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Witkiewicz M, Baranowska B, Węgrzynowska M, Kiersnowska I, Karzel K, Bączek G, Sys D, Scholz A, Crowther S, Teliga-Czajkowska J, Tataj-Puzyna U. Perinatal Outcomes and Level of Labour Difficulty in Deliveries with Right and Left Foetal Position-A Preliminary Study. Healthcare (Basel) 2024; 12:864. [PMID: 38667626 PMCID: PMC11049945 DOI: 10.3390/healthcare12080864] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty. METHODS The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women. FINDINGS When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult. CONCLUSIONS The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly.
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Affiliation(s)
- Magdalena Witkiewicz
- Department of Gynecologic and Obstetrical Didactics, Medical University of Warsaw, 00-581 Warsaw, Poland; (M.W.); (G.B.); (J.T.-C.)
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (M.W.); (U.T.-P.)
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (M.W.); (U.T.-P.)
| | - Iwona Kiersnowska
- Department of Basic Nursing, Medical University of Warsaw, 01-445 Warsaw, Poland;
| | - Katarzyna Karzel
- Faculty of Psychology, University of Warsaw, 00-183 Warsaw, Poland;
| | - Grażyna Bączek
- Department of Gynecologic and Obstetrical Didactics, Medical University of Warsaw, 00-581 Warsaw, Poland; (M.W.); (G.B.); (J.T.-C.)
| | - Dorota Sys
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland;
| | - Anna Scholz
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland;
| | - Susan Crowther
- Center for Midwifery and Women’s Health Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1010, New Zealand;
| | - Justyna Teliga-Czajkowska
- Department of Gynecologic and Obstetrical Didactics, Medical University of Warsaw, 00-581 Warsaw, Poland; (M.W.); (G.B.); (J.T.-C.)
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland; (M.W.); (U.T.-P.)
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Unnikrishnan G, Ilzhöfer P, Scholz A, Hölzl C, Götzelmann A, Gupta RK, Zhao J, Krauter J, Weber S, Makki N, Büchler HP, Pfau T, Meinert F. Coherent Control of the Fine-Structure Qubit in a Single Alkaline-Earth Atom. Phys Rev Lett 2024; 132:150606. [PMID: 38682979 DOI: 10.1103/physrevlett.132.150606] [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] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/11/2024] [Indexed: 05/01/2024]
Abstract
We report on the first realization of a novel neutral atom qubit encoded in the spin-orbit coupled metastable states ^{3}P_{0} and ^{3}P_{2} of a single ^{88}Sr atom trapped in an optical tweezer. Raman coupling of the qubit states promises rapid single-qubit rotations on par with the fast Rydberg-mediated two-body gates. We demonstrate preparation, readout, and coherent control of the qubit. In addition to driving Rabi oscillations bridging an energy gap of more than 17 THz using a pair of phase-locked clock lasers, we also carry out Ramsey spectroscopy to extract the transverse qubit coherence time T_{2}. When the tweezer is tuned into magic trapping conditions, which is achieved in our setup by tuning the tensor polarizability of the ^{3}P_{2} state via an external control magnetic field, we measure T_{2}=1.2 ms. A microscopic quantum mechanical model is used to simulate our experiments including dominant noise sources. We identify the main constraints limiting the observed coherence time and project improvements to our system in the immediate future. Our Letter opens the door for a so-far-unexplored qubit encoding concept for neutral atom-based quantum computing.
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Affiliation(s)
- G Unnikrishnan
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - P Ilzhöfer
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - A Scholz
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - C Hölzl
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - A Götzelmann
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - R K Gupta
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - J Zhao
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - J Krauter
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - S Weber
- Institute for Theoretical Physics III and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - N Makki
- Institute for Theoretical Physics III and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - H P Büchler
- Institute for Theoretical Physics III and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - T Pfau
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - F Meinert
- 5. Physikalisches Institut and Center for Integrated Quantum Science and Technology, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
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3
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Sieroszewski P, Bomba-Opon D, Czajkowski K, Drews K, Grzesiak M, Leszczynska-Gorzelak B, Scholz A, Kalinka J, Kosinka-Kaczynska K, Kwiatkowski S, Mierzynski R, Preis K, Ropacka-Lesiak M, Swiatkowska-Freund M, Wielgos M, Zimmer M, Huras H. Guidelines of the Polish Society of Gynecologists and Obstetricians on the diagnosis and management of pregnancies complicated by prelabor rupture of the membranes. Ginekol Pol 2024:VM/OJS/J/98339. [PMID: 38506477 DOI: 10.5603/gpl.98339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 03/21/2024] Open
Affiliation(s)
- Piotr Sieroszewski
- 1st Department of Gynaecology and Obstetrics, Medical University of Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Krzysztof Drews
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Grzesiak
- Department of Perinatology, Obstetrics and Gynaecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland
| | | | - Anna Scholz
- 1st Department of Obstetrics and Gynecology, CMKP in Warsaw, Poland
| | | | - Katarzyna Kosinka-Kaczynska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education in Warsaw, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Independent Public Clinical Hospital No 2, Medical University in Szczecin, Poland
| | - Radzislaw Mierzynski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Krzysztof Preis
- The Academy of Applied Medical and Social Sciences Elblag, Poland
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynaecology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Mariusz Zimmer
- 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland
| | - Hubert Huras
- Department of Obstetrics and Perinatology Collegium Medicum Jagiellonia University Cracow, Poland
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Strojny AA, Baran A, Wiejak K, Scholz A, Maksym RB. Diagnostic and Therapeutic Challenges of Oligosymptomatic Vesicovaginal Fistula in the Complex Case of Endometriosis. Clin Pract 2024; 14:436-442. [PMID: 38525712 PMCID: PMC10961752 DOI: 10.3390/clinpract14020033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024] Open
Abstract
Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient's medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions' size and location. In this case, the patient's VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient's fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality.
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Affiliation(s)
- Agnieszka A. Strojny
- 1 Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-004 Warsaw, Poland; (A.A.S.); (A.S.)
| | - Arkadiusz Baran
- 1 Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-004 Warsaw, Poland; (A.A.S.); (A.S.)
| | - Katarzyna Wiejak
- University Clinical Centre, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Anna Scholz
- 1 Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-004 Warsaw, Poland; (A.A.S.); (A.S.)
| | - Radosław B. Maksym
- 1 Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-004 Warsaw, Poland; (A.A.S.); (A.S.)
