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Oberhauser FB, Koch A, Czaczkes TJ. Small differences in learning speed for different food qualities can drive efficient collective foraging in ant colonies. Behav Ecol Sociobiol 2018. [DOI: 10.1007/s00265-018-2583-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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77
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Herbers U, Trautwein C, Tacke F, Koch A. [Diagnosis and stage-adapted treatment of acute pancreatitis]. Med Klin Intensivmed Notfmed 2018; 113:593-605. [PMID: 30094503 DOI: 10.1007/s00063-018-0466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
Acute pancreatitis is a potentially life-threatening disease, which is morphologically classified into interstitial edematous or necrotizing pancreatitis. According to the revised Atlanta classification, mild, moderate and severe clinical courses are differentiated regarding local and systemic complications as well as concomitant organ failure. In the initial disease phase, the therapeutic measures are focused on (aggressive) volume replacement, early enteral nutrition and adequate analgesia. Characteristic in the course of severe acute pancreatitis are abdominal necroses, which require individualized and interdisciplinary treatment with antibiotic therapy, drainage and definitive necrosectomy. Necrosectomy should be planned as a "step-up approach" using interventional-radiological, endoscopic and minimally invasive surgical procedures.
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Hansel G, Koch A, Wollina U. Dresdner Dermatologische Demonstration 2018 – 14. April 2018. AKTUELLE DERMATOLOGIE 2018. [DOI: 10.1055/a-0603-4523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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79
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Knobloch J, Jungck D, Koch A. The Molecular Mechanisms of Thalidomide Teratogenicity and Implications for Modern Medicine. Curr Mol Med 2018; 17:108-117. [PMID: 28429672 DOI: 10.2174/1566524017666170331162315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/22/2022]
Abstract
Thalidomide is a teratogen that affects many organs but primarily induces limb truncations like phocomelia. Rodents are thalidomide resistant. In the 1950s, this has led to misinterpretations of animal tests and to the fatal assumption that the drug was safe for pregnant women to use against morning sickness. The result was one of the biggest scandals in medical history: 10.000 and more infants with birth defects in Europe. Nonetheless, thalidomide still has its place in modern medicine as it has strong therapeutic potential: it has been approved by the FDA for multiple myeloma and erythema nodosum leprosum, and its anti-inflammatory, immunomodulatory and antiangiogenic activities are considered in many other refractory diseases. The aim is to develop derivatives that are not teratogenic but maintain the therapeutic potential. This requires detailed knowledge about the underlying molecular mechanisms. Much progress has been made in deciphering the teratogenic mechanisms in the last decade. Here, we summarize these mechanisms, explain thalidomide resistance of rodents, and discuss possible mechanisms that could explain why the drug primarily targets the developing limb in the embryo. We also summarize the most important therapeutic mechanisms. Finally, we discuss which therapeutic and teratogenic mechanisms do and do not overlap, and if there is a chance for the development of non-teratogenic thalidomide derivatives with therapeutic potential.
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Koch A, Brites D, Stucki D, Evans JC, Seldon R, Heekes A, Mulder N, Nicol M, Oni T, Warner DF, Mizrahi V, Parkhill J, Gagneux S, Martin DP, Wilkinson RJ. A19 The impact of HIV-1 on the evolution of Mycobacterium tuberculosis. Virus Evol 2018. [PMCID: PMC5905528 DOI: 10.1093/ve/vey010.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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81
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Pizanis N, Carstens H, Koch A, Luedike P, Rassaf T, Kamler M. Mid-term Survival after Ventricular Assist Device Implantation in Patients ≥70 Years. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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82
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Benabu JC, Stoll F, Koch A, Molière S, Bellocq JP, Mathelin C. De-escalating systemic therapy in triple negative breast cancer: The example of secretory carcinoma. J Gynecol Obstet Hum Reprod 2018; 47:163-165. [PMID: 29409947 DOI: 10.1016/j.jogoh.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/28/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
Triple negative breast cancers have the highest relapse risk and the least favourable prognosis of all breast cancer subtypes, leading to an escalation of chemotherapy, substantially during recent years. Secretory carcinoma of the breast is a rare triple negative neoplasm, first described in children but more often presenting in adults. We report a case of a 70-years-old woman, initially diagnosed on the biopsy with a triple negative infiltrating Not Otherwise Specified (NOS) carcinoma of the breast, before it was later correctly identified as a secretory carcinoma, notably because of an abundant intra and extracellular secretory material. This new diagnosis, confirmed by fluorescence in-situ hybridization analysis showing ETS variant 6 (ETV6) gene rearrangement, allowed the de-escalation of chemotherapy therapy. Four years later, the patient is free of recurrences.
