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Kramuschke M, Renner A, Kersting A. [Burnout : Symptoms, diagnostics and treatment approaches]. Nervenarzt 2024; 95:484-493. [PMID: 38625570 DOI: 10.1007/s00115-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
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Affiliation(s)
- M Kramuschke
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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Guler SA, Scheschkowski T, Renner A, Kämpf L, Gasser M, Maurer B. Interdisciplinary Diagnosis and Management of Patients with Interstitial Lung Disease and Connective Tissue Disease. Chest 2024:S0012-3692(24)00281-2. [PMID: 38447641 DOI: 10.1016/j.chest.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
Diagnosis of interstitial lung diseases (ILD) can be challenging, and the identification of an associated connective tissue disease (CTD) is crucial to estimate prognosis and establish the optimal treatment approach. Diagnostic delay, limited expertise and fragmented care are barriers that impede the delivery of comprehensive healthcare for patients with rare, complex and multiorgan diseases such as CTD and ILD. In this article we present our perspective on the interdisciplinary diagnosis and interprofessional treatment of patients with ILD and suspected CTD or CTD at risk for ILD. We outline the structure of our service, delineating the roles and responsibilities of the team members. Additionally, we provide an overview of our patient population including diagnostic approaches and specific treatments and illustrate a patient case. Furthermore, we focus on specific benefits and challenges of joint interdisciplinary and interprofessional patient consultations. The importance of rheumatology and pulmonology assessments in specific patient populations is emphasized. Finally, we explore future directions and discuss potential strategies to improve care delivery for patients with CTD-ILD.
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Affiliation(s)
- Sabina A Guler
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Lung Precision Medicine (LPM), Department for BioMedical Research (DBMR), University of Bern, Switzerland.
| | - Tobias Scheschkowski
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anja Renner
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lea Kämpf
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias Gasser
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Britta Maurer
- Lung Precision Medicine (LPM), Department for BioMedical Research (DBMR), University of Bern, Switzerland; Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Renner A, Ausserhofer D, Zúñiga F, Simon M, Serdaly C, Favez L. Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis. Int J Nurs Stud 2022; 134:104320. [PMID: 35868214 DOI: 10.1016/j.ijnurstu.2022.104320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes. OBJECTIVE This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics. DESIGN Time-series cross-sectional analysis. SETTING Nursing homes in Switzerland. PARTICIPANTS A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018. METHODS To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index-Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect. RESULTS We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed. CONCLUSIONS Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care. TWEETABLE ABSTRACT Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.
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Affiliation(s)
- Anja Renner
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Claudiana Research, College of Health Care-Professions Claudiana, Lorenz-Böhler-Strasse 13, 39100 Bozen, Italy.
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Christine Serdaly
- serdaly&ankers snc, 210 route de Florissant, 1231 Conches, Switzerland.
| | - Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
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Müller I, Mancinetti M, Renner A, Bridevaux PO, Brutsche MH, Clarenbach C, Garzoni C, Lenoir A, Naccini B, Ott S, Piquilloud L, Prella M, Que YA, Soccal PM, von Garnier C, Geiser TK, Funke-Chambour M, Guler S. Frailty assessment for COVID-19 follow-up: a prospective cohort study. BMJ Open Respir Res 2022; 9:9/1/e001227. [PMID: 35459694 PMCID: PMC9035838 DOI: 10.1136/bmjresp-2022-001227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/08/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19. OBJECTIVES To investigate frailty and the CFS for post-COVID-19 follow-up. METHODS This prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively. RESULTS Of the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2-3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=-0.48, p<0.001) (criterion validity) and with the St George's Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=-0.25, p<0.001), 6 min walk distance (r=-0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02). CONCLUSIONS The CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.
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Affiliation(s)
- Ilena Müller
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Marco Mancinetti
- Department of Internal Medicine, Hopital cantonal de Fribourg, Fribourg, Switzerland
| | - Anja Renner
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | | | - Christian Garzoni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland.,Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
| | - Alexandra Lenoir
- Division of Pulmonary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bruno Naccini
- Department of Pulmonary Medicine, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Sebastian Ott
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Pulmonary Medicine, Sankt Claraspital AG, Basel, Switzerland
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Maura Prella
- Division of Pulmonary Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Paola Marina Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneve, Switzerland
| | | | - Thomas K Geiser
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland.,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland .,Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
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Roehr S, Jung FU, Pabst A, Grochtdreis T, Nagl M, Renner A, Hoffmann R, Koenig HH, Kersting A, Riedel-Heller SG. A self-help app for Syrian refugees with posttraumatic stress (Sanadak): results of a randomized controlled trial. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Syrian refugees often develop posttraumatic stress as a result of the Syrian civil war and migration stressors. However, there is a lack of adequate treatments. The smartphone app Sanadak was developed and evaluated to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress.
Methods
In a randomized controlled trial, eligible individuals were allocated to the intervention group (IG; app) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis.