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Szumilewicz A, Davenport MHH, Scholz A, Sikora-Szubert A, Santos-Rocha R, Karowicz-Bilinska A, Zembron-Lacny A, Ciechanowski K, Krzywanski J, Kwiatkowski S, Kostka T, Sieroszewski P, Kwiatkowska E. Translation and cross-cultural adaptation of the Get Active Questionnaire for Pregnancy (kwestionariusz "Badź Aktywna w Ciąży") to support physical activity among pregnant women in Poland. Ginekol Pol 2024:VM/OJS/J/97888. [PMID: 38334341 DOI: 10.5603/gpl.97888] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Physical activity during pregnancy is established to derive clinically meaningful improvements in pregnancy, childbirth, and postpartum health outcomes. Evidence-based pre-screening tools have been developed to support the implementation of physical activity programmes, and enhance communication between health care providers, exercise professionals and pregnant women. The Get Active Questionnaire for Pregnancy (GAQ-P) and the Health Care Provider Consultation Form for Prenatal Physical Activity (HCPCF) empower pregnant women to identify whether they require additional counselling from their obstetric health care provider in terms of physical activity. However, these tools are not available in Polish. This work details the process taken to translate the GAQ-P and HCPCF into Polish. MATERIAL AND METHODS We followed the translation process outlined by the Translation and Cultural Adaptation International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines between August 2022 and August 2023. We formed an expert group that included representatives of the Polish Society of Sports Medicine, The Polish Society of Gynaecologists and Obstetricians, practitioners, and scientists in physical activity during pregnancy. We implemented 9 of the 10 steps recommended by ISOPR in the translation process. At the Cognitive Debriefing stage, we collected opinions on the Polish version of GAQ-P and HCPCF from 70 stakeholders on the clarity and cultural appropriateness of the translation. RESULTS AND CONCLUSIONS Target users have positively evaluated the Polish version of GAQ-P and HCPCF. Thanks to the ISPOR methodology, we obtained a trustworthy, evidence-based screening tools, which can reduce the barriers for most women to be physically active during pregnancy.
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Affiliation(s)
- Anna Szumilewicz
- Faculty of Physical Culture, Gdansk University of Physical Activity and Sport, Gdansk, Poland.
| | - Margie H H Davenport
- Women and Children's Health Research Institute, Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Anna Scholz
- Reproductive Health Department, Center for Post-Graduate Medical Education, Warsaw, Poland
| | - Anita Sikora-Szubert
- Clinical Department of Pathology of Pregnancy and Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | - Rita Santos-Rocha
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- CIPER Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Lisbon, Portugal
| | - Agata Karowicz-Bilinska
- Clinical Department of Pathology of Pregnancy and Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | - Agnieszka Zembron-Lacny
- Departments of Applied Physiology and Clinical Physiology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Kazimierz Ciechanowski
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | | | - Sebastian Kwiatkowski
- Clinical Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Clinical Department of Geriatric Medicine, Medical University of Lodz, Poland
| | - Piotr Sieroszewski
- Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | - Ewa Kwiatkowska
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
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Zielińska M, Pawłowska A, Orzeł A, Sulej L, Muzyka-Placzyńska K, Baran A, Filipecka-Tyczka D, Pawłowska P, Nowińska A, Bogusławska J, Scholz A. Wound Microbiota and Its Impact on Wound Healing. Int J Mol Sci 2023; 24:17318. [PMID: 38139146 PMCID: PMC10743523 DOI: 10.3390/ijms242417318] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Wound healing is a complex process influenced by age, systemic conditions, and local factors. The wound microbiota's crucial role in this process is gaining recognition. This concise review outlines wound microbiota impacts on healing, emphasizing distinct phases like hemostasis, inflammation, and cell proliferation. Inflammatory responses, orchestrated by growth factors and cytokines, recruit neutrophils and monocytes to eliminate pathogens and debris. Notably, microbiota alterations relate to changes in wound healing dynamics. Commensal bacteria influence immune responses, keratinocyte growth, and blood vessel development. For instance, Staphylococcus epidermidis aids keratinocyte progression, while Staphylococcus aureus colonization impedes healing. Other bacteria like Group A Streptococcus spp. And Pseudomonas affect wound healing as well. Clinical applications of microbiota-based wound care are promising, with probiotics and specific bacteria like Acinetobacter baumannii aiding tissue repair through molecule secretion. Understanding microbiota influence on wound healing offers therapeutic avenues. Tailored approaches, including probiotics, prebiotics, and antibiotics, can manipulate the microbiota to enhance immune modulation, tissue repair, and inflammation control. Despite progress, critical questions linger. Determining the ideal microbiota composition for optimal wound healing, elucidating precise influence mechanisms, devising effective manipulation strategies, and comprehending the intricate interplay between the microbiota, host, and other factors require further exploration.
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Affiliation(s)
- Małgorzata Zielińska
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
| | - Agnieszka Pawłowska
- Students Research Group of Obstetrics and Gynecology Department at St. Sophia Hospital, 01-004 Warsaw, Poland; (A.P.)
| | - Anna Orzeł
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
| | - Luiza Sulej
- Students Research Group of Obstetrics and Gynecology Department at St. Sophia Hospital, 01-004 Warsaw, Poland; (A.P.)
| | - Katarzyna Muzyka-Placzyńska
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
| | - Arkadiusz Baran
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
| | - Dagmara Filipecka-Tyczka
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
| | - Paulina Pawłowska
- Students Scientific Association, Department of Hygiene and Epidemiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Aleksandra Nowińska
- Students Scientific Association, Department of Hygiene and Epidemiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Joanna Bogusławska
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland;
| | - Anna Scholz
- Ist Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (M.Z.); (A.O.)
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Scholz A, Gehres V, Schrimpf A, Bleckwenn M, Deutsch T, Geier AK. Long-term mentoring relationships in undergraduate longitudinal general practice tracks - a qualitative study on the perspective of students and general practitioners. Med Educ Online 2023; 28:2149252. [PMID: 36463500 PMCID: PMC9728122 DOI: 10.1080/10872981.2022.2149252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Longitudinal general practice tracks have been established in medical faculties in Europe and worldwide to attract more graduates to general practice careers. In many programs, long-term mentoring relationships play an important role in providing students with positive role models, regular practical experiences, and acquisition of clinical skills in a community context. However, little is known about students' and general practitioner mentors' expectations, experiences, challenges, and ideas for improvement within these long-term mentoring relationships in general practice in our medical education system. METHODS Qualitative study based on semi-structured interviews with 15 students and 13 mentors. Interviews were audio-recorded and transcribed verbatim. MAXQDA was used for data analysis, following a mixed deductive/inductive approach. RESULTS Both groups had few and rather unstated expectations, particularly regarding their relationships. Consequently, expectations were often not clearly communicated. Nevertheless, a high level of satisfaction and good opportunities for teaching were achieved for both sides. The evolving familiarity facilitated a positive learning environment. Students valued independent medical tasks continuously adjusted to their current abilities. However, some felt a reluctance to demand their mentor's time and consideration. Conversely, the mentors criticized a lack of initiative from some of the students and wished that they would get more actively involved. Students, in contrast, wished for more guidance at the start of the project and joint events to deepen the relationship. CONCLUSIONS With this study, we gained detailed insights into and understanding of the nature of long-term relationships between students and mentors. Points for improvement revealed included: 1) education of both participating groups on the goals and benefits of mentoring, including binding expectations for the participants; 2) intensified support and training of teaching physicians; 3) structured and accompanied establishment of initial contact between mentor and mentee; and 4) encouraged additional shared (teaching) time, individualized timing, and intensification, if desired.