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83
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Koch A, Mizrahi V. Mycobacterium tuberculosis. Trends Microbiol 2018; 26:555-556. [PMID: 29580884 DOI: 10.1016/j.tim.2018.02.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 11/27/2022]
Abstract
In this infographic, the genetics, phylogeny, physiology, and pathogenesis mechanisms of Mycobacterium tuberculosis are shown. Mycobacterium tuberculosis is the etiological agent of tuberculosis (TB), the leading cause of death due to a single infectious agent, claiming 1.7 million lives in 2016. Of the deaths attributable to TB in 2016, 22% occurred in people coinfected with HIV, and close to 5% of the 10.4 million incident cases of this disease were resistant to at least two of the first-line TB drugs. In this infographic, we describe the fundamental features of the genetics, phylogeny, and physiology of this member of the phylum Actinobacteria, which is associated increasingly with drug resistance mediated by mutations and rearrangements in its single, circular chromosome. We also highlight the key pathogenesis mechanisms employed by this slow-growing, facultative intracellular bacterium, which include avoidance of host cell clearance by arrest of the normal macrophage maturation process.
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Seiler F, Trudzinski FC, Fähndrich S, Watz H, Jörres RA, Koch A, Welte T, Vogelmeier C, Biertz F, Bals R. Definition und Charakterisierung eines inflammatorischen Phänotyps bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) – Ergebnisse aus der nationalen COPD-Kohorte COSYCONET. Pneumologie 2018. [DOI: 10.1055/s-0037-1619351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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85
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Yanik S, Betke L, Jamal Jameel KJ, Rhode S, Bülthoff E, Bürger P, Kronsbein J, Jungck D, Grunwald T, Tenbusch M, Koch A, Knobloch J. Die Zytokinantwort von Leukozyten auf humane Rhinoviren ist bei COPD und Rauchern supprimiert. Pneumologie 2018. [DOI: 10.1055/s-0037-1619391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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86
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Knobloch J, Lehnert M, Yanik S, Casjens S, Körber S, Lotz A, Betke L, Raulf M, Zschiesche W, Weiß T, Kronsbein J, Pesch B, Brüning T, Koch A. Modulation der T-Zell- und Monozytenaktivität durch Schweißrauchexposition – Daten aus der Weldox II Studie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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87
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Koch A, Tacke F. Invasive Candida-Infektionen bei Leberzirrhose. Med Klin Intensivmed Notfmed 2018; 113:139-140. [DOI: 10.1007/s00063-017-0328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022]
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Ronnander P, Simon L, Spilgies H, Koch A, Scherr S. Dissolving polyvinylpyrrolidone-based microneedle systems for in-vitro delivery of sumatriptan succinate. Eur J Pharm Sci 2018; 114:84-92. [DOI: 10.1016/j.ejps.2017.11.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/08/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
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89
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Haahr S, Michelsen SW, Andersson M, Bjorn-Mortensen K, Soborg B, Wohlfahrt J, Melbye M, Koch A. Non-specific effects of BCG vaccination on morbidity among children in Greenland: a population-based cohort study. Int J Epidemiol 2018; 45:2122-2130. [PMID: 28338723 DOI: 10.1093/ije/dyw244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/13/2022] Open
Abstract
Background The potential non-specific effects of BCG (Bacillus Calmette-Guérin) vaccination, with reported reduction of infectious disease morbidity among vaccinated children, in addition to the protective effect against tuberculosis (TB), are highly debated. In Greenland, BCG vaccination was introduced in 1955, but temporarily discontinued from 1991 to 1996 due to nationwide policy changes. Using the transient vaccination stop, we aimed to investigate possible non-specific effects of BCG vaccination by measuring nation-wide hospitalization rates due to infectious diseases other than TB among vaccinated and unvaccinated children. Methods A retrospective cohort study including