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Birkelbach B, Lutz D, Ruppert C, Henneke I, Lopez-Rodriguez E, Günther A, Ochs M, Mahavadi P, Knudsen L. Linking progression of fibrotic lung remodeling and ultrastructural alterations of alveolar epithelial type II cells in the amiodarone mouse model. Am J Physiol Lung Cell Mol Physiol 2015; 309:L63-75. [PMID: 25957292 DOI: 10.1152/ajplung.00279.2014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 05/07/2015] [Indexed: 01/08/2023] Open
Abstract
Chronic injury of alveolar epithelial type II cells (AE2 cells) represents a key event in the development of lung fibrosis in animal models and in humans, such as idiopathic pulmonary fibrosis (IPF). Intratracheal delivery of amiodarone to mice results in a profound injury and macroautophagy-dependent apoptosis of AE2 cells. Increased autophagy manifested in AE2 cells by disturbances of the intracellular surfactant. Hence, we hypothesized that ultrastructural alterations of the intracellular surfactant pool are signs of epithelial stress correlating with the severity of fibrotic remodeling. With the use of design-based stereology, the amiodarone model of pulmonary fibrosis in mice was characterized at the light and ultrastructural level during progression. Mean volume of AE2 cells, volume of lamellar bodies per AE2 cell, and mean size of lamellar bodies were correlated to structural parameters reflecting severity of fibrosis like collagen content. Within 2 wk amiodarone leads to an increase in septal wall thickness and a decrease in alveolar numbers due to irreversible alveolar collapse associated with alveolar surfactant dysfunction. Progressive hypertrophy of AE2 cells and increase in mean individual size and total volume of lamellar bodies per AE2 cell were observed. A high positive correlation of these AE2 cell-related ultrastructural changes and the deposition of collagen fibrils within septal walls were established. Qualitatively, similar alterations could be found in IPF samples with mild to moderate fibrosis. We conclude that ultrastructural alterations of AE2 cells including the surfactant system are tightly correlated with the progression of fibrotic remodeling.
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Tranberg T, Lassen JF, Kaltoft AK, Hansen TM, Stengaard C, Knudsen L, Trautner S, Terkelsen CJ. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study. Scand J Trauma Resusc Emerg Med 2015; 23:37. [PMID: 25898992 PMCID: PMC4411930 DOI: 10.1186/s13049-015-0114-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mechanical chest compressions have been proposed to provide high-quality cardiopulmonary resuscitation (CPR), but despite the growing use of mechanical chest compression devices, only few studies have addressed their impact on CPR quality. This study aims to evaluate mechanical chest compressions provided by LUCAS-2 (Lund University Cardiac Assist System) compared with manual chest compression in a cohort of out-of-hospital cardiac arrest (OHCA) cases. METHODS In this prospective study conducted in the Central Denmark Region, Denmark, the emergency medical service attempted resuscitation and reported data on 696 non-traumatic OHCA patients between April 2011 and February 2013. Of these, 155 were treated with LUCAS CPR after an episode with manual CPR. The CPR quality was evaluated using transthoracic impedance measurements collected from the LIFEPAK 12 defibrillator, and the effect was assessed in terms of chest compression rate, no-flow time and no-flow fraction; the fraction of time during resuscitation in which the patient is without spontaneous circulation receiving no chest compression. RESULTS The median total episode duration was 21 minutes, and the episode with LUCAS CPR was significantly longer than the manual CPR episode, 13 minutes vs. 5 minutes, p < 0.001. The no-flow fraction was significantly lower during LUCAS CPR (16%) than during manual CPR (35%); difference 19% (95% CI: 16% to 21%; p < 0.001). No differences were found in pre- and post-shock no-flow time throughout manual CPR and LUCAS CPR. Contrary to the manual CPR, the average compression rate during LUCAS CPR was in conformity with the current Guidelines for Resuscitation, 102/minute vs. 124/minute, p < 0.001. CONCLUSION Mechanical chest compressions provided by the LUCAS device improve CPR quality by significantly reducing the NFF and by improving the quality of chest compression compared with manual CPR during OHCA resuscitation. However, data on end-tidal Co2 and chest compression depth surrogate parameters of CPR quality could not be reported.