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Affiliation(s)
- Anna Scholz
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Vera Gehres
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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8
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Menezes AC, Dixon C, Scholz A, Nicholson R, Leckenby A, Azevedo A, Baker S, Gilkes AF, Davies S, Darley RL, Tonks A. RUNX3 overexpression inhibits normal human erythroid development. Sci Rep 2022; 12:1243. [PMID: 35075235 PMCID: PMC8786893 DOI: 10.1038/s41598-022-05371-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
RUNX proteins belong to a family of transcription factors essential for cellular proliferation, differentiation, and apoptosis with emerging data implicating RUNX3 in haematopoiesis and haematological malignancies. Here we show that RUNX3 plays an important regulatory role in normal human erythropoiesis. The impact of altering RUNX3 expression on erythropoiesis was determined by transducing human CD34+ cells with RUNX3 overexpression or shRNA knockdown vectors. Analysis of RUNX3 mRNA expression showed that RUNX3 levels decreased during erythropoiesis. Functionally, RUNX3 overexpression had a modest impact on early erythroid growth and development. However, in late-stage erythroid development, RUNX3 promoted growth and inhibited terminal differentiation with RUNX3 overexpressing cells exhibiting lower expression of glycophorin A, greater cell size and less differentiated morphology. These results suggest that suppression of RUNX3 is required for normal erythropoiesis. Overexpression of RUNX3 increased colony formation in liquid culture whilst, corresponding RUNX3 knockdown suppressed colony formation but otherwise had little impact. This study demonstrates that the downregulation of RUNX3 observed in normal human erythropoiesis is important in promoting the terminal stages of erythroid development and may further our understanding of the role of this transcription factor in haematological malignancies.
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Affiliation(s)
- Ana Catarina Menezes
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Christabel Dixon
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Anna Scholz
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Rachael Nicholson
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Adam Leckenby
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Aleksandra Azevedo
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Sarah Baker
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK.,Cardiff Experimental Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Amanda F Gilkes
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK.,Cardiff Experimental Cancer Medicine Centre (ECMC), School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Sara Davies
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Richard L Darley
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK
| | - Alex Tonks
- Division of Cancer & Genetics, Department of Haematology, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, UK.
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9
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Muller I, Taylor PN, Daniel RM, Hales C, Scholz A, Candler T, Pettit RJ, Evans WD, Shillabeer D, Draman MS, Dayan CM, Tang HKC, Okosieme O, Gregory JW, Lazarus JH, Rees DA, Ludgate ME. CATS II Long-term Anthropometric and Metabolic Effects of Maternal Sub-optimal Thyroid Function in Offspring and Mothers. J Clin Endocrinol Metab 2020; 105:5836234. [PMID: 32396189 DOI: 10.1210/clinem/dgaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT AND OBJECTIVES The Controlled Antenatal Thyroid Screening Study I (CATS-I) was a randomized controlled trial investigating the effects of levothyroxine therapy for suboptimal gestational thyroid function (SGTF), comparing outcomes in children of treated (SGTF-T) with untreated (SGTF-U) women during pregnancy. This follow-up study, CATS-II, reports the long-term effects on anthropometric, bone, and cardiometabolic outcomes in mothers and offspring and includes a group with normal gestational thyroid function (NGTF). DESIGN & PARTICIPANTS 332 mothers (197 NGTF, 56 SGTF-U, 79 SGTF-T) aged 41.2±5.3 years (mean±SD) and 326 paired children assessed 9.3±1.0 years after birth for (i) body mass index (BMI); (ii) lean, fat, and bone mass by dual-energy X-ray absorptiometry; (iii) blood pressure, augmentation index, and aortic pulse-wave-velocity; and (iv) thyroid function, lipids, insulin, and adiponectin. The difference between group means was compared using linear regression. RESULTS Offspring's measurements were similar between groups. Although maternal BMI was similar between groups at CATS-I, after 9 years (at CATS-II) SGTF-U mothers showed higher BMI (median [interquartile ratio] 28.3 [24.6-32.6] kg/m2) compared with NGTF (25.8 [22.9-30.0] kg/m2; P = 0.029), driven by fat mass increase. At CATS-II SGTF-U mothers also had higher thyroid-stimulating hormone (TSH) values (2.45 [1.43-3.50] mU/L) than NGTF (1.54 [1.12-2.07] mU/L; P = 0.015), since 64% had never received levothyroxine. At CATS-II, SGTF-T mothers had BMI (25.8 [23.1-29.8] kg/m2, P = 0.672) and TSH (1.68 [0.89-2.96] mU/L; P = 0.474) values similar to NGTF mothers. CONCLUSIONS Levothyroxine supplementation of women with SGTF did not affect long-term offspring anthropometric, bone, and cardiometabolic measurements. However, absence of treatment was associated with sustained long-term increase in BMI and fat mass in women with SGTF.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Peter N Taylor
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhian M Daniel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Charlotte Hales
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Scholz
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Toby Candler
- MRC The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Pettit
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - William D Evans
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - Dionne Shillabeer
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mohd S Draman
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Colin M Dayan
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Hiu K C Tang
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Oncology, Nottingham University NHS Trust, Nottingham, UK
| | - Onyebuchi Okosieme
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - John H Lazarus
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Marian E Ludgate
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Taylor PN, Eligar V, Muller I, Scholz A, Dayan C, Okosieme O. Combination Thyroid Hormone Replacement; Knowns and Unknowns. Front Endocrinol (Lausanne) 2019; 10:706. [PMID: 31695677 PMCID: PMC6817486 DOI: 10.3389/fendo.2019.00706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
Hypothyroidism is common throughout the world and readily diagnosed with thyroid function tests. Management should be straightforward but appears not to be the case. Thyroid hormone replacement with levothyroxine monotherapy is the standard treatment which is effective in the majority of cases. However, 10-15% of patients established on levothyroxine do not feel their health is entirely restored and some patients prefer the addition of liothyronine. Proponents of liothyronine argue that the ratio of T3 and T4 hormones is substantially altered on T4 monotherapy and therefore both hormones may be needed for optimal health. This remains controversial as clinical trials have not demonstrated superiority of combination therapy (levothyroxine and liothyronine) over levothyroxine monotherapy. There is now a pressing need for further studies and in particular randomized controlled trials in this area. To help design and facilitate dedicated trials and better understand thyroid hormone replacement, this review summarizes the evidence where there is established knowledge and agreement (knowns) and areas where research is lacking (unknowns). Agreements include the extent of dissatisfaction with levothyroxine monotherapy, biases in testing for hypothyroidism and prescribing levothyroxine, as well as variable thresholds for prescribing levothyroxine and challenges in liothyronine dosing. The review will also highlight and summarize the unknowns including the long-term safety profile of liothyronine, and potential biomarkers to identify individuals who might benefit most from combination therapy.
