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Mascherpa M, Pegoire C, Meroni A, Minopoli M, Thilaganathan B, Frick A, Bhide A. Prenatal prediction of adverse outcome using different charts and definitions of fetal growth restriction. Ultrasound Obstet Gynecol 2024; 63:605-612. [PMID: 38145554 DOI: 10.1002/uog.27568] [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] [Received: 08/17/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Antenatal growth assessment using ultrasound aims to identify small fetuses that are at higher risk of perinatal morbidity and mortality. This study explored whether the association between suboptimal fetal growth and adverse perinatal outcome varies with different definitions of fetal growth restriction (FGR) and different weight charts/standards. METHODS This was a retrospective cohort study of 17 261 singleton non-anomalous pregnancies at ≥ 24 + 0 weeks' gestation that underwent routine ultrasound at a tertiary referral hospital. Estimated fetal weight (EFW) and Doppler indices were converted into percentiles using a reference standard (INTERGROWTH-21st (IG-21)) and various reference charts (Hadlock, Fetal Medicine Foundation (FMF) and Swedish). Test characteristics were assessed using the consensus definition, Society for Maternal-Fetal Medicine (SMFM) definition and Swedish criteria for FGR. Adverse perinatal outcome was defined as perinatal death, admission to the neonatal intensive care unit at term, 5-min Apgar score < 7 and therapeutic cooling for neonatal encephalopathy. The association between FGR according to each definition and adverse perinatal outcome was compared. Multivariate logistic regression analysis was used to test the strength of association between ultrasound parameters and adverse perinatal outcome. Ultrasound parameters were also tested for correlation. RESULTS IG-21, Hadlock and FMF fetal size references classified as growth-restricted 1.5%, 3.6% and 4.6% of fetuses, respectively, using the consensus definition and 2.9%, 8.8% and 10.6% of fetuses, respectively, using the SMFM definition. The sensitivity of the definition/chart combinations for adverse perinatal outcome varied from 4.4% (consensus definition with IG-21 charts) to 13.2% (SMFM definition with FMF charts). Specificity varied from 89.4% (SMFM definition with FMF charts) to 98.6% (consensus definition with IG-21 charts). The consensus definition and Swedish criteria showed the highest specificity, positive predictive value and positive likelihood ratio in detecting adverse outcome, irrespective of the reference chart/standard used. Conversely, the SMFM definition had the highest sensitivity across all investigated growth charts. Low EFW, abnormal mean uterine artery pulsatility index (UtA-PI) and abnormal cerebroplacental ratio were significantly associated with adverse perinatal outcome and there was a positive correlation between the covariates. Multivariate logistic regression showed that UtA-PI > 95th percentile and EFW < 5th percentile were the only parameters consistently associated with adverse outcome, irrespective of the definitions or fetal growth chart/standard used. CONCLUSIONS The apparent prevalence of FGR varies according to the definition and fetal size reference chart/standard used. Irrespective of the method of classification, the sensitivity for the identification of adverse perinatal outcome remains low. EFW, UtA-PI and fetal Doppler parameters are significant predictors of adverse perinatal outcome. As these indices are correlated with one other, a prediction algorithm is advocated to overcome the limitations of using these parameters in isolation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Mascherpa
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, Università degli Studi di Brescia, Brescia, Italy
| | - C Pegoire
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Meroni
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, Università degli Studi di Pavia, Pavia, Italy
| | - M Minopoli
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, Università degli Study di Parma, Parma, Italy
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Frick
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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Bergmann H, Czaja EM, Frick A, Klaaß U, Marquart R, Rudovsky A, Holland D, Wysocki P, Lehnau D, Schröder R, Rogoll L, Sauter-Louis C, Homeier-Bachmann T. Remote Sensing Provides a Rapid Epidemiological Context for the Control of African Swine Fever in Germany. Sensors (Basel) 2023; 23:8202. [PMID: 37837032 PMCID: PMC10575123 DOI: 10.3390/s23198202] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
Transboundary disease control, as for African swine fever (ASF), requires rapid understanding of the locally relevant potential risk factors. Here, we show how satellite remote sensing can be applied to the field of animal disease control by providing an epidemiological context for the implementation of measures against the occurrence of ASF in Germany. We find that remotely sensed observations are of the greatest value at a lower jurisdictional level, particularly in support of wild boar carcass search efforts.