Results
Of 170 screened individuals (aged 18-65 years), 133 were eligible and randomized to the IG (n = 65) or CG (n = 68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95%CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95%CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d = 0.86, 95%CI 0.46 to 1.25; stereotype application: d = 0.60, 95%CI 0.22 to 0.99) and after 4 months (d = 0.52, 95%CI 0.12 to 0.92; d = 0.50, 95%CI 0.10 to 0.90).
Conclusions
Sanadak reduced mild to moderate posttraumatic stress in Syrian refugees, but not superior to the control condition. Therefore, Sanadak may not be suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach.
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Affiliation(s)
- S Roehr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - FU Jung
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - A Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - T Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - A Renner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - R Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - H-H Koenig
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
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Omran H, Deutsch MA, Scholtz S, Renner A, Scholtz W, Hakim Meibodi K, Rudolph TK, Gummert J, Rudolph V. Impact of impaired renal function on kinetics of high-sensitive troponin I (hs-cTnI) following cardiac surgery. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Renal insufficiency might result in increased levels of cardiac troponin due to decreased elimination. Hence, the diagnostic utility of hs-cTnI might be lower in patients with impaired renal function. There is only scarce data on kinetics of high-sensitivity cardiac troponin I (hs-cTnI) following cardiac surgery with regard to renal function.
Purpose
The aim of this study was to assess the impact of impaired renal function on the kinetics of hs-cTnI following cardiac surgery differentiating between patients with and without postoperative myocardial infarction (PMI) and to analyze the prognostic value of hs-cTnI elevations in patients with impaired renal function.
Methods
We performed a retrospective analysis of all adult patients (>18 years) who underwent cardiac surgery at our hospital between Jan, 1st 2013 and May, 1st 2019.
Serial measurements of high-sensitive cardiac troponin I (hs-cTnI) were assessed from baseline up to 48 hours after surgery. Renal function was assessed based on estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula with impaired renal function defined by GFR <60 ml/min. Postoperative myocardial infarction was defined by new vessel occlusion on angiography. Predictors of long-term all-cause mortality were assessed by cox regression analysis.
Results
A total of 14,465 patients were included (51.4% underwent coronary artery bypass grafting (CABG), 39.4% had valvular procedures and 9.2% thoracic aortic procedures).
Levels of hs-cTnI were higher in patients with impaired renal function in the overall collective (figure 1). However, in patients with postoperative myocardial infarction levels of hs-cTnI did not differ with regard to renal function (figure 2).
Cox regression analysis showed postoperative elevation of hs-cTnI to be a significant predictor of long-term all-cause mortality over a median follow-up of 3.0 years regardless of baseline kidney function (Hazards ratio 1.67, 95% Confidence interval [1.46–1.91], p<0.001).
Conclusion
Renal function had an impact on postoperative hs-cTnI kinetics only in patients with an uneventful postoperative course. In patients with postoperative myocardial infarction kinetics of hs-cTnI were not affected by baseline renal function. Moreover, elevated hs-cTnI levels were a significant predictor of all-cause mortality regardless of baseline renal function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Omran
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - M A Deutsch
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - S Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - A Renner
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - W Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - K Hakim Meibodi
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - T K Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Gummert
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - V Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
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Renner A, Jäckle D, Kaiser J, Hoffmann R, Kersting A. IPSA-Studie: Posttraumatischer Stress nach belastenden Ereignissen im Arztberuf. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - D Jäckle
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - J Kaiser
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - R Hoffmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
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Opacic D, Ibishi A, Radakovic D, Irimi A, Deutsch MA, Renner A, Sitzer M, Gummert J. Off-Pump Coronary Artery Bypass Surgery Reduces Perioperative Stroke Rate in Patients with Asymptomatic Internal Carotid Artery Stenosis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Omran H, Deutsch M, Groezinger E, Renner A, Neumann J, Westermann D, Scholtz W, Rudolph T, Gummert J, Rudolph V, Hakim-Meibodi K. Usefulness of troponin in selecting patients for invasive coronary angiography after cardiac surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Great uncertainty exists about the indication for invasive coronary angiography (ICA) in patients with suspected acute coronary syndrome following cardiac surgery.
Aim
The aim of this study was to define clinical criteria that best identify patients who benefit from ICA after cardiac surgery.
Methods
We performed a retrospective analysis of all patients who underwent cardiac surgery between January 2009 and May 2019 at our center. Exclusion criteria included pediatric patients as well as pacemaker, TAVR and LVAD implantation and heart transplantation procedures. The primary outcome was usefulness of ICA as defined by consequent PCI or re-operation due to ICA findings. ECG changes (ST-elevations) and high-sensitivity Troponin I (hsTrop I) were analyzed.