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Scholz A, Handke J, Gillmann HJ, Dehne S, Janssen H, Arens C, Hansen N, Espeter F, Uhle F, Weigand M, Motsch J, Larmann J. P4464Low levels of circulating CD25high CD127low regulatory T cells predict perioperative major cardiovascular and cerebrovascular events after non-cardiac surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Scholz
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - J Handke
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - H.-J Gillmann
- Hannover Medical School, Department of Anesthesiology and Intensive Care Medicine, Hannover, Germany
| | - S Dehne
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - H Janssen
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - C Arens
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - N Hansen
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - F Espeter
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - F Uhle
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - M Weigand
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - J Motsch
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - J Larmann
- University Hospital of Heidelberg, Department of Anesthesiology, Heidelberg, Germany
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12
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Handke J, Scholz A, Gillmann HJ, Dehne S, Janssen H, Arens C, Hansen N, Espeter F, Uhle F, Weigand MA, Motsch J, Larmann J. P6252Preoperative plasma presepsin predicts major adverse cardiac and cerebrovascular complications after elective, non-cardiac surgery - post-hoc analysis from the LeukoCAPE-2 trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6252] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Handke
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - A Scholz
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - H.-J Gillmann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | - S Dehne
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - H Janssen
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - C Arens
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - N Hansen
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - F Espeter
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - F Uhle
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - M A Weigand
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - J Motsch
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
| | - J Larmann
- University Hospital of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
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Abstract
Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Diana Albrecht
- University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - Anna Scholz
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Gala Gutierrez-Buey
- Clinica Universidad de Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Colin M Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Onyebuchi E Okosieme
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
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Taylor P, Dehbozorgi S, Tabasum A, Scholz A, Bhatt H, Stewart P, Kumar P, Draman MS, Watt A, Rees A, Hayhurst C, Davies S. Cerebral salt wasting following traumatic brain injury. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160142. [PMID: 28458890 PMCID: PMC5404462 DOI: 10.1530/edm-16-0142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022] Open
Abstract
Summary Hyponatraemia is the most commonly encountered electrolyte disturbance in neurological high dependency and intensive care units. Cerebral salt wasting (CSW) is the most elusive and challenging of the causes of hyponatraemia, and it is vital to distinguish it from the more familiar syndrome of inappropriate antidiuretic hormone (SIADH). Managing CSW requires correction of the intravascular volume depletion and hyponatraemia, as well as mitigation of on-going substantial sodium losses. Herein we describe a challenging case of CSW requiring large doses of hypertonic saline and the subsequent substantial benefit with the addition of fludrocortisone. Learning points:
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Affiliation(s)
- Peter Taylor
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Thyroid Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, CardiffUK
| | - Sasan Dehbozorgi
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Arshiya Tabasum
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Anna Scholz
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Harsh Bhatt
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Philippa Stewart
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Pranav Kumar
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Mohd S Draman
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Thyroid Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, CardiffUK
| | - Alastair Watt
- Department of Diabetes and Endocrinology, North Devon District Hospital, BarnstapleUK
| | - Aled Rees
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Institute of Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, CardiffUK
| | - Caroline Hayhurst
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Stephen Davies
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
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15
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Zitzelsberger T, Hetterich H, Lorbeer R, Scholz A, Auweter S, Bamberg F, Peters A, Reiser M, Schlett C. Myokardialer Strain mittels MR-basiertem Feature Tracking: Machbarkeit und Assoziation zu Risiko-Faktoren in einer Bevölkerungsstichprobe ohne kardiovaskuläre Erkrankungen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600263] [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: 10/19/2022]
Affiliation(s)
- T Zitzelsberger
- Universitätsklinik Tübingen, Diagnostische und interventionelle Radiologie, Tübingen
| | - H Hetterich
- LMU München, Insitut für Radiologie, München
| | - R Lorbeer
- LMU München, Institut für Radiologie, München
| | - A Scholz
- Universitätsklinik Tübingen, Diagnostische und interventionelle Radiologie, Tübingen
| | - S Auweter
- LMU München, Institut für Radiologie, München
| | - F Bamberg
- Universitätsklinik Tübingen, Diagnostische und interventionelle Radiologie, Tübingen
| | - A Peters
- Helmholtz Zentrum München, Institute of Epidemiology II, Neuherberg
| | - M Reiser
- LMU München, Institut für Radiologie, München
| | - C Schlett
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
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16
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Suominen M, Fagerlund K, Rissanen J, Konkol Y, Alhoniemi E, Mumberg D, Ziegelbauer K, Käskönen S, Halleen J, Vessella R, Scholz A. 63 Radium-223 dichloride – Efficacy and mode-of-action in a mouse model of prostate cancer bone metastasis. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70189-3] [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: 10/24/2022]
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Scholz A, Cremer S, Harter P, Mittelbronn M, van Slyke P, Dumont D, Plate KH. AI-26 * OVERCOMING RESISTANCE TO VEGF-BLOCKADE BY TARGETING THE ANGIOPOIETIN/TIE2 AXIS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou238.26] [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: 11/13/2022] Open
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18
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Leenen M, Scholz A, Lefering R, Flohé S. Limited volume resuscitation in hypotensive elderly multiple trauma is safe and prevents early clinical dilutive coagulopathy -- a matched-pair analysis from TraumaRegister DGU(®). Injury 2014; 45 Suppl 3:S59-63. [PMID: 25284236 DOI: 10.1016/j.injury.2014.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of permissive hypotension includes a restrained volume preclinical therapy. However, in the elderly patients, this approach has raised concerns because of the increased cardiovascular risk profile and a higher incidence of hypertension under normal conditions. The aim of the study was to examine whether preclinical administration of restrictive volume therapy in the elderly patient can be safe. PATIENTS AND METHODS A retrospective matched-pair analysis with the data set of the TraumaRegister DGU(®) (TR-DGU) was performed based on data of 176 pairs of totally 67,000 patients. To address elderly potentially bleeding patients without major brain injury the following inclusion criteria were chosen: patients ≥ 60 years, ISS ≥ 16, AIS head<4, preclinical blood pressure between 60 and 100 mmHg and recorded preclinical volume administration. Patients that met the inclusion criteria (908) were divided into two groups: pre-clinical volume resuscitation ≤ 1000 ml (=low volume) and >1000 ml (high volume). Patients with high- and low-volume fluid replacement were matched according to the following criteria: age group, gender, date of the accident ± 5 years, ISS, GCS, preclinical intubation, ground-/air-transport, pre-clinical blood pressure. RESULTS Preclinical volume resuscitation showed a difference of about 1000 ml between the "low volume" and "high volume" group. The "low volume" group showed a significantly elongated prothrombin time. The amount of blood products given in the emergency department was not significantly different. The ventilation was 2 days shorter in the "low volume", although the number of patients with severe thoracic trauma was greater in this group. The length of stay in the ICU differed by 3 days in favour of the "low volume" group. The overall mortality was almost the same in both groups. CONCLUSIONS Based on these data it can be assumed that the lower preclinical volume administration has a positive effect on the initial coagulation status in elderly patients. In spite of some limitations such as low number of matched pairs, we draw the cautious conclusion that a restrictive preclinical volume therapy is safe and also indicated in elderly patients.