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Frøkiaer J, Knudsen L, Mortensen J, Djurhuus JC, Jensen FT. The impact of different urinary flow rates on renoscintigraphy. CONTRIBUTIONS TO NEPHROLOGY 2015; 79:74-6. [PMID: 2225871 DOI: 10.1159/000418154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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79
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Lutz D, Gazdhar A, Lopez-Rodriguez E, Ruppert C, Mahavadi P, Günther A, Klepetko W, Bates JH, Smith B, Geiser T, Ochs M, Knudsen L. Alveolar derecruitment and collapse induration as crucial mechanisms in lung injury and fibrosis. Am J Respir Cell Mol Biol 2015; 52:232-43. [PMID: 25033427 DOI: 10.1165/rcmb.2014-0078oc] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) and bleomycin-induced pulmonary fibrosis are associated with surfactant system dysfunction, alveolar collapse (derecruitment), and collapse induration (irreversible collapse). These events play undefined roles in the loss of lung function. The purpose of this study was to quantify how surfactant inactivation, alveolar collapse, and collapse induration lead to degradation of lung function. Design-based stereology and invasive pulmonary function tests were performed 1, 3, 7, and 14 days after intratracheal bleomycin-instillation in rats. The number and size of open alveoli was correlated to mechanical properties. Active surfactant subtypes declined by Day 1, associated with a progressive alveolar derecruitment and a decrease in compliance. Alveolar epithelial damage was more pronounced in closed alveoli compared with ventilated alveoli. Collapse induration occurred on Day 7 and Day 14 as indicated by collapsed alveoli overgrown by a hyperplastic alveolar epithelium. This pathophysiology was also observed for the first time in human IPF lung explants. Before the onset of collapse induration, distal airspaces were easily recruited, and lung elastance could be kept low after recruitment by positive end-expiratory pressure (PEEP). At later time points, the recruitable fraction of the lung was reduced by collapse induration, causing elastance to be elevated at high levels of PEEP. Surfactant inactivation leading to alveolar collapse and subsequent collapse induration might be the primary pathway for the loss of alveoli in this animal model. Loss of alveoli is highly correlated with the degradation of lung function. Our ultrastructural observations suggest that collapse induration is important in human IPF.
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Winkler C, Bahlmann O, Viereck J, Knudsen L, Wedekind D, Hoymann HG, Madsen J, Thum T, Hohlfeld JM, Ochs M. Impact of a Met(11)Thr single nucleotide polymorphism of surfactant protein D on allergic airway inflammation in a murine asthma model. Exp Lung Res 2014; 40:154-63. [PMID: 24712849 DOI: 10.3109/01902148.2014.891062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The surfactant-associated proteins SP-A and D are pattern recognition molecules with collectin structure. A single nucleotide polymorphism (SNP) exchanging a methionine (Met) for a threonine (Thr) in the amino-terminal SP-D domain influences the oligomeric structure and function of the protein. In this study, we investigated the susceptibility of mice transgenic for the human SP-D Met(11)Thr SNP to allergic airway inflammation and consequences for microRNA (miRNA, miR) expression. Mice expressing either human Met or Thr SP-D were sensitized and challenged with ovalbumin (OVA) in an acute model of allergic asthma. The influence of the SP-D polymorphism on the allergic airway inflammation was evaluated by lung function measurement, pulmonary inflammation parameters, morphological analysis and miRNA expression. Airway hyperresponsiveness, allergic inflammation, and mucus metaplasia were not significantly different between mice expressing one or the other allelic variant of SP-D. OVA sensitization and challenge led to significant airway hyperresponsiveness in wildtype mice and significantly lower eosinophil numbers and interleukin 5 levels in Thr SP-D mice. OVA challenge induced an upregulation of miR-21 and 155 in Thr SP-D mice and a downregulation of miR-21 in Met SP-D mice. Our results show that murine expression of human polymorphic SP-D variants does not significantly influence the severity of allergic airway inflammation. MiR-21 and 155 are differentially regulated in transgenic mice in response to allergic inflammation. Further studies are required to elucidate the impact of this SNP on inflammatory conditions of the lung.