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Affiliation(s)
- Hannes Bergmann
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Eva-Maria Czaja
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Annett Frick
- LUP-Luftbild Umwelt Planung GmbH, Große Weinmeisterstraße 3a, 14469 Potsdam, Germany;
| | - Ulf Klaaß
- Landesamt für Arbeitsschutz, Verbraucherschutz und Gesundheit, Abteilung Verbraucherschutz, Dezernat V2, Dorfstraße 1, 14513 Teltow OT Ruhlsdorf, Germany; (U.K.); (R.M.); (A.R.); (D.H.)
| | - Ronny Marquart
- Landesamt für Arbeitsschutz, Verbraucherschutz und Gesundheit, Abteilung Verbraucherschutz, Dezernat V2, Dorfstraße 1, 14513 Teltow OT Ruhlsdorf, Germany; (U.K.); (R.M.); (A.R.); (D.H.)
| | - Annett Rudovsky
- Landesamt für Arbeitsschutz, Verbraucherschutz und Gesundheit, Abteilung Verbraucherschutz, Dezernat V2, Dorfstraße 1, 14513 Teltow OT Ruhlsdorf, Germany; (U.K.); (R.M.); (A.R.); (D.H.)
| | - Diana Holland
- Landesamt für Arbeitsschutz, Verbraucherschutz und Gesundheit, Abteilung Verbraucherschutz, Dezernat V2, Dorfstraße 1, 14513 Teltow OT Ruhlsdorf, Germany; (U.K.); (R.M.); (A.R.); (D.H.)
| | - Patrick Wysocki
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Daike Lehnau
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Ronald Schröder
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Lisa Rogoll
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Carola Sauter-Louis
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
| | - Timo Homeier-Bachmann
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (H.B.); (E.-M.C.); (P.W.); (D.L.); (R.S.); (L.R.); (C.S.-L.)
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Lehmler S, Förster M, Frick A. Modelling Green Volume Using Sentinel-1, -2, PALSAR-2 Satellite Data and Machine Learning for Urban and Semi-Urban Areas in Germany. Environ Manage 2023:10.1007/s00267-023-01826-9. [PMID: 37233749 DOI: 10.1007/s00267-023-01826-9] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/30/2023] [Indexed: 05/27/2023]
Abstract
Urban Green Infrastructure (UGI) provides ecosystem services such as cooling of temperatures and is majorly important for climate change adaptation. Green Volume (GV) describes the 3-D space occupied by vegetation and is highly useful for the assessment of UGI. This research uses Sentinel-2 (S-2) optical data, vegetation indices (VIs), Sentinel-1 (S-1) and PALSAR-2 (P-2) radar data to build machine learning models for yearly GV estimation on large scales. Our study compares random and stratified sampling of reference data, assesses the performance of different machine learning algorithms and tests model transferability by independent validation. The results indicate that stratified sampling of training data leads to improved accuracies when compared to random sampling. While the Gradient Tree Boost (GTB) and Random Forest (RF) algorithms show generally similar performance, Support Vector Machine (SVM) exhibits considerably greater model error. The results suggest RF to be the most robust classifier overall, achieving highest accuracies for independent and inter-annual validation. Furthermore, modelling GV based on S-2 features considerably outperforms using only S-1 or P-2 based features. Moreover, the study finds that underestimation of large GV magnitudes in urban forests constitutes the biggest source of model error. Overall, modelled GV explains around 79% of the variability in reference GV at 10 m resolution and over 90% when aggregated to 100 m resolution. The research shows that accurately modelling GV is possible using openly available satellite data. Resulting GV predictions can be useful for environmental management by providing valuable information for climate change adaptation, environmental monitoring and change detection.
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Affiliation(s)
- Sebastian Lehmler
- LUP - Luftbild Umwelt Planung GmbH, Große Weinmeisterstrasse 3a, 14469, Potsdam, Germany.
- Technische Universität Berlin, Geoinformation in Environmental Planning Lab, Strasse des 17. Juni 145, 10623, Berlin, Germany.
| | - Michael Förster
- Technische Universität Berlin, Geoinformation in Environmental Planning Lab, Strasse des 17. Juni 145, 10623, Berlin, Germany
| | - Annett Frick
- LUP - Luftbild Umwelt Planung GmbH, Große Weinmeisterstrasse 3a, 14469, Potsdam, Germany
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Giorgione V, O'Driscoll J, Di Fabrizio C, Frick A, Cauldwell M, Khalil A, Thilaganathan B. Relationship between peripartum maternal cardiac phenotype and maternal outcome in women with hypertensive disorders of pregnancy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2309] [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: 11/13/2022] Open
Abstract
Abstract
Background
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and neonatal morbidity worldwide.
