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Langrehr JM, Lohmann R, Raakow R, Jonas S, Klupp J, Bechstein WO, Neuhaus R, Neuhaus P. Chronic rejection after orthotopic liver transplantation is increased under induction therapy with interleukin-2 receptor antibody BT563. Transplant Proc 2001; 33:2290-1. [PMID: 11377531 DOI: 10.1016/s0041-1345(01)01993-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lüsebrink R, Blumhardt G, Lohmann R, Bachmann S, Knoop M, Lemmens HP, Neuhaus P. Does concommitant splenectomy raise the mortality of liver transplant recipients? Transpl Int 2001; 7 Suppl 1:S634-6. [PMID: 11271326 DOI: 10.1111/j.1432-2277.1994.tb01461.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Within a 17-month period, 130 orthotopic liver transplantations were performed in our hospital. Nine of these were retransplantations and were not included in our analysis. In the remaining 121 patients, splenectomy was performed in 34 patients, either synchronously with the transplant procedure (27 patients) or in the postoperative period (7 patients). Indications for splenectomy were lienalis-steal syndrome in 15 patients and hypersplenism in 15 cases. The number of rejection episodes was fairly equal in both groups (splenectomized vs. non-splenectomized, 61.7% vs. 63.9%, respectively). There was a marked difference in the frequency of infectious episodes (61.7% vs. 25.3%) that resulted in a decreased survival rate (77.5% vs. 95.4%) for splenectomized patients. Therefore, we recommend splenectomy only for very selected patients and investigate the banding of the splenic artery as an alternative.
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Raakow R, Blumhardt G, Kling N, Bechstein WO, Lohmann R, Neuhaus P. Results of liver transplantation in acute liver failure caused by viral hepatitis. Transpl Int 2001; 7 Suppl 1:S227-8. [PMID: 11271210 DOI: 10.1111/j.1432-2277.1994.tb01353.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fulminant liver failure due to acute viral hepatitis is the most common emergency indication for liver transplantation. The postoperative course is highly correlated with the type and duration of infection. The complication rate is lowest in fulminant hepatitis B patients and highest in subacute hepatitis C/NANB patients.
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Banhart F, Lohmann R. An object-oriented approach for structuring the electronic medical record. Stud Health Technol Inform 2001; 77:622-6. [PMID: 11187628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We implemented a framework for modelling the electronic medical record on top of an object-oriented model. Clinical patient data are structured in a uniform way through the use of a comprehensive data model. The meaning of the information elements is explicitly determined by a medical data dictionary. The data structures of both, medical record and data dictionary are implemented, using a semantically rich, object-oriented data model. We examined several possibilities for the graphical preparation of the inherently recursive data structures. Again, we use object-oriented frameworks for the implementation of flexible user interfaces to the electronic medical record with a consistent look-and-feel.
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Langrehr JM, Klupp J, Pfitzmann R, Neumann U, Lohmann R, Jonas S, Neuhaus R, Steinmüller T, Neuhaus P. A prospective, randomized trial with quadruple versus dual tacrolimus-based induction after liver transplantation. Transplant Proc 2001; 33:1520. [PMID: 11267404 DOI: 10.1016/s0041-1345(00)02579-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Langrehr JM, Lohmann R, Guckelberger O, Müller AR, Raakow R, Nüssler NC, Klupp J, Pfitzmann R, Jonas S, Settmacher U, Steinmüller T, Neuhaus P. IL-2 receptor antibody induction increases the risk for chronic rejection after liver transplantation. Transplant Proc 2001; 33:1433-4. [PMID: 11267360 DOI: 10.1016/s0041-1345(00)02541-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ockenden WA, Lohmann R, Shears JR, Jones KC. The significance of PCBs in the atmosphere of the southern hemisphere. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2001; 8:189-94. [PMID: 11505903 DOI: 10.1007/bf02987384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Air monitoring stations were set up at 2 sites in the southern hemisphere--Moody Brook, Falkland Island (51 degrees 25' S, 57 degrees 56' W) and Halley, Research Station, Antarctica (75 degrees 35' S, 26 degrees 30' W). PCBs were monitored at the stations throughout 1999. Highest concentrations were observed when temperatures were greater. In general, concentrations were greater at Moody Brook than at Halley, although the difference in concentrations between sites was less for more chlorinated congeners. Air concentrations at both sites were compared with samples collected nearby over-water. Over water air concentrations were found to be greater than over land air concentrations. Concentrations were also compared with literature data for air concentrations at a remote site in the Canadian Arctic. Atmospheric concentrations of tri-chlorinated biphenyls were found to be approximately double those reported for Ellesmere Island in the Canadian Arctic, whilst concentrations in samples from Antarctica were very similar to those found in the high Arctic. Most other PCBs were a factor of 2-4 greater in the Canadian Arctic.