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Affiliation(s)
- M Leenen
- Heinrich Heine University Hospital Duesseldorf, Department of Trauma and Handsurgery, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - A Scholz
- Heinrich Heine University Hospital Duesseldorf, Department of Trauma and Handsurgery, Moorenstr. 5, 40225 Duesseldorf, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine, Witten/Herdecke University, Germany
| | - S Flohé
- Heinrich Heine University Hospital Duesseldorf, Department of Trauma and Handsurgery, Moorenstr. 5, 40225 Duesseldorf, Germany
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19
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Güldner M, Becker S, Wolf U, Düber C, Friesenecker A, Gast KK, Heil W, Hoffmann C, Karpuk S, Otten EW, Rivoire J, Salhi Z, Scholz A, Schreiber LM, Terekhov M. Application unit for the administration of contrast gases for pulmonary magnetic resonance imaging: optimization of ventilation distribution for (3) He-MRI. Magn Reson Med 2014; 74:884-93. [PMID: 25213218 DOI: 10.1002/mrm.25433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/24/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 11/05/2022]
Abstract
PURPOSE MRI of lung airspaces using gases with MR-active nuclei ((3) He, (129) Xe, and (19) F) is an important area of research in pulmonary imaging. The volume-controlled administration of gas mixtures is important for obtaining quantitative information from MR images. State-of-the-art gas administration using plastic bags (PBs) does not allow for a precise determination of both the volume and timing of a (3) He bolus. METHODS A novel application unit (AU) was built according to the requirements of the German medical devices law. Integrated spirometers enable the monitoring of the inhaled gas flow. The device is particularly suited for hyperpolarized (HP) gases (e.g., storage and administration with minimal HP losses). The setup was tested in a clinical trial (n = 10 healthy volunteers) according to the German medicinal products law using static and dynamic ventilation HP-(3) He MRI. RESULTS The required specifications for the AU were successfully realized. Compared to PB-administration, better reproducibility of gas intrapulmonary distribution was observed when using the AU for both static and dynamic ventilation imaging. CONCLUSION The new AU meets the special requirements for HP gases, which are storage and administration with minimal losses. Our data suggest that gas AU-administration is superior to manual modes for determining the key parameters of dynamic ventilation measurements.
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Affiliation(s)
- M Güldner
- Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - U Wolf
- Department of Radiology, University Medical Center Mainz, Mainz, Germany
| | - C Düber
- Department of Radiology, University Medical Center Mainz, Mainz, Germany
| | | | - K K Gast
- Department of Radiology, University Medical Center Mainz, Mainz, Germany
| | - W Heil
- Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - C Hoffmann
- Department of Radiology, University Medical Center Mainz, Mainz, Germany
| | - S Karpuk
- Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - E W Otten
- Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - J Rivoire
- Department of Radiology, Section of Medical Physics, University Medical Center Mainz, Mainz, Germany
| | - Z Salhi
- Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - A Scholz
- Department of Radiology, Section of Medical Physics, University Medical Center Mainz, Mainz, Germany
| | - L M Schreiber
- Department of Radiology, Section of Medical Physics, University Medical Center Mainz, Mainz, Germany
| | - M Terekhov
- Department of Radiology, Section of Medical Physics, University Medical Center Mainz, Mainz, Germany
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Plate KH, Scholz A, Mittelbronn M, Harter P, Dumont D, van Slyke P, Reiss Y. MOVING BEYOND VEGF: INHIBING GLIOMA ANGIOGENESIS BY TARGETING THE TIE2/ANGIOPOIETIN SIGNALING PATHWAY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.55] [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: 11/14/2022] Open
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Stelzer B, Alcalá J, Whelan E, Scholz A. Emission line diagnostics for accretion and outflows in young very low-mass stars and brown dwarfs. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20136408005] [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: 11/14/2022] Open
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Abuhusain H, Matin A, Qiao Q, Shen H, Daniels B, Laaksonen M, Teo C, Don A, McDonald K, Jahangiri A, De Lay M, Lu K, Park C, Carbonell S, Bergers G, Aghi MK, Anand M, Tucker-Burden C, Kong J, Brat DJ, Bae E, Smith L, Muller-Greven G, Yamada R, Nakano-Okuno M, Feng X, Hambardzumyan D, Nakano I, Gladson CL, Berens M, Jung S, Kim S, Kiefer J, Eschbacher J, Dhruv H, Vuori K, Hauser C, Oshima R, Finlay D, Aza-Blanc P, Bessarabova M, Nikolsky Y, Emig D, Bergers G, Lu K, Rivera L, Chang J, Burrell K, Singh S, Hill R, Zadeh G, Li C, Chen Y, Mei X, Sai K, Chen Z, Wang J, Wu M, Marsden P, Das S, Eskilsson E, Talasila KM, Rosland GV, Leiss L, Saed HS, Brekka N, Sakariassen PO, Lund-Johansen M, Enger PO, Bjerkvig R, Miletic H, Gawrisch V, Ruttgers M, Weigell P, Kerkhoff E, Riemenschneider M, Bogdahn U, Vollmann-Zwerenz A, Hau P, Ichikawa T, Onishi M, Kurozumi K, Maruo T, Fujii K, Ishida J, Shimazu Y, Oka T, Chiocca EA, Date I, Jain R, Griffith B, Khalil K, Scarpace