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81
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Philipsen PA, Knudsen L, Gniadecka M, Ravnbak MH, Wulf HC. Correction to: Diagnosis of malignant melanoma and basal cell carcinoma by in vivo NIR-FT Raman spectroscopy is independent of skin pigmentation. Photochem Photobiol Sci 2014. [DOI: 10.1007/bf03549803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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82
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Mahavadi P, Henneke I, Ruppert C, Knudsen L, Venkatesan S, Liebisch G, Chambers RC, Ochs M, Schmitz G, Vancheri C, Seeger W, Korfei M, Guenther A. Altered surfactant homeostasis and alveolar epithelial cell stress in amiodarone-induced lung fibrosis. Toxicol Sci 2014; 142:285-97. [PMID: 25163675 DOI: 10.1093/toxsci/kfu177] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Amiodarone (AD) is a highly efficient antiarrhythmic drug with potentially serious side effects. Severe pulmonary toxicity is reported in patients receiving AD even at low doses and may cause interstitial pneumonia as well as lung fibrosis. Apoptosis of alveolar epithelial type II cells (AECII) has been suggested to play an important role in this disease. In the current study, we aimed to establish a murine model of AD-induced lung fibrosis and analyze surfactant homeostasis, lysosomal, and endoplasmic reticulum (ER) stress in this model. AD/vehicle was instilled intratracheally into C57BL/6 mice, which were sacrificed on days 7, 14, 21, and 28. Extent of lung fibrosis development was assessed by trichrome staining and hydroxyproline measurement. Cytotoxicity was assessed by lactate dehydrogenase assay. Phospholipids (PLs) were analyzed by mass spectrometry. Surfactant proteins (SP) and markers for apoptosis, lysosomal, and ER stress were studied by Western blotting and immunohistochemistry. AECII morphology was evaluated by electron microscopy. Extensive lung fibrosis and AECII hyperplasia were observed in AD-treated mice already at day 7. Surfactant PL and SP accumulated in AECII over time. In parallel, induction of apoptosis, lysosomal, and ER stress was encountered in AECII of mice lungs and in MLE12 cells treated with AD. In vitro, siRNA-mediated knockdown of cathepsin D did not alter the AD-induced apoptotic response. Our data suggest that mice exposed to intratracheal AD develop severe pulmonary fibrosis, exhibit extensive surfactant alterations and cellular stress, but AD-induced AECII apoptosis is not mediated primarily via cathepsin D.
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Wehling J, Kellner M, Izykowski N, Braubach P, Warnecke G, Knudsen L, Haverich A, Wiegmann B, Vogel-Claussen J, Kreipe H, Länger F, Kühnel M, Jonigk D. Integrative molecular and anatomical characterization of idiopathic pulmonary fibrosis. Pneumologie 2014. [DOI: 10.1055/s-0034-1376804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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84
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Ahuja S, Henneke I, Knudsen L, Gochuico BR, Ruppert C, Ochs M, Korfei M, Seeger W, Guenther A, Mahavadi P. Deficient Autophagy in Hermansky-Pudlak Syndrome associated lung fibrosis. Pneumologie 2014. [DOI: 10.1055/s-0034-1376807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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85
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Krabbe S, Bolce R, Brahe C, Døhn U, Wu G, Ejbjerg B, Hetland M, Sasso E, Chernoff D, Hansen M, Knudsen L, Hansen A, Madsen O, Hasselquist M, Møller J, Østergaard M. FRI0042 Validation of A Multi-Biomarker Disease Activity Score in Rheumatoid Arthritis in Relation to Imaging Inflammation and Damage. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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86
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Lutz D, Gazdhar A, Lopez-Rodriguez E, Mahavadi P, Günther A, Klepetko W, Bates JH, Smith B, Geiser T, Ochs M, Knudsen L. Alveolar derecruitment and collapse induration as crucial mechanisms in lung injury and fibrosis. Pneumologie 2014. [DOI: 10.1055/s-0034-1376809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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87
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Lopez-Rodriguez E, Boden C, Knippenberg S, Pascual A, Perez-Gil J, Kolb M, Gauldie J, Maus U, Ochs M, Knudsen L. In vivo effects of TGF-β1 in lung surfactant regulation, lung meachanics amd structure. Pneumologie 2014. [DOI: 10.1055/s-0034-1376812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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88