Purpose
The aim of this study is to assess maternal cardiac function in women affected by HDP in singleton pregnancy and investigate the relationship between abnormal cardiac findings and maternal outcomes.
Methods
In this single-centre prospective longitudinal study, 190 women with a diagnosis of HDP underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. Left ventricle morphology (LVM) and diastolic dysfunction (DD) were evaluated according to according to British Society of Echocardiography guidelines. Patients were classified into three groups according to TTE findings: (1) normal LVM and DD, (2) abnormal LVM or abnormal DD, (3) abnormal LVM and abnormal DD. Maternal indices were compared among these groups.
Results
56 (29.5%) patients affected by HDP were included in group 1, 69 (36.3%) in group 2 and 65 (34.2%) in group 3. Gestational age at delivery and birthweight centile were similar among the groups. Women in group 3 were significantly older than group 2 and group 1 (35.1±5.4 years vs 32.6±6.3 vs 33.1±5.8 years years, respectively, p=0.043). Group 2 and 3 showed a higher blood pressure in the first trimester of pregnancy compared to group 1 (mean arterial pressure: 94.3±7.2 mmHg vs 95.5±8.2 mmHg vs 91.6±8.3 mmHg, p=0.024), while no significant difference was found in body mass index among the three groups (group 1: 26.4±5.4, group 2: 28.0±6.4; group 3: 27.7±5.0, p=0.293). HDP women with LVM and DD (group 3) were more likely to be admitted to high dependency unit (35.4%) than women in group 2 and 1 (14.5% and 23.6%, respectively, p=0.019).
Conclusions
Abnormal echocardiographic findings were associated with a worse maternal cardiovascular phenotype that required a closer maternal cardiovascular monitoring in the peripartum period.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).
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Affiliation(s)
- V Giorgione
- St George's University of London, London, United Kingdom
| | - J O'Driscoll
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - C Di Fabrizio
- St George's University of London, London, United Kingdom
| | - A Frick
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - M Cauldwell
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - A Khalil
- St George's University of London, London, United Kingdom
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Giorgione V, O'Driscoll J, Di Fabrizio C, Frick A, Cauldwell M, Khalil A, Thilaganathan B. Strain analysis by two-dimensional speckle tracking echocardiography for evaluating left ventricular systolic function in women with pre-eclampsia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2310] [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
Previous echocardiographic studies have shown that most women affected by pre-eclampsia present with mild-to moderate diastolic dysfunction and left ventricle remodelling with a preserved systolic function. These alterations appear more severe when pre-eclampsia develops before 34 weeks of gestation.
Purpose
The aim of this study is to compare left ventricular systolic (LV) function by using 2-D speckle tracking echocardiography in women with early-onset and late-onset pre-eclampsia.
Methods
In this single-centre prospective longitudinal study, 119 women with a diagnosis of pre-eclampsia underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. LV function was assessed using two-dimensional speckle-tracking strain imaging on 4-chamber views with a frame rate of 60–90 frames/second. Strain analysis quantification was performed using a commercial software.
Results
Pre-eclampsia was diagnosed before and after 34 weeks in 37.3% (44/119) and 62.7% (74/119) of the patients, respectively. Maternal characteristics, such as maternal age, body mass index, pre-existing hypertension and nulliparity, did not show any significant difference between the two groups. Although LV remodelling/hypertrophy and diastolic dysfunction occurred more often in early-onset pre-eclampsia compared to late-onset (65.9% vs 60.8% and 59.1% vs 51.4%, respectively), this difference was not statistically significant (p=0.580 and p=0.414, respectively). Similarly, LV mass index was 80.1±16.3 in pre-eclampsia <34 and 79.1±15 >34 (p=0.715) and E/e' was 7.8±1.9 and 7.6±1.7 (p=0.424). However, global longitudinal strain (GLS) was significantly lower (−16.4±2.4 vs −17.6±2.4, p=0.030) and apical rotation was higher (11.1±5.9 vs 8.7±4.7, p=0.019) in early-onset pre-eclampsia. A positive weak correlation has been found between GLS and difference in days from pre-eclampsia diagnosis to delivery (r=0.2, p=0.002).
Conclusions
Lower GLS in women affected by early-onset pre-eclampsia compared to late-onset pre-eclampsia might be useful to detect sub-clinical LV systolic impairment. Although further studies are needed, this sensitive marker may have a role in identifying women at risk of preterm delivery and/or severe maternal morbidity in the peripartum period.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).