all children born in Greenland aged 3 months to 3 years from 1989 to 2004. A personal identification number assigned at birth allowed for follow-up through national registers. Information on hospitalization due to infectious diseases was obtained from the Greenlandic inpatient register using ICD-8 and ICD-10 codes. Participants with notified TB were censored. Incidence rate ratios (IRR) were estimated using Poisson regression. Results Overall, 19 363 children, hereof 66% BCG-vaccinated, were followed for 44 065 person-years and had 2069 hospitalizations due to infectious diseases. IRRs of hospitalization in BCG-vaccinated as compared with BCG-unvaccinated children were 1.07 [95% confidence interval (CI) 0.96-1.20] for infectious diseases overall, and specifically 1.10 (95% CI 0.98-1.24) for respiratory tract infections. Among BCG-vaccinated children aged 3 to 11 months, the IRR of hospitalization due to infectious diseases was 1.00 (95% CI 0.84-1.19) as compared with BCG-unvaccinated children. Conclusion Our results do not support the hypothesis that neonatal BCG vaccination reduces morbidity in children caused by infectious diseases other than TB.
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Koch A, Victor N, Ziegler S. Deficits and Remedy of the Standard Random Effects Methods in Meta-analysis. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractThe random effects model is often used in meta-analyses. A corresponding significance test based on a normal approximation has been established. Its type I error is derived in this article by theoretical considerations and computer simulations. The test can be conservative as well as unacceptably anti-conservative. The anti-conservatism increases with the increasing number of patients and the decreasing number of studies. A modification is proposed, which keeps the nominal level asymptotically as the number of patients approaches infinity. Simulations show that the modified test is often conservative, but its conservatism is small in those situations where the standard test is highly anti-conservative.
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Sonntagbauer M, Koch A, Strouhal U, Zacharowski K, Weber CF. Catecholamine crisis during induction of general anesthesia. Anaesthesist 2018; 67:209-215. [DOI: 10.1007/s00101-018-0409-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/12/2017] [Accepted: 12/15/2017] [Indexed: 11/24/2022]
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Anker JCH, Koch A, Ethelberg S, Mølbak K, Larsen J, Jepsen MR. Distance to pig farms as risk factor for community-onset livestock-associated MRSA CC398 infection in persons without known contact to pig farms-A nationwide study. Zoonoses Public Health 2018; 65:352-360. [PMID: 29314752 DOI: 10.1111/zph.12441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 11/30/2022]
Abstract
MRSA CC398 is an emerging MRSA strain found in livestock, mainly in pigs. Direct occupational livestock contact is the principal risk factor for human MRSA CC398 infection. Nonetheless, in recent years, an increasing number of MRSA CC398 cases has been observed in persons without known pig contact. Such cases, referred to as MRSA CC398 of unknown origin (MUO CC398), have, like livestock-onset (LO) MRSA CC398 cases, been found concentrated in rural, livestock-producing areas. The presence of MUO CC398 cases indicates alternative and unknown MRSA CC398 transmission pathways into the community. We performed a nationwide study in Denmark of the geographic distributions of MRSA cases in general and persons with MUO CC398 or LO MRSA CC398 infections (1 January 2006-11 February 2015), with the Danish population as background population. Place of living of study persons was mapped using the ArcGIS software, and information on pig farms was retrieved from the Central Husbandry Register. The incidence of MUO CC398 infections was clearly higher in rural than in urban areas, and such cases lived on average closer to pig farms than the general population. However, within three pig-farming-dense municipalities, patients with MUO CC398 infections did not live closer to pig farms than population controls. This shows that direct environmental spread from neighbouring pig farms of MRSA CC398 is unlikely. Instead, community spread through other means of transmission than direct spread from farms may more likely explain the clustering of MUO CC398 in livestock-dense areas.