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Lohmann R, Langrehr JM, Raakow R, Jonas S, Klupp J, Steinmüller T, Neuhaus R, Neuhaus P. Impact of primary immunosuppression on the incidence of infectious complications after orthotopic liver transplantation. Transplant Proc 2000; 32:2229-30. [PMID: 11120145 DOI: 10.1016/s0041-1345(00)01647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rayes N, Oettle H, Schmidt CA, Lohmann R, Steinmüller T, Bechstein WO, Neuhaus P. Preemptive therapy in CMV-antigen positive patients after liver transplantation--a prospective trial. Ann Transplant 2000; 4:12-7. [PMID: 10850585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Preemptive therapy with intravenous ganciclovir and CMV-hyperimmunoglobulin in asymptomatic CMV pp65-antigen positive patients was compared with treatment of only symptomatic CMV-disease after liver transplantation in an open prospective study. PATIENTS AND METHODS 48 out of 200 liver transplant recipients became positive during six weeks follow-up after transplantation. 17 out of these 48 patients who were already symptomatic at the time of positive antigen testing were successfully treated with ganciclovir and CMV-hyperimmunoglobulin. 31 asymptomatic antigen-positive patients were randomised to receive preemptive therapy or to receive therapy only at onset of clinical symptoms. RESULTS Only two out of 15 patients in this latter group without preemptive therapy developed CMV-syndrome and were successfully treated with intravenous ganciclovir. 13 patients did not experience any clinical symptoms or disease and were therefore spared unneccessary toxicity and costs. The overall incidence of CMV-infection and -disease in the whole study population of 200 liver transplant recipients was 25% and 10%. As expected, CMV-negative patients who received an organ from a seropositive donor were at a higher risk of CMV-infection and -disease, but did not show more severe infections clinically. Patients with IL-2 receptor antibody induction therapy seemed to have a higher risk for CMV-infection and -disease.
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Neuhaus P, Klupp J, Langrehr JM, Neumann U, Gebhardt A, Pratschke J, Tullius SG, Lohmann R, Radke C, Rayes N, Neuhaus R, Bechstein WO. Quadruple tacrolimus-based induction therapy including azathioprine and ALG does not significantly improve outcome after liver transplantation when compared with standard induction with tacrolimus and steroids: results of a prospective, randomized trial. Transplantation 2000; 69:2343-53. [PMID: 10868638 DOI: 10.1097/00007890-200006150-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tacrolimus in combination with prednisolone has been proven to be a safe and effective immunosuppressive induction therapy in solid organ transplantation. However, it remains unclear whether a tacrolimus-based quadruple induction regimen with azathioprine and an antilymphocytic preparation could further improve the results after orthotopic liver transplantation. Therefore, we designed a prospective, randomized study to compare the immunosuppressive efficacy of dual (tacrolimus and prednisolone) and quadruple (tacrolimus, azathioprine, ALG Merieux and prednisolone) induction after liver transplantation. METHODS After randomization, 120 consecutive patients of primary liver transplants were divided into the dual group (n=59) and the quadruple group (n=61) and followed for a minimum of 3 years. RESULTS Patient survival at 3 years was 88.2% in the dual versus 94.9% in the quadruple group. Overall 25 patients in each group (41 and 42%, respectively) developed acute rejection. There was no difference in the number and severity of rejections. In each group only four patients required OKT3-therapy, however, although three of four patients in the quadruple group responded to OKT3 and cleared rejection, none of the four patients in the dual group were treated successfully with OKT3 (P<0.02). Rejection in these patients resolved only after additional treatment with mycophenolate mofetil. Adverse events and infections were equally distributed in both groups. Asymptomatic Cytomegalovirus infections were more common in the quadruple group (P<0.02). As of today, only one patient developed posttransplant lymphoproliferative disease (dual group). CONCLUSIONS The data from our single-center study indicate that both tacrolimus-based dual and quadruple immunosuppressive induction regimens yield similar safety and effectiveness after liver transplantation.