Results
48,136 patients were screened and after applying exclusion criteria 29,359 patients were finally included in the analysis (mean age 67.8±11.0 years, 31.1% females, Euroscore II 5.14±8.9%). A total of 1,171 patients (4%) underwent post-op ICA. The primary outcome occurred in 440 patients (1.5%) of which 290 underwent consequent PCI and 214 underwent consequent re-operation. Baseline characteristics are shown in table 1. Unadjusted analyses did not identify significant differences in the level of cardiac biomarkers between useful-ICA and unuseful-ICA groups.
In multivariate regression analysis, only ST-elevation on ECG predicted the primary outcome (OR 1.33, 95% CI 1.003–1.76).
Dichotomizing hsTrop I concentrations by applying the guideline-specified cut-off (>70x URL) resulted in correct classification of useful-ICA patients in 95.7%. However, the false-positive rate was also extremely high (83.6%) with a positive predictive value (PPV) of 1.6% and a negative predictive value (NPV) of 99.6% (accuracy 17.5%).
Using area under the curve (ROC) analysis following optimal cut-off values for hsTrop I were identified: in CABG patients a cut-off value of >650x URL (corresponding absolute value 17000 ng/L) was defined with a corresponding sensitivity of 83.3%, specificity of 83.6%, PPV of 8.9% and NPV of 99.6% (accuracy 83.6%). In non-CABG patients (i.e. valve or aortic procedures), the cut-off was about twice as high as that for CABG patients (1,350x URL or 35,000 ng/L) with a corresponding sensitivity of 84.1%, specificity of 89.2%, PPV of 5.9% and NPV of 99.9% (accuracy 89.1%).
Conclusion
Our study demonstrates that currently recommended cut-off concentrations of high-sensitivity troponin are not useful for guiding clinical decision-making in patients with suspected acute coronary syndrome following cardiac surgery, while substantially higher cut-off values might be useful. Those cut-off values critically depend on the type of cardiac surgery performed (CABG vs. non-CABG).
Troponin_Curves post-op
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Omran
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - M.A Deutsch
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - E Groezinger
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - A Renner
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Neumann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - W Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - T Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Gummert
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - V Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - K Hakim-Meibodi
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
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10
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Vishlenkova EA, Renner A. [Historical study of medical geography in Russia]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2019; 27:924-929. [PMID: 31765548 DOI: 10.32687/0869-866x-2019-27-5-924-929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
This article provides an overview of the change of topics in the medical-geographical studies in Russia. It highlights the conventional nature of this science, its dependence on political, ideological and scientific demands as well as institutional difficulties. It concludes that the goal of further historical research is to focus on the restoration of synchronous meanings of medical geography, its links with other disciplines and the elucidation of Russia's participation in the transnational project of medico-geographical research.
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Affiliation(s)
- E A Vishlenkova
- National Research University Higher School of Economics; 107000, Moscow, Russia,
| | - A Renner
- Ludwig-Maximilians-Universität in Munich, Germany
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Renner A, Rausch I, Cal Gonzalez J, Frass-Kriegl R, de Lara LN, Sieg J, Laistler E, Glanzer M, Dungl D, Moser E, Beyer T, Figl M, Birkfellner W. A head coil system with an integrated orbiting transmission point source mechanism for attenuation correction in PET/MRI. Phys Med Biol 2018; 63:225014. [PMID: 30418935 DOI: 10.1088/1361-6560/aae9a9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The combination of positron emission tomography (PET) and magnetic resonance imaging (MRI) provides a benefit for diagnostic imaging. Still, attenuation correction (AC) is a challenge in PET/MRI compared to stand-alone PET and PET-computed tomography (PET/CT). In the absence of photonic transmission sources, AC in PET/MRI is usually based on retrospective segmentation of MR images or complex additional MR-sequences. However, most methods available today are still challenged by either the incorporation of cortical bone or substantial anatomical variations of subjects. This leads to a bias in quantification of tracer concentration in PET. Therefore, we have developed a fully integrated transmission source system for PET/MRI of the head to enable direct measurement of attenuation coefficients using external positron emitters, which is the reference standard in AC. Based on a setup called the 'liquid drive' presented by Jones et al (1995) two decades ago, we built a head coil system consisting of an MR-compatible hydraulic system driving a point source on a helical path around a 24-channel MR-receiver coil to perform a transmission scan. Sinogram windowing of the moving source allows for post-injection measurements. The prototype was tested in the Siemens Biograph mMR using a homogeneous water phantom and a phantom with air cavities and a Teflon (PTFE) cylinder. The second phantom was measured both with and without emission activity. For both measurements air, water and Teflon were clearly distinguishable and homogeneous regions of the phantom were successfully reproduced in the AC map. For water the linear attenuation coefficient was measured as (0.096 ± 0.005) cm-1 in accordance with the true physical value. This combined MR head coil and transmission source system is, to our knowledge, the first working example to use an orbiting point source in PET/MRI and may be helpful in providing fully-quantitative PET data in neuro-PET/MRI.