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Affiliation(s)
- V Giorgione
- St George's University of London, London, United Kingdom
| | - J O'Driscoll
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - C Di Fabrizio
- St George's University of London, London, United Kingdom
| | - A Frick
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - M Cauldwell
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - A Khalil
- St George's University of London, London, United Kingdom
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Baumeister RGH, Wallmichrath J, Weiss M, Baumeister SHC, Frick A. MICROSURGICAL LYMPHATIC VASCULAR GRAFTING AND SECONDARY LIPOSUCTION: RESULTS OF COMBINATION TREATMENT IN SECONDARY LYMPHEDEMA. Lymphology 2020. [DOI: 10.2458/lymph.4653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical treatment of lymphedema with liposuction typically requires subsequent compression therapy. Here we describe an approach where secondary arm lymphedemas are initially treated by autologous lymphatic grafting to bypass the axilla and restore lymphatic flow. In the presence of excess adipose tissue, liposuction is then performed in a second procedure. To assess outcomes, the authors evaluated 28 consecutive adult patients who had undergone secondary liposuction following lymphatic grafting. Arm volumes were measured prior to lymphatic grafting and after the secondary liposuction. The necessity for additional treatment by compression garment and manual lymphatic drainage was assessed prior to lymphatic grafting and after the secondary liposuction following the direct postoperative regimen. The mean arm volumes were reduced significantly (p<0.001) from a mean of 3417±171 (SEM) cm3 prior to lymphatic grafting to 3020±125 cm3 after reconstruction of the lymphatic vascular system and finally to 2516±104 cm3 after the secondary liposuction (SLS). All 28 adult patients underwent continuous compression and manual lymph-drainage (MLD) prior to the reconstructive surgery. All 28 patients were evaluated regarding necessity of any additional therapy more than 6 months after SLS with a median follow up period of 37 months (range, 7-160 months). 18 of 28 patients did not require any supportive therapy beyond 6 months after SLS to maintain the results. Three patients continued to utilize manual lymphatic drainage, 4 used a combination of MLD and compression therapy and 3 used elastic compression therapy (one patient only while at work). These results indicate that microsurgical restoration of lymphatic outflow followed by SLS eliminates the need for additional treatment in more than two thirds of patients.
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Benazzo A, Schwarz S, Schweiger T, Frick A, Moser B, Matilla J, Lang G, Taghavi S, Jaksch P, Klepetko W, Hoetzenecker K. Respiratory Failure Treated by ECLS in Previously Unscreened Patients - Is Lung Transplantation Feasible? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.458] [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: 12/01/2022] Open
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Hartwig M, Loor G, Bottiger B, Warnecke G, Sommer W, Frick A, Neyrinck A, Villavicencio-Theoduloz M, Drezek K, Daoud D, Wei Q, Huddleston S, Landeweer M, Toyoda Y, Kashem M, Chandrashekaran S, Machuca T, Plascencia R, Smith M, Van Raemdonck D. Effect of Time of Intraoperative Circulatory Support on Incidence of High-Grade Primary Graft Dysfunction (PGD): Multicenter Analysis on Use of Extracorporeal Life Support (ECLS) during Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.346] [Citation(s) in RCA: 1] [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: 11/24/2022] Open
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9
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Benazzo A, Schwarz S, Schweiger T, Frick A, Muraközy G, Lambers C, Moser B, Matilla J, Lang G, Taghavi S, Klepetko W, Hoetzenecker K, Jaksch P. Outcome of Extracorporeal Photopheresis as Add-On Therapy in Patients for Antibody-Mediated Rejection after Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1303] [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] Open
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Frick A, Kifjak D, Taghavi S, Lang G, Moser B, Schwarz S, Benazzo A, Klepetko W, Jaksch P, Hoetzenecker K. Lung Transplantation for Acute Respiratory Distress Syndrome Patients: A Single Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.338] [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: 11/24/2022] Open
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Frick A, Kostiv V, Vojtassakova D, Akolekar R, Nicolaides KH. Comparison of different methods of measuring angle of progression in prediction of labor outcome. Ultrasound Obstet Gynecol 2020; 55:391-400. [PMID: 31692170 DOI: 10.1002/uog.21913] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/01/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES First, to compare the manual sagittal and parasagittal and automated parasagittal methods of measuring the angle of progression (AoP) by transperineal ultrasound during labor, and, second, to develop models for the prediction of time to delivery and need for Cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor. METHODS This was a prospective observational study of transperineal ultrasound in a cohort of 512 women with a singleton pregnancy undergoing induction of labor. A random selection of 50 stored images was assessed for inter- and intraobserver reliability of AoP measurements using the manual sagittal and parasagittal and automated parasagittal methods. In cases of vaginal delivery, univariate