L, Mikkelsen T, Kalkanis S, Schultz L, Jalali S, Chung C, Burrell K, Foltz W, Zadeh G, Jiang C, Wang H, Kijima N, Hosen N, Kagawa N, Hashimoto N, Chiba Y, Kinoshita M, Sugiyama H, Yoshimine T, Klank R, Decker S, Forster C, Price M, SantaCruz K, McCarthy J, Ohlfest J, Odde D, Kurozumi K, Onishi M, Ichikawa T, Fujii K, Ishida J, Shimazu Y, Chiocca EA, Kaur B, Date I, Huang Y, Lin Q, Mao H, Wang Y, Kogiso M, Baxter P, Man C, Wang Z, Zhou Y, Li XN, Liang J, Piao Y, de Groot J, Lu K, Rivera L, Chang J, Bergers G, McDonell S, Liang J, Piao Y, Henry V, Holmes L, de Groot J, Michaelsen SR, Stockhausen MT, Hans, Poulsen S, Rosland GV, Talasila KM, Eskilsson E, Jahedi R, Azuaje F, Stieber D, Foerster S, Varughese J, Ritter C, Niclou SP, Bjerkvig R, Miletic H, Talasila KM, Soentgerath A, Euskirchen P, Rosland GV, Wang J, Huszthy PC, Prestegarden L, Skaftnesmo KO, Sakariassen PO, Eskilsson E, Stieber D, Keunen O, Nigro J, Vintermyr OK, Lund-Johansen M, Niclou SP, Mork S, Enger PO, Bjerkvig R, Miletic H, Mohan-Sobhana N, Hu B, De Jesus J, Hollingsworth B, Viapiano M, Muller-Greven G, Carlin C, Gladson C, Nakada M, Furuta T, Sabit H, Chikano Y, Hayashi Y, Sato H, Minamoto T, Hamada JI, Fack F, Espedal H, Obad N, Keunen O, Gotlieb E, Sakariassen PO, Miletic H, Niclou SP, Bjerkvig R, Bougnaud S, Golebiewska A, Stieber D, Oudin A, Brons NHC, Bjerkvig R, Niclou SP, O'Halloran P, Viel T, Schwegmann K, Wachsmuth L, Wagner S, Kopka K, Dicker P, Faber C, Jarzabek M, Hermann S, Schafers M, O'Brien D, Prehn J, Jacobs A, Byrne A, Oka T, Ichikawa T, Kurozumi K, Inoue S, Fujii K, Ishida J, Shimazu Y, Chiocca EA, Date I, Olsen LS, Stockhausen M, Poulsen HS, Plate KH, Scholz A, Henschler R, Baumgarten P, Harter P, Mittelbronn M, Dumont D, Reiss Y, Rahimpour S, Yang C, Frerich J, Zhuang Z, Renner D, Jin F, Parney I, Johnson A, Rockne R, Hawkins-Daarud A, Jacobs J, Bridge C, Mrugala M, Rockhill J, Swanson K, Schneider H, Szabo E, Seystahl K, Weller M, Takahashi Y, Ichikawa T, Maruo T, Kurozumi K, Onishi M, Ouchida M, Fuji K, Shimazu Y, Oka T, Chiocca EA, Date I, Umakoshi M, Ichikawa T, Kurozumi K, Onishi M, Fujii K, Ishida J, Shimazu Y, Oka T, Chiocca EA, Kaur B, Date I, Sim H, Gruenbacher P, Jakeman L, Viapiano M, Wang H, Jiang C, Wang H, Jiang C, Parker J, Dionne K, Canoll P, DeMasters B, Waziri A. ANGIOGENESIS AND INVASION. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not172] [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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Trajkovic-Arsic M, Heid I, Esposito I, Steiger K, Teichmann N, Steingötter A, Menne D, Scholz A, Rummeny EJ, Siveke J, Braren R. ADC as therapy response marker for pancreatic ductal adenocarcinoma in genetically engineered mice. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346234] [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: 10/26/2022]
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Scholz A, Posten C. Verwendung Ionenaustausch-funktionalisierter Magnetpartikel zur In-situ-Magnetseparation (ISMS). CHEM-ING-TECH 2012. [DOI: 10.1002/cite.201250271] [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: 11/10/2022]
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Schmieder R, Puehler F, Neuhaus R, Mumberg D, Ziegelbauer K, Scholz A. 959 The MEK Inhibitor BAY 86-9766 Prolongs Survival in Orthotopic, Syngeneic Animal Models of Hepatocellular Carcinoma and Pancreatic Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71578-2] [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: 10/28/2022]
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Otto N, Schulz P, Scholz A, Hauff P, Schlegelberger B, Detjen KM, Wiedenmann B. The proline TP53 variant stimulates likely lymphangiogenesis in an orthotopic mouse model of pancreatic cancer. Br J Cancer 2011; 106:348-57. [PMID: 22146521 PMCID: PMC3261666 DOI: 10.1038/bjc.2011.521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Pancreatic cancer is a deadly disease characterised by high incidence of TP53 mutations. Restoration of TP53 function is perceived as a highly attractive therapeutic strategy, whose effects are not well characterised. Methods: The current work adapted an inducible strategy of stage-specific reexpression of wild-type (wt) TP53 in an in vivo orthotopic mouse model of pancreatic cancer. Results: The reconstitution of wt TP53 function in TP53-mutant DanG and MiaPaCa-2 cells caused G1 cell cycle arrest but no evidence of apoptosis induction. Consistent with subcutaneous xenograft models, we found that wt TP53 reduced primary tumour growth. Wt TP53 reexpression during early tumour growth led to significant increase in vascularisation. This correlated with an unexpectedly high rate of micro-metastases in lymph nodes of animals with wt TP53 induction, despite the 90% decrease in median primary tumour weight. Reexpression of wt TP53 later in tumour development did not significantly affect the number of CD31-reactive vessels, but increased lymphatic vessel density. Conclusion: The increased number of lymphatic vessels and micro-metastases suggests that wt TP53 induction complexly affected the biology of different tumour constituents of pancreatic cancer. Our observation suggests that combination of the inducible system with an orthotopic model can yield important insights into in vivo pancreatic cancer biology.
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Affiliation(s)
- N Otto
- 1] Department of Internal Medicine, Division of Hepatology and Gastroenterology, Charité Berlin, Campus Virchow Clinic, 13353 Berlin, Germany.