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Lohmann R, Langrehr JM, Raakow R, Neuhaus R, Bechstein WO, Neuhaus P. Long-term survival after orthotopic liver transplantation with regard to country of origin and residence. Transplant Proc 2000; 32:516. [PMID: 10812091 DOI: 10.1016/s0041-1345(00)00868-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lohmann R, Langrehr JM, Klupp J, Jonas S, Raakow R, Bechstein WO, Neuhaus R, Neuhaus P. Infectious complications after orthotopic liver transplantation with different immunosuppressive induction regimens. Transplant Proc 2000; 32:537-8. [PMID: 10812102 DOI: 10.1016/s0041-1345(00)00879-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lohmann R, Langrehr JM, Neuhaus R, Raakow R, Bechstein WO, Neuhaus P. Long-term survival and complications after orthotopic liver transplantation for postnecrotic cirrhosis. Transplant Proc 2000; 32:599. [PMID: 10812131 DOI: 10.1016/s0041-1345(00)00909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pawlik TM, Lohmann R, Souba WW, Bode BP. Hepatic glutamine transporter activation in burn injury: role of amino acids and phosphatidylinositol-3-kinase. Am J Physiol Gastrointest Liver Physiol 2000; 278:G532-41. [PMID: 10762606 DOI: 10.1152/ajpgi.2000.278.4.g532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Burn injury elicits a marked, sustained hypermetabolic state in patients characterized by accelerated hepatic amino acid metabolism and negative nitrogen balance. The transport of glutamine, a key substrate in gluconeogenesis and ureagenesis, was examined in hepatocytes isolated from the livers of rats after a 20% total burn surface area full-thickness scald injury. A latent and profound two- to threefold increase in glutamine transporter system N activity was first observed after 48 h in hepatocytes from injured rats compared with controls, persisted for 9 days, and waned toward control values after 18 days, corresponding with convalescence. Further studies showed that the profound increase was fully attributable to rapid posttranslational transporter activation by amino acid-induced cell swelling and that this form of regulation may be elicited in part by glucagon. The phosphatidylinositol-3-kinase (PI3K) inhibitors wortmannin and LY-294002 each significantly attenuated transporter stimulation by amino acids. The data suggest that PI3K-dependent system N activation by amino acids may play an important role in fueling accelerated hepatic nitrogen metabolism after burn injury.
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Lohmann R, Gahr M. Muscle-dependent and hormone-dependent differentiation of the vocal control premotor nucleus robustus archistriatalis and the motornucleus hypoglossus pars tracheosyringealis of the zebra finch. JOURNAL OF NEUROBIOLOGY 2000; 42:220-31. [PMID: 10640329 DOI: 10.1002/(sici)1097-4695(20000205)42:2<220::aid-neu6>3.0.co;2-e] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sex differences in the vertebrate brain (brain sex) are thought to develop owing to the tissue specific action of gonadal hormones similar to the development of secondary sex characteristics of the body. Small sex differences in body anatomy could, however, retrogradely control the sexual differentiation of the central nervous system. This possibility has so far been verified only for motorneuron pools, since the connectivity of sex-specific higher brain areas to the sexual dimorphic periphery is frequently not well known. Here, we tested whether somatic sex differences feed back on higher brain areas by bilateral denervation of the syringeal musculature of zebra finches before, during, and after onset of estrogen-sensitive sexual differentiation of forebrain vocal nuclei such as RA (nucleus robustus archistriatalis). In the zebra finch, the sound-producing musculature (the syrinx), the syrinx motornucleus hypoglossus pars tracheosyringealis (nXIIts), and the RA are much larger in males compared to females. Tract tracing studies revealed that the volume and neuron size distribution of the nXIIts was sexually dimorphic in intact but not in animals denervated as juveniles. In contrast, the volume of RA and size of RA neurons of denervated animals were highly sexually dimorphic. Furthermore, estrogen masculinized the RA of denervated females. Thus, sexual differentiation of the RA but not of the nXIIts appears independent of somatic sex differences. The syrinx muscles are, however, important for the soma size of those RA neurons that project to the nXIIts.