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Viereck J, Knudsen L, Schneider JP, Ochs M, Thum T. The role of surfactant protein D in fibrotic lung remodelling. Pneumologie 2014. [DOI: 10.1055/s-0034-1376777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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89
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Mahavadi P, Henneke I, Knudsen L, Venkatesan S, Ruppert C, Hegermann J, Liebisch G, Wrede C, Chambers R, Ochs M, Schmitz G, Vancheri C, Seeger W, Korfei M, Guenther A. Regulation of macroautophagy in amiodarone induced pulmonary fibrosis. Pneumologie 2014. [DOI: 10.1055/s-0034-1376801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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90
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Jakobsen LK, Bøtker MT, Lawrence LP, Sloth E, Knudsen L. Systematic training in focused cardiopulmonary ultrasound affects decision-making in the prehospital setting - two case reports. Scand J Trauma Resusc Emerg Med 2014; 22:29. [PMID: 24886932 PMCID: PMC4016794 DOI: 10.1186/1757-7241-22-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
We present two cases from the Helicopter Emergency Medical Services (HEMS) in Denmark, in which prehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology that induced a radical change for the critical patient's course.
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Herrmann G, Knudsen L, Madershahian N, Mühlfeld C, Frank K, Rahmanian P, Wahlers T, Wittwer T, Ochs M. Effects of exogenous surfactant on the non-heart-beating donor lung graft in experimental lung transplantation - a stereological study. J Anat 2014; 224:594-602. [PMID: 24527871 DOI: 10.1111/joa.12167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/29/2022] Open
Abstract
The use of non-heart-beating donor (NHBD) lungs may help to overcome the shortage of lung grafts in clinical lung transplantation, but warm ischaemia and ischaemia/reperfusion injury (I/R injury) resulting in primary graft dysfunction represent a considerable threat. Thus, better strategies for optimized preservation of lung grafts are urgently needed. Surfactant dysfunction has been shown to contribute to I/R injury, and surfactant replacement therapy is effective in enhancing lung function and structural integrity in related rat models. In the present study we hypothesize that surfactant replacement therapy reduces oedema formation in a pig model of NHBD lung transplantation. Oedema formation was quantified with (SF) and without (non-SF) surfactant replacement therapy in interstitial and alveolar compartments by means of design-based stereology in NHBD lungs 7 h after cardiac arrest, reperfusion and transplantation. A sham-operated group served as control. In both NHBD groups, nearly all animals died within the first hours after transplantation due to right heart failure. Both SF and non-SF developed an interstitial oedema of similar degree, as shown by an increase in septal wall volume and arithmetic mean thickness as well as an increase in the volume of peribron-chovascular connective tissue. Regarding intra-alveolar oedema, no statistically significant difference could be found between SF and non-SF. In conclusion, surfactant replacement therapy cannot prevent poor outcome after prolonged warm ischaemia of 7 h in this model. While the beneficial effects of surfactant replacement therapy have been observed in several experimental and clinical studies related to heart-beating donor lungs and cold ischaemia, it is unlikely that surfactant replacement therapy will overcome the shortage of organs in the context of prolonged warm ischaemia, for example, 7 h. Moreover, our data demonstrate that right heart function and dysfunctions of the pulmonary vascular bed are limiting factors that need to be addressed in NHBD.
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Mahavadi P, Henneke I, Knudsen L, Ruppert C, Venkatesan S, Liebisch G, Chambers RC, Piskulak K, Ochs M, Schmitz G, Vancheri C, Seeger W, Korfei M, Guenther A. Regulation of macroautophagy in amiodarone induced pulmonary fibrosis. Pneumologie 2014. [DOI: 10.1055/s-0033-1363111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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93
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Clemmesen L, Knudsen L. [Ultrasound guidance during placement of central venous catheter can prevent arrhythmias]. Ugeskr Laeger 2013; 175:2498-2499. [PMID: 24629121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Central venous access under ultrasound guidance is widely supported in current medical practice. This case report describes a new method where the tip of the guide-wire is visualized in real-time, withheld from the heart and thereby avoiding the risk of guide-wire induced arrhythmias.