linear, multiple linear and quantile regression analyses were performed to predict time to delivery. Univariate and multivariate binomial logistic regression analyses were performed to predict CS for FTP in the first stage of labor. RESULTS The intraclass correlation coefficient (ICC) for the manual parasagittal method for a single observer was 0.97 (95% CI, 0.95-0.98) and for two observers it was 0.96 (95% CI, 0.93-0.98), indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (95% CI, 0.88-0.96) and for two observers it was 0.74 (95% CI, 0.58-0.84), indicating moderate reliability for a single observer and poor reliability between two observers. Bland-Altman analysis demonstrated narrower limits of agreement for the manual parasagittal approach than for the sagittal approach for both a single and two observers. The automated parasagittal method failed to capture an image in 19% of cases. The mean difference in AoP measurements between the sagittal and manual parasagittal methods was 11°. In pregnancies resulting in vaginal delivery, 54% of the variation in time to delivery was explained in a model combining parity, epidural and syntocinon use during labor and the sonographic findings of fetal head position and AoP. In the prediction of CS for FTP in the first stage of labor, a model which combined maternal factors with the sonographic measurements of AoP and estimated fetal weight was superior to one utilizing maternal factors alone (area under the receiver-operating-characteristics curve, 0.80 vs 0.76). CONCLUSIONS First, the method of measuring AoP with the greatest reliability is the manual parasagittal technique and future research should focus on this technique. Second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings. Third, the ability of AoP to provide clinically useful prediction of CS for FTP in the first stage of labor is limited. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Frick
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - V Kostiv
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - D Vojtassakova
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Baumeister RGH, Wallmichrath J, Weiss M, Baumeister SHC, Frick A. Microsurgical lymphatic vascular grafting and secondary liposuction: Results of combination treatment in secondary lymphedema. Lymphology 2020; 53:38-47. [PMID: 32521129] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Surgical treatment of lymphedema with liposuction typically requires subsequent compression therapy. Here we describe an approach where secondary arm lymphedemas are initially treated by autologous lymphatic grafting to bypass the axilla and restore lymphatic flow. In the presence of excess adipose tissue, liposuction is then performed in a second procedure. To assess outcomes, the authors evaluated 28 consecutive adult patients who had undergone secondary liposuction following lymphatic grafting. Arm volumes were measured prior to lymphatic grafting and after the secondary liposuction. The necessity for additional treatment by compression garment and manual lymphatic drainage was assessed prior to lymphatic grafting and after the secondary liposuction following the direct postoperative regimen. The mean arm volumes were reduced significantly (p<0.001) from a mean of 3417± 171 (SEM) cm3 prior to lymphatic grafting to 3020±125 cm3 after reconstruction of the lymphatic vascular system and finally to 2516±104 cm3 after the secondary liposuction (SLS). All 28 adult patients underwent continuous compression and manual lymph-drainage (MLD) prior to the reconstructive surgery. All 28 patients were evaluated regarding necessity of any additional therapy more than 6 months after SLS with a median follow up period of 37 months (range, 7-160 months). 18 of 28 patients did not require any supportive therapy beyond 6 months after SLS to maintain the results. Three patients continued to utilize manual lymphatic drainage, 4 used a combination of MLD and compression therapy and 3 used elastic compression therapy (one patient only while at work). These results indicate that microsurgical restoration of lymphatic outflow followed by SLS eliminates the need for additional treatment in more than two thirds of patients.
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Affiliation(s)
- R G H Baumeister
- Consultant in Lymphology and Microsurgery Chirurgische Klinik Muenchen Bogenhausen and Urologische Klinik Muenchen Planegg, Munich
| | - J Wallmichrath
- Former Head of the Division of Plastic-, Hand- and Microsurgery, Department of Surgery, Campus Grosshadern, Ludwig-Maximilians University, Munich
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - M Weiss
- Department of Nuclear Medicine, University Hospital, LMU Munich, Germany
| | - S H C Baumeister
- Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - A Frick
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Rodó C, Suy A, Sulleiro E, Soriano-Arandes A, Maiz N, García-Ruiz I, Arévalo S, Rando A, Anton A, Vázquez Méndez É, Garrido M, Frick A, Rodrigo C, Pumarola T, Carreras E. Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study. Clin Microbiol Infect 2019; 25:633.e5-633.e9. [PMID: 30771526 DOI: 10.1016/j.cmi.2019.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/06/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region. METHODS According to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained. RESULTS Seventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1-64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50-80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies. CONCLUSION The prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.