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Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999; 230:808-18; discussion 819. [PMID: 10615936 PMCID: PMC1420945 DOI: 10.1097/00000658-199912000-00010] [Citation(s) in RCA: 547] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate different strategies for extended resections of hilar cholangiocarcinomas on radicality and survival. SUMMARY BACKGROUND DATA Surgical resection of hilar cholangiocarcinoma is the only potentially curative treatment. Resection of central bile duct carcinomas, however, cannot always comply with the general principles of surgical oncology to achieve wide tumor-free margins with no-touch techniques. METHODS From 1988 to 1998, 95 patients underwent resection of hilar cholangiocarcinoma. Eighty patients had hilar and hepatic resections and 15 had liver transplantation and partial pancreatoduodenectomy (LTPP; i.e., eradication of the entire biliary tract using a no-touch technique). RESULTS The 60-day death rate was 8%. The overall 1- and 5-year survival rates were 67% and 22%, respectively. Five-year survival rates after R0, R1, and R2 resections were 37%, 9%, and 0%. In a multivariate analysis, surgical radicality was the strongest determinant of survival (p < 0.001). The rate of formally curative resection (R0 resection) was significantly lower in hilar resections (29%) than in liver resections (left hemihepatectomy 59%, right hemihepatectomy 55%, right trisegmentectomy 65%; p < 0.05). The highest rate of R0 resection was observed after LTPP (93%; p < 0.05). Right trisegmentectomies achieved the highest rate of 5-year survival after R0 resection (57%). In a multivariate analysis of patient survival after R0 resection, additional portal vein resection was the only significant factor. The 5-year survival rate after formally curative liver resection with portal vein resection was 65% versus 28% without. CONCLUSION Extended resections, especially right trisegmentectomies and LTPP, resulted in the highest rate of R0 resection. Right trisegmentectomy together with portal vein resection best represents the principles of surgical oncology and may be regarded as the surgical procedure of choice. Immunosuppression limits the applicability of LTPP.
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Stiedl O, Radulovic J, Lohmann R, Birkenfeld K, Palve M, Kammermeier J, Sananbenesi F, Spiess J. Strain and substrain differences in context- and tone-dependent fear conditioning of inbred mice. Behav Brain Res 1999; 104:1-12. [PMID: 11125727 DOI: 10.1016/s0166-4328(99)00047-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The performance of C57BL/6J (6J), C57BL/6N (6N), DBA/2J (2J) and DBA/2N (2N) mice in context- and tone-dependent fear conditioning was determined 24 h after fear conditioning to evaluate and compare different behavioral measures as indices of emotional learning. Freezing, the change in activity and the size of the explored area were evaluated as behavioral parameters indicating fear. Additionally, the heart rate (HR) increase elicited by tone presentation was evaluated as an autonomic indicator of fear. During the context-dependent memory test, freezing was high only in 6J and 6N mice, whereas a drop of activity and a reduced exploratory area was measured in all strains. During the tone-dependent memory test, high freezing, low activity, reduced exploratory area and a strong HR increase were demonstrated only in 6N and 6J mice, whereas behavioral and HR changes of 2J and 2N mice were always low. In extinction tests, context- and tone-dependent freezing of 6J mice decayed significantly faster than the freezing of 6N mice, whereas in both substrains the conditioned tachycardia to tone extinguished similarly in the home cage. The data demonstrate that monitoring of additional behavioral measures besides freezing and autonomic measures is necessary to interpret differences in associative learning performance of mouse strains that could be related to a differential expression of fear.