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Affiliation(s)
- A Renner
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria. Institute of Applied Physics, Vienna University of Technology, 1040 Vienna, Austria
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Renner A, Kaluza I, Marth K, Moeslinger T, Pohl W. P112 Exhaled nitric oxide is a possible biomarker for predicting complications in cystic fibrosis patients. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Trummer U, Novak-Zezula S, Renner A, Wilczewska I. 2.10-P10Cost savings through timely treatment for irregular migrants and European Union citizens without insurance. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- U Trummer
- Center For Health And Migration, Vienna, Austria
| | | | - A Renner
- Center For Health And Migration, Vienna, Austria
| | - I Wilczewska
- Center For Health And Migration, Vienna, Austria
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14
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Renner A, Neukam K, RÖsner T, Elert O, Lange V. Pumpless Extracorporeal Lung Assist as Supportive Therapy in a Patient with Diffuse Alveolar Hemorrhage. Int J Artif Organs 2018; 31:279-81. [DOI: 10.1177/039139880803100313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our 18-year old female patient suffered from microscopic polyangiitis. After invasive diagnostics, a diffuse alveolar hemorrhage occurred, leading to acute lung failure. In spite of differential ventilation, respiratory insufficiency and lactate-acidosis increased quickly. Due to the massive hemorrhage, a pumpless extracorporeal lung assist was implanted and, after six hours, low-dose heparinization was started. In response to this therapy, hypercapnia and acidosis improved quickly and were completely eliminated within 24 hours. Simultaneously, treatment with prednisolon and cyclophosphamid was started. After 7 days, the patient's conditions allowed weaning from the pumpless extracorporeal lung assist and after 9 days she was extubated. In conclusion, the pumpless lung assist was shown to be a very practical option to treat the most serious forms of hypercapnia, especially for patients disposed to diffuse bleeding.
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Affiliation(s)
- A. Renner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - K. Neukam
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - T. RÖsner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - O. Elert
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - V. Lange
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
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Puehler T, Dia M, Ibishi A, El-Hashem G, Renner A, Hakim-Meibodi K, Ensminger S, Boergermann J, Zittermann A, Gummert J. Carotid Artery Stenosis does not Increase the Perioperative Risk of Stroke in Patients Undergoing Aortic Non-Clamping and No-touch off-pump Surgery- A Retrospective Single-Center Analysis. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T. Puehler
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - M. Dia
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Ibishi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - G. El-Hashem
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Renner
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - S. Ensminger
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Boergermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Zittermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Gummert
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
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Tanios A, Braunegger-Kallinger G, Loder C, Renner A. Effectiveness of community health promotion targeting children and adolescents in rural areas. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pühler T, Fujita B, Renner A, Hakim-Meibodi K, Bögermann J, Morshuis M, Gummert J, Ensminger S. Operative Myokardrevaskularisation bei schlechter linksventrikulärer Funktion – STICH forever? Aktuel Kardiol 2016. [DOI: 10.1055/s-0042-114219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T. Pühler
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - B. Fujita
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - A. Renner
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - K. Hakim-Meibodi
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Bögermann
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - M. Morshuis
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Gummert
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - S. Ensminger
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
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Khalil M, Renner A, Langkammer C, Enzinger C, Ropele S, Stojakovic T, Scharnagl H, Bachmaier G, Pichler A, Archelos JJ, Fuchs S, Seifert-Held T, Fazekas F. Cerebrospinal fluid lipocalin 2 in patients with clinically isolated syndromes and early multiple sclerosis. Mult Scler 2016; 22:1560-1568. [DOI: 10.1177/1352458515624560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022]
Abstract
Background: Lipocalin 2 (LCN2) may be involved in the immunopathogenesis of multiple sclerosis (MS) and might further impact on iron homoeostasis. Brain iron accumulates in MS; however, the association to iron-related proteins is still unsolved. Objective: To investigate cerebrospinal fluid (CSF) and serum LCN2, transferrin (Trf) and ferritin in early MS in relation to disease evolution and longitudinal brain iron accumulation. Methods: We analysed CSF and serum LCN2 by enzyme-linked immunosorbent assay (ELISA) and Trf and ferritin by nephelometry in 55 patients (45 clinically isolated syndrome (CIS), 10 MS, median clinical follow-up 4.8 years) and 63 controls. In patients, we assessed sub-cortical grey matter iron by 3T magnetic resonance imaging (MRI) R2* relaxometry (median imaging follow-up 2.2 years). Results: Compared to controls serum ( p < 0.01), CSF ( p < 0.001) LCN2 and CSF Trf ( p < 0.001) levels were reduced in the patients. CSF LCN2 correlated with CSF Trf ( r = 0.5, p < 0.001). In clinically stable patients, CSF LCN2 levels correlated with basal ganglia iron accumulation ( r = 0.5, p < 0.05). In CIS, higher CSF LCN2 levels were associated with conversion to clinically definite MS ( p < 0.05). Conclusion: We demonstrate altered LCN2 regulation in early MS and provide first evidence for this to be possibly linked to both clinical MS activity and iron accumulation in the basal ganglia.