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Affiliation(s)
- C Rodó
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - A Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Sulleiro
- Department of Microbiology, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Soriano-Arandes
- Tropical Medicine and International Health Unit, Hospital Universitari Vall d'Hebron, Barcelona, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain; Pediatric Infectious Diseases and Immunodeficiences Unit, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I García-Ruiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Arévalo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Rando
- Department of Microbiology, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Anton
- Department of Microbiology, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - É Vázquez Méndez
- Department of Paediatric Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Garrido
- Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Frick
- Tropical Medicine and International Health Unit, Hospital Universitari Vall d'Hebron, Barcelona, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain; Pediatric Infectious Diseases and Immunodeficiences Unit, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Rodrigo
- Pediatric Infectious Diseases and Immunodeficiences Unit, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Pumarola
- Department of Microbiology, Hospital Universitari Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vos R, Van Herck A, Vanaudenaerde B, Verleden S, Van Raemdonck D, Frick A, Neyrinck A, Verleden G. A Prospective, Randomized, Placebo-controlled Trial of Pre-transplant and Prompt Post-transplant Treatment With Azithromycin to Improve Early Allograft Function and Outcome After Lung Transplantation (NCT01915082). J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.203] [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: 10/17/2022] Open
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Landrock S, Wallmichrath J, Baumeister RGH, Bartenstein P, Frick A, Weiss M. The clinical yield of SPECT/CT for the assessment of lymphatic transport disorders. Nuklearmedizin 2018; 52:235-43. [DOI: 10.3413/nukmed-0587-13-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/12/2013] [Indexed: 11/20/2022]
Abstract
ZusammenfassungZiel dieser Studie war zu untersuchen, ob die zusätzliche Bildgebung mittels SPECT/CTTechnik den diagnostischen Wert der planaren Lymphszintigraphie bei Patienten mit Lymphtransportstörungen verbessern kann. Patienten, Methoden: Über einen festgelegten Zeitraum von zwei Jahren wurden 36 konsekutive Patienten (27 Frauen, 9 Männer, Alter 27–87 Jahre) in unsere Studie eingeschlossen. Zusätzlich zur planaren Lymphszintigraphie wurden weitere ergänzende SPECT/CT-Akquisitionen der betroffenen Extremitäten oder des Körperstamms durchgeführt. Insgesamt erfolgte eine prospektive Auswertung von 48 anatomischen Lymphabflussregionen mittels planarer Szintigraphie und tomographischer SPECT/CT. Ergebnisse: In 28/48 Fällen (58%) brachte die SPECT/CTBildgebung klinisch relevante Zusatzinformationen im Vergleich zur planaren Technik; darunter 27 bezüglich der exakten anatomischen Lokalisation der Transportstörungen sowie 8 Fälle, bei denen die Ausdehnung der lymphogenen Störung mittels SPECT/CT ausgedehnter beurteilt wurde als in der alleinigen planaren Szintigraphie. In 3 Fällen konnte durch die SPECT/CT differenzialdiagnostisch zwischen Lymphknoten versus Lymphozele differenziert werden. In keinem der Fälle konnten Lymphgefäße/-transplantate durch die morphologische CT-Komponente dargestellt werden. Schlussfolgerungen: Die zusätzlich zur planaren Lymphszintigraphie durchgeführte SPECT/CT präzisiert die anatomische Zuordnung lymphogen bedingter Transportstörungen und somit die Abschätzung der Ausdehnung der Pathologie. Des Weiteren löst sie Überlagerungseffekte anatomischer Strukturen durch die tomographische Akquisition auf und ermöglicht die Differenzialdiagnose von Lymphknoten versus Lymphozelen.