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Belanger K, Tozer R, Burdette-Radoux S, Davis M, Lohmann R, Zee B, Wainman N, Seymour L. Results of a randomized phase II study of two schedules of bryostatin-I in patients with malignant melanoma: experience with the multivariate stopping rule. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81937-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schneider G, Heuft G, Lohmann R, Nehen HG, Kruse A, Senf W. [Psychogenic impairment and current feelings in the elderly. Which options are offered by the biographical perspective?]. Psychother Psychosom Med Psychol 1999; 49:195-201. [PMID: 10416339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
In the Eldermen study funded by the German Research Association (DFG), a consecutive sample of patients, aged > or = 60 (n = 120) and being treated for a variety of internal medical complaints in an acute geriatric hospital were examined with the help of comprehensive somatic diagnostics, standardised questionnaires, and a semi-structured biographical interview. The study investigates the relationship between burdensome and supportive biographical experiences and the extent of psychogenic impairment as well as aspects of feeling tone and self-concept in later life. For the degree of psychogenic impairment (Impairment Score. IS; Schepank 1995), subjectively experienced burdens and support were found to be more relevant than "objective" burdens. As expected, subjective burdens consistently experienced over several life phases, particularly in association with limited experienced support, were found to be associated with greater psychogenic impairment and a higher "case risk" in later life. However, the patients with the highest values for current life satisfaction as well as a more positive self-concept were not those patients who never experienced more burdens than support in their biographies, but rather those who experienced more burden than support in one life phase. The results are presented in relation to models of learning theory and object relation theory and discussed for their clinical relevance.
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Lohmann R, Souba WW, Bode BP. Rat liver endothelial cell glutamine transporter and glutaminase expression contrast with parenchymal cells. THE AMERICAN JOURNAL OF PHYSIOLOGY 1999; 276:G743-50. [PMID: 10070052 DOI: 10.1152/ajpgi.1999.276.3.g743] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Despite the central role of the liver in glutamine homeostasis in health and disease, little is known about the mechanism by which this amino acid is transported into sinusoidal endothelial cells, the second most abundant hepatic cell type. To address this issue, the transport of L-glutamine was functionally characterized in hepatic endothelial cells isolated from male rats. On the basis of functional analyses, including kinetics, cation substitution, and amino acid inhibition, it was determined that a Na+-dependent carrier distinct from system N in parenchymal cells, with properties of system ASC or B0, mediated the majority of glutamine transport in hepatic endothelial cells. These results were supported by Northern blot analyses that showed expression of the ATB0 transporter gene in endothelial but not parenchymal cells. Concurrently, it was determined that, whereas both cell types express glutamine synthetase, hepatic endothelial cells express the kidney-type glutaminase isozyme in contrast to the liver-type isozyme in parenchymal cells. This represents the first report of ATB0 and kidney-type glutaminase isozyme expression in the liver, observations that have implications for roles of specific cell types in hepatic glutamine homeostasis in health and disease.