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Affiliation(s)
- M Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - A Renner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Langkammer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - H Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - G Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - A Pichler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - JJ Archelos
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Fuchs
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Seifert-Held
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
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Affiliation(s)
- A. Renner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
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Pühler T, Dia M, Zittermann A, Börgermann J, Renner A, Ensminger S, Gummert J. Off-pump Revascularization with Bilateral Mammary Artery -Single Center Proof of Concept after 5 Years. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Helms S, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Renner A, Gummert J. Coronary Revascularization in Diabetic Patients: 3-year Survival Data for Off-pump and on-pump Technique. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Börgermann J, Preindl K, Renner A, Aboud A, Hakim K, Benzinger M, Pühler T, Ensminger S, Becker T, Zittermann A, Kuss O, Gummert J. Midterm Outcome after Anaortic and Clampless Off-pump and Conventional Coronary Artery Bypass Grafting - Analysis of 5,422 Unselected Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ostermann H, Renner A, Schneider P, Bobek J, Vogler S. A cost/benefit analysis of self-care initiatives in the European Union – who benefits, who gains? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schmidt-Wiborg P, Renner A. Kompetenzen für Prävention in der Gesundheitsselbsthilfe – Praxisbeispiele für die Entwicklung und den Transfer von Kompetenzen in die Praxis. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Pöschinger T, Renner A, Eisa F, Dobosz M, Brauweiler R, Kalender WA, Scheuer W. Abstract 2071A: Anti-VEGF treatment in orthotopic breast cancer xenografts: Dynamic contrast-enhanced micro-CT correlates with 3D multispectral fluorescence histology. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2071a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim:
Here, we evaluate the ability of dynamic contrast-enhanced micro-computed tomography (DCE micro-CT) in combination with 3D fluorescence ultramicroscopy (UM) to assess the early physiological and morphological treatment response of orthotopic breast tumors to anti-angiogenic drug therapy.
Methods:
Non-invasive DCE micro-CT was performed on breast cancer xenografts (KPL-4) that were treated twice with an antibody against the vascular endothelial growth factor (VEGF) or a control antibody. Tumor physiology was assessed in different tumor regions of interests measuring the relative blood volume (rBV) and the permeability-surface area product (PS). Parametric maps were calculated on a voxel-by-voxel basis to evaluate intra-tumor vascular heterogeneity. Mean physiological measurements were compared with morphological measures of the tumor vascular architecture (microvessel density (MVD) and relative vessel volume (rVV)) as obtained by 3-dimensional fluorescence UM. Additionally, vessel leakage was assessed by UM quantifying the penetration strength of a co-injected fluorescence-labeled therapeutic antibody into the tumor tissue.
Results:
Examination of the parametric maps revealed significantly different spatial patterns of intra-tumoral blood supply (rBV) between anti-VEGF-treated tumors and control. While a characteristic rim vascularization (high rBV values in the tumor periphery) was observed in the control tumors, treated tumors showed a widely homogeneous blood supply. Compared with high-resolution UM, these physiological rBV maps showed excellent agreement with the morphological appearance of the 3D tumor vascular architecture. Assessment of the mean physiology showed a significant decrease of rBV (p<0.01) and PS (p<0.05) in the tumor periphery after anti-angiogenic treatment. The reduction of rBV correlated well with a significant reduction of rVV (p<0.01) in the corresponding tumor region. The decrease in PS was found consistent with a significantly reduced antibody uptake (p<0.01) in the tumor tissue after treatment. No treatment effect was observed by tumor volume.
Conclusions:
DCE micro-CT used along with UM provides comprehensive and complementary information of the physiological and morphological anti-angiogenic treatment response in breast cancer xenografts. This technology may help to improve current standard methods in the assessment of anti-angiogenic drug efficacy in preclinical drug development.
