
    ABSTRACT: Several research groups have recently reported on markedly reduced levels of 5-hydroxymethylcytosine (5hmC) in human breast, liver, lung, pancreatic, colon, prostate, brain, and myeloid cancers. We studied benign compound nevi (BCN, n=17), dysplastic compound nevi (DCN, n=15), superficial spreading melanomas [SSM, stratified in <1 mm (n=19) and >4 mm (n=18) Breslow tumor thickness], and cutaneous metastatic disease (CMD, n=24). Immunohistochemistry included specific antibodies against 5hmC, 5-methylcytosine (5mC), and ten-eleven translocation 2 protein (TET2). Immunohistological scoring showed significantly (P<0.0001) higher median 5hmC levels in BCN and DCN than in thin SSM, thick SSM, and CMD. 5mC immunoreactivity did not differ significantly (P=0.15) between nevi and melanoma. The intensity of TET2 expression was predominantly weak but was found to be significantly (P<0.0001) more often in nevi than in thin SSM, thick SSM, and CMD. We have shown that 5hmC levels and TET2 expression are significantly reduced in advanced melanomas compared with nevi and thin melanomas. It is suggested that 5hmC and TET2 possibly play an important role in the epigenetic regulation of melanoma development and progression.
    Melanoma research 03/2013; · 2.06 Impact Factor
  • T Gambichler, D Belz, S Terras, A Kreuter
    [Show abstract] [Hide abstract]
    ABSTRACT: We read with great interest the paper of Edmonds et al. (1) who observed that men with penile lichen sclerosus (PLS) have significantly increased extracellular matrix protein 1 (ECM1) serum levels when compared to healthy controls (HC). Similar results were previously found in women with vulvar LS (VLS).(2) Edmonds et al. 1 postulated that anti-ECM1 antibodies are not the causative mechanism but present an epiphenomenon in LS. Nevertheless, there is evidence for humoral as well as cell-mediated autoimmunopathogenic mechanisms driving LS.(1-5).
    British Journal of Dermatology 01/2013; · 3.76 Impact Factor

Publication Stats

3k Citations
738.27 Total Impact Points


  • 2000–2014
    • Ruhr-Universität Bochum
      • Department of Plastic Surgery
      Bochum, North Rhine-Westphalia, Germany
  • 2011
    • University of Cologne
      • Institute of Virology
      Köln, North Rhine-Westphalia, Germany
  • 2010
    • Heinrich-Heine-Universität Düsseldorf
      • Klinik für Nephrologie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2001–2003
    • Centexbel
      Bruxelles, Brussels Capital Region, Belgium