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O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, Dutemeyer V, Fiolna M, Frick A, Karagiotis N, Mastrodima S, de Paco Matallana C, Papaioannou G, Pazos A, Plasencia W, Nicolaides KH. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49:756-760. [PMID: 28295782 DOI: 10.1002/uog.17455] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [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: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To compare the performance of screening for pre-eclampsia (PE) based on risk factors from medical history, as recommended by NICE and ACOG, with the method proposed by The Fetal Medicine Foundation (FMF), which uses Bayes' theorem to combine the a-priori risk from maternal factors, derived by a multivariable logistic model, with the results of various combinations of biophysical and biochemical measurements. METHODS This was a prospective multicenter study of screening for PE in 8775 singleton pregnancies at 11-13 weeks' gestation. A previously published FMF algorithm was used for the calculation of patient-specific risk of PE in each individual. The detection rates (DRs) and false-positive rates (FPRs) for delivery with PE < 32, < 37 and ≥ 37 weeks were estimated and compared with those derived from application of NICE guidelines and ACOG recommendations. According to NICE, all high-risk pregnancies should be offered low-dose aspirin. According to ACOG, use of aspirin should be reserved for women with a history of PE in at least two previous pregnancies or PE requiring delivery < 34 weeks' gestation. RESULTS In the study population, 239 (2.7%) cases developed PE, of which 17 (0.2%), 59 (0.7%) and 180 (2.1%) developed PE < 32, < 37 and ≥ 37 weeks, respectively. Screening with use of the FMF algorithm based on a combination of maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) detected 100% (95% CI, 80-100%) of PE < 32 weeks, 75% (95% CI, 62-85%) of PE < 37 weeks and 43% (95% CI, 35-50%) of PE ≥ 37 weeks, at a 10.0% FPR. Screening with use of NICE guidelines detected 41% (95% CI, 18-67%) of PE < 32 weeks, 39% (95% CI, 27-53%) of PE < 37 weeks and 34% (95% CI, 27-41%) of PE ≥ 37 weeks, at 10.2% FPR. Screening with use of ACOG recommendations detected 94% (95% CI, 71-100%) of PE < 32 weeks, 90% (95% CI, 79-96%) of PE < 37 weeks and 89% (95% CI, 84-94%) of PE ≥ 37 weeks, at 64.2% FPR. Screening based on the ACOG recommendations for use of aspirin detected 6% (95% CI, 1-27%) of PE < 32 weeks, 5% (95% CI, 2-14%) of PE < 37 weeks and 2% (95% CI, 0.3-5%) of PE ≥ 37 weeks, at 0.2% FPR. CONCLUSION Performance of screening for PE at 11-13 weeks' gestation by the FMF algorithm using a combination of maternal factors, MAP, UtA-PI and PlGF, is by far superior to the methods recommended by NICE and ACOG. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N O'Gorman
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - L C Poon
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
- Chinese University of Hong Kong, Hong Kong, China
| | - D L Rolnik
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
| | - A Syngelaki
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
| | - M de Alvarado
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
- Homerton University Hospital, London, UK
| | | | - V Dutemeyer
- Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Fiolna
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
- Medway Maritime Hospital, Gillingham, UK
| | - A Frick
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
- Lewisham University Hospital, London, UK
| | - N Karagiotis
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
| | - S Mastrodima
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
- North Middlesex University Hospital, London, UK
| | | | | | - A Pazos
- Hospital Universitario San Cecilio, Granada, Spain
| | - W Plasencia
- Hospiten Group, Tenerife, Canary Islands, Spain
| | - K H Nicolaides
- Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK
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Frick A, Åhs F, Palmquist ÅM, Pissiota A, Wallenquist U, Fernandez M, Jonasson M, Appel L, Frans Ö, Lubberink M, Furmark T, von Knorring L, Fredrikson M. Overlapping expression of serotonin transporters and neurokinin-1 receptors in posttraumatic stress disorder: a multi-tracer PET study. Mol Psychiatry 2016; 21:1400-7. [PMID: 26619809 DOI: 10.1038/mp.2015.180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/10/2015] [Accepted: 10/06/2015] [Indexed: 02/07/2023]
Abstract
The brain serotonergic system is colocalized and interacts with the neuropeptidergic substance P/neurokinin-1 (SP/NK1) system. Both these neurochemical systems have independently been implicated in stress and anxiety, but interactions between them might be crucial for human anxiety conditions. Here, we examined the serotonin and substance P/neurokinin-1 (SP/NK1) systems individually as well as their overlapping expression in 16 patients with posttraumatic stress disorder (PTSD) and 16 healthy controls. Participants were imaged with the highly selective radiotracers [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile (DASB) and [(11)C]GR205171 assessing serotonin transporter (SERT) and NK1 receptor availability, respectively. Voxel-wise analyses in the amygdala, our a priori-defined region of interest, revealed increased number of NK1 receptors, but not SERT in the PTSD group. Symptom severity, as indexed by the Clinician-administered PTSD Scale, was negatively related to SERT availability in the amygdala, and NK1 receptor levels moderated this relationship. Exploratory, voxel-wise whole-brain analyses revealed increased SERT availability in the precentral gyrus and posterior cingulate cortex of PTSD patients. Patients, relative to controls, displayed lower degree of overlapping expression between SERT and NK1 receptors in the putamen, thalamus, insula and lateral orbitofrontal gyrus, lower overlap being associated with higher PTSD symptom severity. Expression overlap also explained more of the symptomatology than did either system individually, underscoring the importance of taking interactions between the neurochemical systems into account. Thus, our results suggest that aberrant serotonergic-SP/NK1 couplings contribute to the pathophysiology of PTSD and, consequently, that normalization of these couplings may be therapeutically important.