Citation Format: Thomas Pöschinger, Anja Renner, Fabian Eisa, Michael Dobosz, Robert Brauweiler, Willi A. Kalender, Werner Scheuer. Anti-VEGF treatment in orthotopic breast cancer xenografts: Dynamic contrast-enhanced micro-CT correlates with 3D multispectral fluorescence histology. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2071A. doi:10.1158/1538-7445.AM2014-2071A
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Affiliation(s)
- Thomas Pöschinger
- 1Discovery Oncology, pRED, Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Fabian Eisa
- 3Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | | | - Robert Brauweiler
- 3Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Willi A. Kalender
- 3Institute of Medical Physics, University of Erlangen, Erlangen, Germany
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Weber TG, Osl F, Renner A, Pöschinger T, Galbán S, Rehemtulla A, Scheuer W. Apoptosis imaging for monitoring DR5 antibody accumulation and pharmacodynamics in brain tumors noninvasively. Cancer Res 2014; 74:1913-23. [PMID: 24509903 PMCID: PMC4269941 DOI: 10.1158/0008-5472.can-13-3001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
High-grade gliomas often possess an impaired blood-brain barrier (BBB), which allows delivery of large molecules to brain tumors. However, achieving optimal drug concentrations in brain tumors remains a significant hurdle for treating patients successfully. Thus, detailed investigations of drug activities in gliomas are needed. To investigate BBB penetration, pharmacodynamics, and tumor retention kinetics of an agonistic DR5 antibody in a brain tumor xenograft model, we utilized a noninvasive imaging method for longitudinal monitoring of apoptosis induction. Brain tumors were induced by intracranial (i.c.) implantation of a luciferase-expressing tumor cell line as a reporter. To quantify accumulation of anti-DR5 in brain tumors, we generated a dosage-response curve for apoptosis induction after i.c. delivery of fluorescence-labeled anti-DR5 at different dosages. Assuming 100% drug delivery after i.c. application, the amount of accumulated antibody after i.v. application was calculated relative to its apoptosis induction. We found that up to 0.20% to 0.97% of antibody delivered i.v. reached the brain tumor, but that apoptosis induction declined quickly within 24 hours. These results were confirmed by three-dimensional fluorescence microscopy of antibody accumulation in explanted brains. Nonetheless, significant antitumor efficacy was documented after anti-DR5 delivery. We further demonstrated that antibody penetration was facilitated by an impaired BBB in brain tumors. These imaging methods enable the quantification of antibody accumulation and pharmacodynamics in brain tumors, offering a holistic approach for assessment of central nervous system-targeting drugs.
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Affiliation(s)
- Thomas G Weber
- Authors' Affiliations: Discovery Oncology, Pharmaceutical Research and Early Development (pRED), Roche Diagnostics GmbH, Penzberg, Germany; and Center for Molecular Imaging, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Franz M, Berndt A, Matusiak-Brückner M, Grün K, Maschek H, Richter P, Schulz U, Gummert J, Figulla H, Renner A. Early reoccurrence of fetal ED-A+ Fibronectin and B+ Tenascin-C splicing variants after human cardiac transplantation: potential impact for targeted therapy of chronic rejection. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Özpeker C, Morshuis M, Schönbrodt M, Börgermann J, Renner A, Gummert J. Aortic insufficiency development in 391 patients supported with four different cf-LVADs: A single center experience. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Puehler T, Ensminger S, Schulz U, Fuchs U, Tigges-Limmer K, Börgermann J, Morshuis M, Hakim K, Oldenburg O, Niedermeyer J, Renner A, Gummert J. [Heart and combined heart-lung transplantation. Indications, chances and risks]. Herz 2014; 39:66-73. [PMID: 24452762 DOI: 10.1007/s00059-013-4042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orthotopic heart transplantation (HTX) is nowadays the worldwide accepted gold standard for the treatment of terminal heart failure. The main indications for HTX are non-ischemic dilatative (54%) and ischemic (37%) heart failure. In the acute phase after HTX the survival rate is approximately 90%. Good short and long-term results with survival rates ranging from 81% after 1 year to more than 50% after 11 years demonstrate that there is currently no real treatment alternative to HTX for treatment of end-stage heart failure. In the case of irreversible pulmonary hypertension in combination with end-stage heart failure or complex congenital heart syndromes, a combined heart and lung transplantation (HLTX) is necessary. Compared with HTX the short-term survival of HLTX is reduced, mostly for technical reasons. Improved long-term results after HTX and HLTX are a result of highly specialized transplantation units and effective immunosuppression. However, a major problem is the shortage of organ donors in Germany and the resulting long waiting times for patients with frequently occurring blood groups of up to 10 months for transplantation. The consequence of the latter is the ever increasing number of implanted cardiac assist devices in patients not only as a bridge to transplant but also as destination therapy.