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Neuhaus R, Kubo A, Lohmann R, Rayes N, Hierholzer J, Neuhaus P. Calcitriol in prevention and therapy of osteoporosis after liver transplantation. Transplant Proc 1999; 31:472-3. [PMID: 10083195 DOI: 10.1016/s0041-1345(98)01713-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lohmann R, Langrehr JM, Klupp J, Neumann U, Guckelberger O, Müller AR, Nüssler NC, Jonas S, Lang M, Settmacher U, Bechstein WO, Neuhaus PJ. Quadruple induction therapy including antithymocyte globulin or interleukin-2 receptor antibody or FK 506-based induction therapy after liver transplantation. Transplant Proc 1999; 31:380. [PMID: 10083151 DOI: 10.1016/s0041-1345(98)01670-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lohmann R, Jones KC. Dioxins and furans in air and deposition: a review of levels, behaviour and processes. THE SCIENCE OF THE TOTAL ENVIRONMENT 1998; 219:53-81. [PMID: 9770324 DOI: 10.1016/s0048-9697(98)00237-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper is a comprehensive, critical review of the levels, behaviour and processes affecting polychlorinated dibenzo-p-dioxins and -furans (PCDD/Fs) in air and deposition. Aspects of sampling, analysis and quality assurance/control are discussed initially, before a review of the PCDD/F concentrations in ambient air is presented. The general trend in sigma P4-8 CDD/F (and sigma TEQ) is: remote sites < 0.5 pg/m3 (sigma TEQ < 10 fg/m3); rural sites approximately 0.5-4 pg/m3 (sigma TEQ approximately 20-50 fg/m3); and urban/industrial sites approximately 10-100 pg/m3 (sigma TEQ approximately 100-400 fg/m3). The commonly held view that a consistent mixture of PCDD/Fs in air exists is evaluated and questioned. Issues of seasonality and short-term changes in air concentrations are also critically discussed, with respect to the possibility of seasonal emission sources to air and seasonally dependent loss processes. Data on the gas-particle partitioning of PCDD/Fs in air are reviewed; the limited database to date is believed to provide evidence for an exchangeable transfer of PCDD/Fs between these two phases. The potential importance of photolytic and radical reaction degradation processes and wet/dry deposition processes in modifying the mixture of PCDD/Fs in air is discussed. Some homologue/congener specific 'weathering' of the mixture of PCDD/Fs emitted to the atmosphere clearly occurs, but in general PCDD/Fs have 'long' atmospheric residence times, rendering them subject to long-range atmospheric transport. Data are reviewed which relate the mixture of PCDD/Fs in air to that in deposition; this leads to the conclusion that different homologue groups (which are partitioned differently between the gas and particulate phase) are transferred to the earth's surface with broadly similar efficiencies.
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Langrehr JM, Glanemann M, Guckelberger O, Klupp J, Neumann U, Machens C, Lohmann R, Knoop M, Lobeck H, Schlag H, Keck H, Settmacher U, Bechstein WO, Neuhaus PJ. A randomized, placebo-controlled trial with anti-interleukin-2 receptor antibody for immunosuppressive induction therapy after liver transplantation. Clin Transplant 1998; 12:303-12. [PMID: 9686324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The introduction of quadruple induction therapy after liver transplantation with the murine anti-interleukin-2 receptor (IL-2R) antibody (BT563) has decreased the incidence of serious side effects, such as tachycardia, hypertension, rash, fever and nausea since it does not lyse its target cell. To investigate the immunosuppressive efficacy of BT563, a placebo-controlled trial was performed and BT563 was added to the standard triple induction after liver transplantation. Forty consecutive recipients of primary orthotopic liver transplants (OLT) (median age 47 yr [range 18-65]) were randomized. All patients received triple immunosuppression with cyclosporine A (CyA), prednisolone (PRED) and azathioprine (AZA). In addition, 19 patients received BT563 (Biotest, Dreieich, Germany) at a dose of 10 mg/d from day 0 until day 12. The remaining 21 patients received a placebo infusion at the same days after transplantation. Minimal follow-up for all patients was 3 yr. Patient survival at 3 yr was 74% in the BT563 group and 90% in placebo group. Similar results were observed for graft survival. Two acute rejection episodes were detected in the BT563 group and 9 acute rejections (5 steroid-resistant) were observed in the placebo group (p < 0.034). The incidences of sepsis, pneumonia, cholangitis, urinary tract infections as well as cytomegalo-virus (CMV) infections were similar in both groups. Side effects of the BT563 therapy and/or post-transplant lymphoproliferative disease (PTLD) were not detected. Quadruple induction therapy with BT563 significantly reduces the incidence of rejection episodes after liver transplantation, while infectious complications and/or PTLD is not increased. Therefore, the anti-IL2 receptor antibody BT563 constitutes a safe and efficient addition to the immunosuppressive induction regimen following OLT.
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Glanemann M, Langrehr JM, Raakow R, Guckelberger O, Lohmann R, Klupp J, Lobeck H, Schlag H, Keck H, Bechstein WO, Settmacher U, Neuhaus P. Anti-IL-2 receptor BT563 versus placebo: a randomized trial for induction therapy after liver transplantation. Transplant Proc 1998; 30:2159-60. [PMID: 9723425 DOI: 10.1016/s0041-1345(98)00572-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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