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Beyerle A, Rueger R, Scholz A, Kontermann R, Heidenreich O. Targeted siRNA delivery to myeloid precursor cells. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1277093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bellmann J, Scholz A. Lebenswege jüdischer und aus dem Judentum stammender Urologen während des Nationalsozialismus. Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256217] [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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Puehler F, Scholz A, Kissel M, Adjei A, Miner J, Hitchcock M, Schmieder R, Mumberg D, Ziegelbauer K. 151 Allosteric MEK inhibitor BAY 86-9766 (RDEA119) shows anti-tumor efficacy in mono-and combination therapy in preclinical models of hepatocellular carcinoma and pancreatic cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71856-5] [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] Open
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Gessner A, Thomas M, Garrido Castro P, Büchler L, Scholz A, Brümmendorf TH, Martinez Soria N, Vormoor J, Greil J, Heidenreich O. Leukemic fusion genes MLL/AF4 and AML1/MTG8 support leukemic self-renewal by controlling expression of the telomerase subunit TERT. Leukemia 2010; 24:1751-9. [DOI: 10.1038/leu.2010.155] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gann H, Glaspell G, Garrad R, Wanekaya A, Ghosh K, Cillessen L, Scholz A, Parker B, Warner M, Delong RK. Interaction of MnO and ZnO nanomaterials with biomedically important proteins and cells. J Biomed Nanotechnol 2010; 6:37-42. [PMID: 20499830 DOI: 10.1166/jbn.2010.1100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Zinc and manganese nanomaterials may have potential for biomedical nanotechnology. Here first generation Zn and Mn oxide nanomaterials were prepared as determined by XRD. Transmission electron microscopy confirmed their nanoscale in two dimensions and revealed a rod or belt-like morphology for MnO or ZnO respectively. Association of MnO and ZnO to three model biomedically important proteins (albumin, protamine and thrombin) has been characterized by ultra-violet and dynamic laser light spectroscopy, UVS and DLLS respectively. UVS demonstrated a concentration-dependent loss of protein from the supernatant upon sedimentation of MnO or ZnO. Shifts in the surface charge of the MnO or ZnO by DLLS confirmed the protein's adsorption to the surface. MnO and ZnO were incubated with live human cells in culture (HeLa, A375 or 1321N1). A marked difference was observed for the two nanomaterials behavior in cell culture where the MnO could be discerned associating at the cell surface whereas the ZnO caused the cells to exhibit a rounded up morphology. Trypan blue dye exclusion studies demonstrated cytotoxicity of the ZnO at high concentrations 62.5-31.5 microg/mL whereas surprisingly the MnO demonstrated no cytotoxicity at any of the concentrations tested.
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Affiliation(s)
- H Gann
- Missouri State University, Department of Biomedical Science, Cell and Molecular Biology Program, Springfield, MO 65894, USA
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Beyaert I, Wäschke N, Scholz A, Varama M, Reinecke A, Hilker M. Relevance of resource-indicating key volatiles and habitat odour for insect orientation. Anim Behav 2010. [DOI: 10.1016/j.anbehav.2010.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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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Scholz A. Nathan Brann und die „Blätter für Beinheilkunde” 1922 – 1934. Akt Dermatol 2010. [DOI: 10.1055/s-0029-1215355] [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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Amor N, Zänker PP, Blümler P, Meise FM, Schreiber LM, Scholz A, Schmiedeskamp J, Spiess HW, Münnemann K. Magnetic resonance imaging of dissolved hyperpolarized 129Xe using a membrane-based continuous flow system. J Magn Reson 2009; 201:93-99. [PMID: 19729327 DOI: 10.1016/j.jmr.2009.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 08/11/2009] [Accepted: 08/11/2009] [Indexed: 05/28/2023]
Abstract
A technique for continuous production of solutions containing hyperpolarized (129)Xe is explored for MRI applications. The method is based on hollow fiber membranes which inhibit the formation of foams and bubbles. A systematic analysis of various carrier agents for hyperpolarized (129)Xe has been carried out, which are applicable as contrast agents for in vivo MRI. The image quality of different hyperpolarized Xe solutions is compared and MRI results obtained in a clinical as well as in a nonclinical MRI setting are provided. Moreover, we demonstrate the application of (129)Xe contrast agents produced with our dissolution method for lung MRI by imaging hyperpolarized (129)Xe that has been both dissolved in and outgassed from a carrier liquid in a lung phantom, illustrating its potential for the measurement of lung perfusion and ventilation.
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Affiliation(s)
- N Amor
- Max Planck Institute for Polymer Research, 55128 Mainz, Germany
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Scholz A, Pugh S, Fardy M, Shafik M, Hall JE. The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*. Anaesthesia 2009; 64:1089-93. [DOI: 10.1111/j.1365-2044.2009.06055.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ingrisch H, Heinze H, Scholz A, Lissner J. Kamera-Perfusions-Szintigraphie der Lunge mit 133-Xenon-Gas und 99m-Technetium-Partikeln. Vergleich der quantitativen und morphologischen Aussage. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229892] [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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Botsch H, Hahn W, Scholz A, Meinhold H. Neue Ergebnisse zum Problem der Messung des Nierenplasmastroms mit radioaktiv markiertem Hippuran. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229730] [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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Scholz A. Renaissance der operativen Dermatologie in der Nachkriegszeit. Entwicklung in der DDR. Akt Dermatol 2009. [DOI: 10.1055/s-0029-1214786] [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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Abstract
UNLABELLED SUMMARY BACKGROUND AND OBJECTIVES: Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. METHODS Patients diagnosed with HIT (1995-2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. RESULTS AND CONCLUSIONS One hundred and thirty HIT cases with a 4T-score >or=4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 euro. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies.
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Affiliation(s)
- T Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik, Hochschule Wismar, Wismar, Germany
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Shah S, Scholz A, Reber H, Schreckenberger M, Viebahn R, Lang H, Korenkov M. Laparoscopic radioisotope-guided sentinel lymph node mapping and excision of the rectum—an experimental study. Langenbecks Arch Surg 2009; 394:483-7. [DOI: 10.1007/s00423-009-0477-9] [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] [Received: 01/30/2009] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
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Scholz A, Wagner K, Welzel M, Remlinger F, Wiedenmann B, Siemeister G, Rosewicz S, Detjen KM. The oral multitarget tumour growth inhibitor, ZK 304709, inhibits growth of pancreatic neuroendocrine tumours in an orthotopic mouse model. Gut 2009; 58:261-70. [PMID: 18829975 DOI: 10.1136/gut.2007.146415] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS Current systemic therapies for neuroendocrine tumours (NETs) do not provide sufficient control of tumour growth. However, efficient evaluation of novel drugs is hindered by the lack of a suitable preclinical animal model. Here an orthotopic mouse model of pancreatic NET is established and used to study the action of ZK 304709, a first in class, oral multitarget tumour growth inhibitor. ZK 304709 is an inhibitor of cyclin-dependent kinases (Cdks) 1, 2, 4, 7 and 9, vascular endothelial growth factor receptor-type kinases (VEGF-RTKs) 1-3 and platelet-derived growth factor receptor-type kinase beta (PDGF-RTKss). METHODS BON and QGP-1 human NET cells were used to study proliferation, survival and cell cycle distribution in vitro. For induction of orthotopic NETs, BON cells were injected into the pancreas of NMRI(nu/nu) mice. Primary tumour growth and metastatic spread were recorded after 9 weeks, and apoptosis, microvessel density and lymphatic vessel density were determined. RESULTS ZK 304709 dose-dependently suppressed proliferation and colony formation of NET cells. Direct effects on NET cells were consistent with Cdk inhibition and involved G(2) cell cycle arrest and apoptosis induction, which was associated with reduced expression of MCL1 (myeloid cell leukaemia sequence 1), survivin and hypoxia-inducible factor 1alpha (HIF1alpha). Apoptosis similarly occurred in vivo in ZK 304709-treated orthotopic BON tumours, resulting in a 80% reduction of primary tumour growth. In contrast, treatment with lanreotide or 5-fluorouracil and streptozotocin failed to inhibit tumour gowth. ZK 304709 also reduced tumour microvessel density, implicating antiangiogenic mechanisms. CONCLUSION BON orthotopic tumours provide an informative model for preclinical drug evaluation in NETs. In this model, ZK 304709 achieved efficacious tumour growth control via induction of apoptosis and inhibition of tumour-induced angiogenesis.