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Affiliation(s)
- T Puehler
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland,
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Furukawa N, Kuss O, Aboud A, Schonbrodt M, Renner A, Hakim Meibodi K, Becker T, Zittermann A, Gummert JF, Borgermann J. Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients. Eur J Cardiothorac Surg 2014; 46:221-6; discussion 226-7. [DOI: 10.1093/ejcts/ezt616] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Poeschinger T, Renner A, Weber T, Scheuer W. Bioluminescence imaging correlates with tumor serum marker, organ weights, histology, and human DNA levels during treatment of orthotopic tumor xenografts with antibodies. Mol Imaging Biol 2013; 15:28-39. [PMID: 22528864 DOI: 10.1007/s11307-012-0559-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE In this study, we correlate results of bioluminescence measurements with established readouts for assessing therapeutic efficacy of antibodies in orthotopic cancer xenografts. PROCEDURES An orthotopic tumor model of pancreatic cancer (AsPC-1-luc) and experimental lung metastasis (A549-luc) were established. Whole-body bioluminescence imaging (BLI) was performed to observe tumor progression under therapy with antibodies targeting different receptor kinases (primary readout). For purpose of verification, anti-tumoral efficacy was cross-validated with results obtained by measurement of organ weights, histology, tumor serum marker analysis (CYFRA 21-1), and quantification of human DNA concentration in the organ of interest (secondary readouts). RESULTS Anti-tumoral efficacy is demonstrated for the antibodies tested. In the pancreas xenograft, a tumor growth inhibition of 95% (p < 0.01) was achieved as compared to control. Therapeutic efficacy could be identified as soon as 1 week after initiation of treatment. In the model of experimental lung metastasis, antibody treatment significantly suppressed tumor growth up to 75% (p < 0.05). All imaging results were confirmed by correlation analysis showing excellent agreement with the secondary readouts. CONCLUSIONS BLI was demonstrated to be a reliable tool for monitoring early drug responses in orthotopic small animal cancer models. BLI allows rapid and non-invasive assessment of tumor load in the animal over time and, thus, provides a suitable method for routine use in preclinical cancer research.
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Affiliation(s)
- Thomas Poeschinger
- Roche Diagnostics GmbH, pRED, Pharma Research & Early Development, DTA Oncology, Nonnenwald 2, 82377 Penzberg, Germany.
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Furukawa N, Aboud A, Schonbrodt M, Renner A, Hakim K, Becker T, Zittermann A, Oliver K, Gummert JF, Borgermann J. 316 * MINISTERNOTOMY VERSUS CONVENTIONAL STERNOTOMY FOR AORTIC VALVE REPLACEMENT: PROPENSITY SCORE ANALYSIS OF 808 PATIENTS. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Börgermann J, Furukawa N, Aboud A, Schönbrodt M, Renner A, Hakim-Meibodi K, Becker T, Zittermann A, Kuss O, Gummert JF. Ministernotomy versus conventional sternotomy for aortic valve replacement: Propensity score analysis of 808 patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Gummert JF. Clinical outcome in elderly patients undergoing mitral valve repair. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Franz M, Hilger I, Neri D, Grün K, Kossatz S, Gummert JF, Figulla HR, Berndt A, Renner A. Cardiac accumulation of a human recombinant antibody recognizing ED-A+ fibronectin after heterotopic rat heart transplantation in vivo: A new strategy to detect and treat chronic cardiac allograft rejection? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Pühler T, Tschöpe D, Börgermann J, Gummert JF. Coronary Revascularization in diabetic patients: Off-pump versus on-pump surgery. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Renner A, Jägle H. Hereditäre Makuladystrophien in der Differenzialdiagnose der AMD. Klin Monbl Augenheilkd 2012; 229:905-9. [DOI: 10.1055/s-0032-1314988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Renner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
| | - H. Jägle
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
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Kellner U, Renner A, Herbst S, Kellner S, Weinitz S, Weber B. Hereditäre Netzhautdystrophien. Augenheilkunde up2date 2012. [DOI: 10.1055/s-0031-1280460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Börgermann J, Zittermann A, Renner A, Parsa A, Aboud A, Becker T, Hakim K, Gummert J. Clampless off-pump surgery is associated with lower mortality and morbidity than conventional coronary artery bypass grafting. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grün K, Drescher K, Kuhnt K, Börgermann J, Hekmat K, Doenst T, Gummert J, Renner A. Heterotopic rat heart transplantation: Accumulation of Ubiquinone in the rat heart allograft depends on ischemia/reperfusion. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gummert J, Aboud A, Parsa M, Renner A, Börgermann J, Paluszkiewicz L, Mirow N, Schirmer U, Hakim K. Is minimal invasive mitral valve surgery a risk factor? - A comparison in 394 consecutive patients between 121 conventional and 273 minimal invasive procedures. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Franz M, Berndt A, Grün K, Neri D, Kosmehl H, Hekmat K, Figulla HR, Gummert J, Renner A. Extra cellular matrix remodelling in chronic cardiac allograft rejection. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Franz M, Grün K, Richter P, Brehm BR, Fritzenwanger M, Hekmat K, Neri D, Gummert J, Figulla HR, Kosmehl H, Berndt A, Renner A. Extra cellular matrix remodelling after heterotopic rat heart transplantation: gene expression profiling and involvement of ED-A+ fibronectin, alpha-smooth muscle actin and B+ tenascin-C in chronic cardiac allograft rejection. Histochem Cell Biol 2010; 134:503-17. [PMID: 20931338 DOI: 10.1007/s00418-010-0750-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2010] [Indexed: 11/29/2022]
Abstract
Chronic cardiac rejection is represented by cardiac allograft vasculopathy (CAV) and cardiac interstitial fibrosis (CIF) known to cause severe complications. These processes are accompanied by remarkable changes in the cardiac extra cellular matrix (cECM). The aim of our study was to analyse the cECM remodelling in chronic rejection and to elucidate a potential role of ED-A domain containing fibronectin (ED-A(+) Fn), alpha smooth muscle actin (ASMA) and B domain containing tenascin-C (B(+) Tn-C). A model of chronic rejection after heterotopic rat heart transplantation was used. Allografts, recipient and control hearts were subjected to histological assessment of rejection grade, to real-time PCR based analysis of 84 genes of ECM and adhesion molecules and to immunofluorescence labelling procedures, including ED-A(+) Fn, ASMA and B(+) Tn-C antibodies. Histological analysis revealed different grades of chronic rejection. By gene expression analysis, a relevant up-regulation of the majority of ECM genes in association with chronic rejection could be shown. For 8 genes, there was a relevant up-regulation in allografts as well as in the corresponding recipient hearts. Association of ASMA positive cells with the grade of chronic rejection could be proven. In CAV and also in CIF there were extensive co-depositions of ED-A(+) Fn, ASMA and B(+) Tn-C. In conclusion, chronic cardiac allograft rejection is associated with a cECM remodelling. ASMA protein deposition in CAV, and CIF is a valuable marker to detect chronic rejection. Interactions of VSMCs and Fibro-/Myofibroblasts with ED-A(+) Fn and B(+) Tn-C might functionally contribute to the development of chronic cardiac rejection.