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Knudsen L, Ochs K, Boxler L, Tornoe I, Lykke-Sorensen G, Mackay RM, Clark HW, Holmskov U, Ochs M, Madsen J. Surfactant protein D (SP-D) deficiency is attenuated in humanised mice expressing the Met(11)Thr short nucleotide polymorphism of SP-D: implications for surfactant metabolism in the lung. J Anat 2013; 223:581-92. [PMID: 24111992 DOI: 10.1111/joa.12120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 01/01/2023] Open
Abstract
Surfactant protein D (SP-D) is part of the innate immune system involved in lung homeostasis. SP-D knockout mice show accumulations of foamy alveolar macrophages, alveolar lipoproteinosis and pulmonary emphysema. Three single nucleotide polymorphisms (SNPs) have been described in the coding sequence of the human SP-D gene SFTPD. Clinical studies showed that the SNP SFTPD with a nucleotide change from A to C resulting in a Met to Thr substitution at position 11 in the protein (Met(11)Thr), is relevant. This study set out to create a humanised mouse model of the Met(11)Thr SNP. Transgenic mice lines expressing either Met(11) or Thr(11) SP-D under the control of the ubiquitously expressed pROSA26 promoter in C57Bl/6 SP-D deficient mice (DKO) was created. Both Met(11) (142 ± 52 ng mL(-1) ) and Thr(11) (228 ± 76 ng mL(-1) ) mice lines expressed human SP-D at almost similar levels. According to the literature this was within the range of SP-D levels found in wildtype (WT) mice (253 ± 22 ng mL(-1) ). Met(11) or Thr(11) SP-D in serum from transgenic mice bound maltose in a calcium-dependent manner, and binding was inhibited in the presence of EDTA or maltose. Bronchoalveolar lavage showed for both transgenic mice lines complementation of the DKO phenotype by restoring cell counts, phospholipid levels and protein content back to WT levels. Cytospins of BAL pellet cells showed a resemblance to WT but both mice lines showed some foamy alveolar macrophages. The stereological analysis showed for none of the mice lines a complete abrogation of emphysematous alterations. However, both Met(11) and Thr(11) mice lines were partially reverted back to a WT phenotype when compared with DKO mice, indicating important effects on surfactant metabolism in vivo.
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Oveland NP, Lossius HM, Aagaard R, Connolly J, Sloth E, Knudsen L. Animal Laboratory Training Improves Lung Ultrasound Proficiency and Speed. J Emerg Med 2013; 45:e71-8. [DOI: 10.1016/j.jemermed.2013.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/05/2013] [Accepted: 03/15/2013] [Indexed: 01/09/2023]
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Gazdhar A, Temuri A, Knudsen L, Gugger M, Schmid RA, Ochs M, Geiser T. Targeted gene transfer of hepatocyte growth factor to alveolar type II epithelial cells reduces lung fibrosis in rats. Hum Gene Ther 2013; 24:105-16. [PMID: 23134111 DOI: 10.1089/hum.2012.098] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Inefficient alveolar wound repair contributes to the development of pulmonary fibrosis. Hepatocyte growth factor (HGF) is a potent growth factor for alveolar type II epithelial cells (AECII) and may improve repair and reduce fibrosis. We studied whether targeted gene transfer of HGF specifically to AECII improves lung fibrosis in bleomycin-induced lung fibrosis. A plasmid encoding human HGF expressed from the human surfactant protein C promoter (pSpC-hHGF) was designed, and extracorporeal electroporation-mediated gene transfer of HGF specifically to AECII was performed 7 days after bleomycin-induced lung injury in the rat. Animals were killed 7 days after hHGF gene transfer. Electroporation-mediated HGF gene transfer resulted in HGF expression specifically in AECII at biologically relevant levels. HGF gene transfer reduced pulmonary fibrosis as assessed by histology, hydroxyproline determination, and design-based stereology compared with controls. Our results indicate that the antifibrotic effect of HGF is due in part to a reduction of transforming growth factor-β(1), modulation of the epithelial-mesenchymal transition, and reduction of extravascular fibrin deposition. We conclude that targeted HGF gene transfer specifically to AECII decreases bleomycin-induced lung fibrosis and may therefore represent a novel cell-specific gene transfer technology to treat pulmonary fibrosis.