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Affiliation(s)
- A Scholz
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Wetzig F, Scholz A, Hoffmann F. Der Effekt einer intrathekalen Triamcinolonacetonid-Therapie unter verschiedenen Basistherapien bei Multipler Sklerose – eine offene prospektive Verlaufsbeobachtung. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086834] [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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Klein CJ, Chan A, Kircher L, Cundiff AJ, Gardner N, Hrovat Y, Scholz A, Kendall BE, Airamé S. Striking a balance between biodiversity conservation and socioeconomic viability in the design of marine protected areas. Conserv Biol 2008; 22:691-700. [PMID: 18325043 DOI: 10.1111/j.1523-1739.2008.00896.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The establishment of marine protected areas is often viewed as a conflict between conservation and fishing. We considered consumptive and nonconsumptive interests of multiple stakeholders (i.e., fishers, scuba divers, conservationists, managers, scientists) in the systematic design of a network of marine protected areas along California's central coast in the context of the Marine Life Protection Act Initiative. With advice from managers, administrators, and scientists, a representative group of stakeholders defined biodiversity conservation and socioeconomic goals that accommodated social needs and conserved marine ecosystems, consistent with legal requirements. To satisfy biodiversity goals, we targeted 11 marine habitats across 5 depth zones, areas of high species diversity, and areas containing species of special status. We minimized adverse socioeconomic impacts by minimizing negative effects on fishers. We included fine-scale fishing data from the recreational and commercial fishing sectors across 24 fisheries. Protected areas designed with consideration of commercial and recreational fisheries reduced potential impact to the fisheries approximately 21% more than protected areas designed without consideration of fishing effort and resulted in a small increase in the total area protected (approximately 3.4%). We incorporated confidential fishing data without revealing the identity of specific fisheries or individual fishing grounds. We sited a portion of the protected areas near land parks, marine laboratories, and scientific monitoring sites to address nonconsumptive socioeconomic goals. Our results show that a stakeholder-driven design process can use systematic conservation-planning methods to successfully produce options for network design that satisfy multiple conservation and socioeconomic objectives. Marine protected areas that incorporate multiple stakeholder interests without compromising biodiversity conservation goals are more likely to protect marine ecosystems.
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Affiliation(s)
- C J Klein
- Centre for Applied Environmental Decision and Analysis, The University of Queensland, St Lucia, Qld 4072, Australia.
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Abstract
Subglottic stenosis (SGS) in pregnancy is rare but may cause a potentially life-threatening delivery and is a challenge to the anaesthetist and the obstetrician. Clinical signs of SGS may not be obvious and the diagnosis can be difficult. Patients usually present with shortness of breath rather than stridor. Many patients have been wrongly diagnosed with asthma and recurrent bronchitis before subsequent discovery of a SGS. Early diagnosis of SGS and multidisciplinary input is important in managing these patients. We present a case of a pregnant woman with a history of Wegener's granulomatosis and the successful multidisciplinary management of her SGS.
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Affiliation(s)
- A Scholz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
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Terekhov M, Wolf U, Scholz A, Schreiber WG. Schnelles In-vivo-19F-MRT-T1-Mapping zur Messung der Konzentration von fluorinierten Gasen in der Lunge. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073739] [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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Wolf U, Scholz A, Terekhov M, Schreiber WG. 19F-MRT der Lunge eines Wash-Outs von C4F8-Gas unter Hochfrequenzoszillationsbeatmung (HFOV). ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073585] [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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Malan CA, Scholz A, Wilkes AR, Hampson MA, Hall JE. Minimum and optimum light requirements for laryngoscopy in paediatric anaesthesia: a manikin study*. Anaesthesia 2007; 63:65-70. [DOI: 10.1111/j.1365-2044.2007.05259.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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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Abstract
BACKGROUND Clonidine has often been applied in combination with local anaesthetics for spinal or epidural anaesthesia. This study was designed to investigate the local anaesthetic-like action of clonidine in superficial dorsal horn neurones. The superficial laminae of the dorsal horn contain three groups of neurones: tonic-, adapting-, and single-spike-firing neurones which are important neuronal structures for pain transmission, receiving most of their primary sensory input from Adelta and C fibres. METHODS Whole cell patch clamp recordings from spinal cord slices of Wistar rats were used to study the action of clonidine on the generation of single and series of action potentials. Voltage clamp recordings in isolated somata were performed to study the effect of clonidine on voltage-gated Na(+) and different types of K(+) currents. RESULTS Firing frequencies of trains of action potentials in tonic-firing neurones are reduced at low concentrations (10 microM) of clonidine, but not in adapting- or single-spike-firing neurones. High concentrations of clonidine (700 microM) are necessary to modify the shape of single action potentials. Low concentrations of clonidine shift the steady-state inactivation curve of Na(+) currents to more negative potentials. At clinical concentrations (6-100 microM) clonidine partially inhibits voltage-gated Na(+) and K(+) channels. CONCLUSIONS Clonidine suppresses the generation of action potentials in tonic-firing spinal dorsal horn neurones. This may be explained, in part, by an interaction with voltage-gated Na(+) and K(+) currents. Clonidine could therefore contribute to analgesia during local anaesthesia.
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Affiliation(s)
- M Wolff
- Clinic for Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany.
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Abstract
Illumination provided by laryngoscope blades varies widely. It is not known what the optimum level of illumination should be during laryngoscopy. So far, no published standards exist for light intensity provided by laryngoscopes. Fifty anaesthetists were recruited to perform laryngoscopy on a manikin with three different laryngoscopes attached to a variable voltage supply. Anaesthetists were asked to find the minimum and optimum level of light they would wish to have for intubation. This study demonstrated that anaesthetists can see the larynx at very low light levels. The optimum level was significantly greater than the minimum level. The vacuum bulb laryngoscopes provides a significant lower light output than halogen and xenon laryngoscopes. There is a large variation in illumination requirements amongst anaesthetists which may make setting standards difficult. A brighter laryngoscope, as suggested by some manufacturers, may not necessarily be a better one.
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Affiliation(s)
- A Scholz
- Department of Anaesthesics and Intensive Care Medicine, University Hospital of Wales Cardiff, Heath Park, Cardiff CF14 4XW, UK.
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