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Wollina U, Gaber B, Koch A. PHOTODYNAMIC TREATMENT WITH NANOEMULSIFIED 5-AMINOLEVULINIC ACID AND NARROW BAND RED LIGHT FOR FIELD CANCERIZATION DUE TO OCCUPATIONAL EXPOSURE TO ULTRAVIOLET LIGHT IRRADIATION. GEORGIAN MEDICAL NEWS 2018:138-143. [PMID: 29461242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Actinic keratosis (AK) is a premalignant epithelial disease that develops on skin chronically exposed to ultraviolet-light. For outdoor workers, AK is an occupational hazard with a potential for malignant transformation into squamous cell carcinoma. Various topical treatments are used to treat AK's. Photodynamic therapy (PDT) promises the highest cure rates. We performed a prospective single center trial evaluating effects of PDT treatment for field cancerization due to occupational exposure to ultraviolet light irradiation in patients unresponsive to the treatment regimen with topical diclofenac gel. For PDT, a nanoemulsified 5-aminolevulinic acid (5-ALA) formulation was combined with narrow band red light irradiation with a peak wavelength of 635 nm and a total light intensity of 37 J/cm2. Clearance rate and adverse events were recorded. Thirty patients with a mean age of 77±10.5 years (26 males and 4 females) were included in the trial. They received between one and nine PDT sessions. Mean pain during PDT was scored at 6.8±2.8 using the visual analogue scale. Patients exhibited a mild immediate erythema after PDT. Among the patients, who tolerated PDT, a complete clearance was achieved in 93.3%, and >90% clearance - in 6.7%. Pain management was performed by cold-air analgesia. In conclusion, PDT with nanoemulsified 5-ALA and narrow band red light irradiation is an effective and safe treatment for occupational field cancerization without systemic toxicity. Adherence to this treatment is much better than to topical treatment.
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Koch A, Favre R, Viville B, Fritz G, Kohler M, Guerra F, Lecointre L, Gaudineau A, Langer B, Weingertner AS, Sananès N. Expectant management and laser photocoagulation in isolated selective intra-uterine growth restriction: A single-center series. J Gynecol Obstet Hum Reprod 2017; 46:731-736. [DOI: 10.1016/j.jogoh.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
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95
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Koch A, Trautwein C, Tacke F. [Acute liver failure]. DER GASTROENTEROLOGE : ZEITSCHRIFT FUR GASTROENTEROLOGIE UND HEPATOLOGIE 2017; 12:507-517. [PMID: 32288842 PMCID: PMC7101900 DOI: 10.1007/s11377-017-0214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute liver failure (ALF) is a rare, but life-threatening disease that is characterized by the acute onset of jaundice, coagulopathy, and hepatic encephalopathy (HE) in patients without pre-existing liver disease. Main causes in Germany are drug toxicity, acetaminophen overdose, and viral hepatitis (A, B, E). For the initial assessment of patients with ALF and the diagnostic algorithm, the early detection of HE, exclusion of liver cirrhosis, immediate diagnosis of the underlying etiology, and evaluation for the necessity of liver transplantation (LT) are critical. Intensive care therapeutic measures aim at preventing or treating complications of ALF. Potentially, plasmapheresis (full plasma exchange) offers a survival benefit for ALF patients who do not undergo LT. The King's College criteria and the Clichy criteria are used as prognostic tools for the indication for LT.