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Fjaeldstad A, Kirk MH, Knudsen L, Bjerring J, Christensen EF. Physician-staffed emergency helicopter reduces transportation time from alarm call to highly specialized centre. DANISH MEDICAL JOURNAL 2013; 60:A4666. [PMID: 23809975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Since 2007, the number of Danish emergency departments has decreased from 44 to 21. Longer distances to specialized treatment have increased the demand for advanced prehospital treatment. A Danish 24/7 Helicopter Emergency Medical System (HEMS) project in western Denmark was initiated on 6 January 2011. The HEMS provides prehospital care delivered by a specialized anaesthesiologist. This study evaluated the effect of HEMS on the time to treatment by a physician (time-to-doctor) and the time from a 112 emergency call to arrival at the highly specialized centre (time-to-centre) for patients with ST-elevation myocardial infarction (STEMI) or severe injury (Injury Severity Score > 15). MATERIAL AND METHODS In this prospective study with a matched historical control group, the time-to-doctor and the time-to-centre for patients with STEMI or severe injury transported by HEMS were compared with geographically matched patients with the same diagnoses and who were transported by ambulance. RESULTS Time-to-centre was reduced from 102 to 84 min. for STEMI and from 322 to 97 min. for severely injured patients after HEMS implementation. HEMS did not substantially reduce time-to-doctor, mainly because of increased availability of physician-staffed cars. In 56% of cases, HEMS was dispatched secondarily more than 30 min. after the ambulance had been dispatched. CONCLUSION Using HEMS reduced time to arrival at a highly specialized centre for patients with STEMI or severe injury. Simultaneous dispatch of an ambulance and HEMS shows potential for further reduction in the time-to-centre and the time-to-doctor. FUNDING not relevant. TRIAL REGISTRATION The trial is registered at the Danish Data Protection Agency.
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Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning. Chest 2013. [PMID: 23188058 DOI: 10.1378/chest.12-1445] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although thoracic ultrasonography accurately determines the size and extent of occult pneumothoraces (PTXs) in spontaneously breathing patients, there is uncertainty about patients receiving positive pressure ventilation. We compared the lung point (ie, the area where the collapsed lung still adheres to the inside of the chest wall) using the two modalities ultrasonography and CT scanning to determine whether ultrasonography can be used reliably to assess PTX progression in a positive-pressure-ventilated porcine model. METHODS Air was introduced in incremental steps into fi ve hemithoraces in three intubated porcine models. The lung point was identified on ultrasound imaging and referenced against the lateral limit of the intrapleural air space identified on the CT scans. The distance from the sternum to the lung point (S-LP) was measured on the CT scans and correlated to the insufflated air volume. RESULTS The mean total difference between the 131 ultrasound and CT scan lung points was 6.8 mm (SD, 7.1 mm; range, 0.0-29.3 mm). A mixed-model regression analysis showed a linear relationship between the S-LP distances and the PTX volume ( P , .001). CONCLUSIONS In an experimental porcine model, we found a linear relation between the PTX size and the lateral position of the lung point. The accuracy of thoracic ultrasonography for identifying the lung point (and, thus, the PTX extent) was comparable to that of CT imaging. These clinically relevant results suggest that ultrasonography may be safe and accurate in monitoring PTX progression during positive pressure ventilation.
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Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasound to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with computed tomography. Scand J Trauma Resusc Emerg Med 2013. [PMCID: PMC3665490 DOI: 10.1186/1757-7241-21-s1-s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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100
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Oveland NP, Lossius HM, Aagaard R, Connolly J, Sloth E, Knudsen L. Animal laboratory training improves lung ultrasound proficiency and speed. Scand J Trauma Resusc Emerg Med 2013. [PMCID: PMC3665560 DOI: 10.1186/1757-7241-21-s1-s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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