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Affiliation(s)
- Marcus Franz
- Department of Internal Medicine I, University Hospital of Jena, Erlanger Allee 101, 07740, Jena, Germany.
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Renner A, Grün K, Börgermann J, Leyh R, Gummert J, Lange V. Heterotopic rat heart transplantation: effect of oxidative stress in the rat heart allograft depends on different anesthetics. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Franz M, Berndt A, Grün K, Richter P, Kosmehl H, Neri D, Gummert J, Figulla HR, Brehm BR, Renner A. Analysis of ED-A+ fibronectin expression after heterotopic rat heart transplantation: association to cardiac allograft rejection and implications for targeted post-transplant therapy. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kellner U, Kellner S, Renner A, Fiebig B, Weinitz S, Weber B. Evidenzbasierte Diagnostik hereditärer Netzhautdystrophien 2009. Klin Monbl Augenheilkd 2009; 226:999-1011. [DOI: 10.1055/s-0028-1109684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hakim K, Friedrich I, Kuss O, Renner A, Gummert JF, Silber RE, Börgermann J. Long-term clinical outcome after minimally invasive direct coronary artery bypass grafting via partial inferior reversed l-shaped sternotomy (PIRLS). Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Renner A, Sagstetter MR, Lutz C, Hamouda K, Schramm Y, Lazariotou M, Leyh RG, Gummert JF, Lange V. Influence of different vein preparation techniques in aorto-coronary-graft operation on the integrity of the endothelium. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lange V, Krannich JH, Kunz C, Lazariotou M, Leyh RG, Gummert JF, Renner A. Influence of protamine/heparin-ratio on postoperative blood loss and transfusion rate in cardiac surgery. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Renner RM, Renner A, Schmid S, Hoesli I, Nars P, Holzgreve W, Surbek DV. Efficacy of a strategy to prevent neonatal early-onset group B streptococcal (GBS) sepsis. J Perinat Med 2007; 34:32-8. [PMID: 16489884 DOI: 10.1515/jpm.2006.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Existing guidelines recommend different strategies to prevent early-onset neonatal GBS sepsis. In 1997, using our own data on incidence and risk factors, we established a new prevention strategy which includes GBS screening at 36 weeks' gestation and intrapartum antibiotic prophylaxis (IAP) in women with positive or unknown GBS colonization with at least one risk factor. The present study evaluates the efficacy of the new prevention strategy. METHODS Retrospective study of the incidence of early-onset GBS sepsis among all live births at the University Women's Hospital Basel between 1997 and 2002. Additional analysis of delivery and post partum period of all GBS sepsis cases, including GBS screening, risk factors during labor (prematurity, rupture of membranes (ROM) <12 h, intrapartum signs of infection), and IAP. Comparison of this group's characteristics G2 (9,385 live births, using the new strategy) with the previous group, G1 (1984-1993, 16,126 live births, without GBS screening or routine IAP) was performed. RESULTS The incidence of early-onset GBS sepsis was reduced from 1/1000 (G1) to 0.53/1000 (G2). We observed a significant reduction of overall intrapartum risk factors in cases of GBS sepsis. CONCLUSION This study suggests that our new prevention strategy is effective in reducing the incidence of early-onset GBS sepsis in neonates. In comparison, implementation of the CDC's prevention strategy might have prevented 2 additional cases in 9385 live births. However, this would have required treating a much larger number of pregnant women with IAP with consequential increasing costs, side effects and complications.
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Affiliation(s)
- Regina M Renner
- Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland
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