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Wunderlich T, Frey N, Kähler W, Lutz M, Radermacher P, Klapa S, Koch I, Tillmans F, Witte J, Koch A. Influence of hyperoxia on diastolic myocardial and arterial endothelial function. Undersea Hyperb Med 2017; 44:521-533. [PMID: 29281189 DOI: 10.22462/11.12.2017.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Hyperoxia is known to influence cardiovascular and endothelial function, but it is unknown if there are differences between younger and older persons. The aim of this study was to monitor changes in myocardial diastolic function and flow-mediated dilatation (FMD) in younger and elderly volunteers, before and after exposure to relevant hyperbaric hyperoxia. METHODS 51 male patients were separated into two groups for this study. Volunteers in Group 1 (n=28, mean age 26 ±6, "juniors") and Group 2 (n=23, mean age 53 ±9, "seniors") received standard HBO₂ protocol (240kPa oxygen). Directly before and after hyperoxic exposure in a hyperbaric chamber we took blood samples (BNP, hs-troponin-t), assessed the FMD and echocardiographic parameters with focus on diastolic function. RESULTS After hyperoxia we observed a high significant decrease in heart rate and systolic/diastolic FMD. Diastolic function varied in both groups: E/A ratio showed a statistically significant increase in Group 1 and remained unchanged in Group 2. E/e' ratio showed a slight but significant increase in Group 1, whereas e'/a' ratio increased in both groups. Deceleration time increased significantly in all volunteers. Isovolumetric relaxation time remained unchanged and ejection fraction showed a decrease only in Group 2. There were no changes in levels of BNP and hs-troponin-t in either group. CONCLUSION Hyperoxia seems to influence endothelial function differently in juniors and seniors: FMD decreases more in seniors, possibly attributable to pre-existing reduced vascular compliance. Hyperoxia-induced bradycardia induced a more pronounced improvement in diastolic function in juniors. The ability of Group 1 to cope with hyperoxia-induced effects did not work in the same manner as with Group 2.
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Gorenoi V, Brehm M, Koch A, Hagen A. Growth Factors for Angiogenesis in Peripheral Arterial Disease. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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98
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Guilloteau L, Anne C, Foury A, Helbling JC, Koch A, Crochet S, Cailleau-Audouin E, Constantin P, Lagarrigue S, Désert C, Mercerand F, Rat C, Delaveau J, Grimaud I, Ledru E, Moisan MP, Leterrier C. Spontaneous intake of essential oils during the early rearing phase of chicks and long-term effects on performance and transcriptome regulation. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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99
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Bavendiek U, Aguirre Davila L, Schwab J, Phillip S, Westenfeld R, Maier L, Stoerk S, Weber K, Koch A, Bauersachs J. P6168Digitoxin serum concentrations affecting patient safety and potential outcome in patients with HFrEF - analyses of the ongoing DIGIT-HF-trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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100
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Bauschke A, Altendorf-Hofmann A, Kissler H, Koch A, Malessa C, Settmacher U. Validity of eleven prognostic scores with respect to intra- and extrahepatic recurrence of hepatocellular carcinoma after liver transplantation. J Cancer Res Clin Oncol 2017; 143:2595-2605. [PMID: 28849266 DOI: 10.1007/s00432-017-2507-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Tumor recurrence is the most frequent cause of death after liver transplantation for hepatocellular carcinoma. We selected ten other prognostic classifications to evaluate their potential to predict the risk of recurrence after LT for HCC as compared to the Milan classification. All of the other scores have not been compared with one another in a single cohort. METHODS Data of 147 consecutive patients transplanted at our department between 1996 and 2014 were analyzed and staged for morphological and functional scores of underlying liver disease. For long-term follow-up, we analyzed intrahepatic (within the liver ± distant metastases) and extrahepatic (distant metastases only) recurrence separately. RESULTS AND CONCLUSIONS The median survival time for all patients was 106 months. The 5- and 10-year observed survival rates were 61 and 43%, respectively. The observed cumulative 5- and 10-year recurrence rates were 37 and 39%, respectively, 10-year intrahepatic and extrahepatic recurrence rates were 12 and 27%, respectively. Median survival time after diagnosis of first recurrence was 7.5 (0-120) months; 2 and 18 months for all, intra- and extrahepatic recurrence, respectively. UCSF-, up to seven-, Shanghai Fudan- or Duvoux classifications can identify patients with a cumulative 10-year recurrence rate below 20%. The pre-therapeutic AFP level should be considered in addition to the geometry of the intrahepatic lesions.
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