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Affiliation(s)
- A Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - F Åhs
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Å M Palmquist
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - A Pissiota
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - U Wallenquist
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - M Fernandez
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - M Jonasson
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - L Appel
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Ö Frans
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - M Lubberink
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - T Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - L von Knorring
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - M Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Månsson KNT, Salami A, Frick A, Carlbring P, Andersson G, Furmark T, Boraxbekk CJ. Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder. Transl Psychiatry 2016; 6:e727. [PMID: 26836415 PMCID: PMC4872422 DOI: 10.1038/tp.2015.218] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/15/2015] [Accepted: 12/02/2015] [Indexed: 01/25/2023] Open
Abstract
Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain's adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure-function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood-oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected P(FWE) = 0.02) and BOLD responsivity (P(FWE) = 0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (P(FWE)=0.04), and CBT-induced reduction of amygdala GM volume (pre-post) correlated positively with reduced anticipatory anxiety after treatment (P(FWE) ⩽ 0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (P(FWE) = 0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.
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Affiliation(s)
- K N T Månsson
- Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Adult Psychiatry, PRIMA Barn och Vuxenpsykiatri, Stockholm, Sweden,Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping SE-581 83, Sweden. E-mail:
| | - A Salami
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - A Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - P Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - G Andersson
- Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - T Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - C-J Boraxbekk
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden,CEDAR, Center for Demographic and Aging Research, Umeå University, Umeå, Sweden
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Weiss MF, Baumeister RGH, Zacherl MJ, Frick A, Bartenstein P, Rominger A. [Microsurgical Autologous Lymph Vessel Transplantation: Does Harvesting Lymphatic Vessel Grafts Induce Lymphatic Transport Disturbances in the Donor Limb?]. HANDCHIR MIKROCHIR P 2015; 47:359-64. [PMID: 26562009 DOI: 10.1055/s-0035-1565122] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether the extirpation of lymphatic vessels induces lymphatic transport disturbances in the donor limb of patients following the harvest of lymph vessel grafts. PATIENTS, MATERIAL AND METHODS A total of 19 consecutive patients (15 females, 4 males; mean age 51.5 years, range 21.8-72.3) were examined by lymphoscintigraphy before and after surgery. The patients had previously been diagnosed with upper or lower limb lymphoedema in accordance with the criteria of the International Society of Lymphology, and autologous lymph vessel transplantation had been intended for treatment. Since only patients with normal scintigraphic tests at the harvesting site were considered for treatment, all consecutive patients (n=19) had normal scintigraphic tests of the donor limb prior to surgery. In order to quantify the visual scintigraphic findings, a well established numeric transport index (TI) was used, which combined 5 visual parameters of transport kinetics. To that end, the following visually assessed criteria were evaluated: temporal and spatial kinetics, radiopharmaceutical distribution pattern, time to appearance of inguinal lymph nodes, qualitative visualisation of lymph nodes and lymph vessels. RESULTS All patients underwent a preoperative scintigraphic baseline study and a postoperative scintigraphic follow-up after autologous lymphatic vessel grafting. The mean time period from the baseline study to the date of microsurgical lymph vessel transplantation was 3.5 months (median 2.5 months). The scintigraphic follow-up was performed 48.6 months (median 57.8 months) following transplantation. In all patients the postoperative TI was very close to the TI calculated in the preoperative baseline scintigraphy, and all TIs were within the normal range (TI<10). The absolute value of deviation of pre- vs. post-operative transport indices was calculated to be 0.2 on average (maximum 0.4). CONCLUSIONS The results show that microsurgical transfer of lymph vessel grafts is possible without compromising lymphatic drainage of the donor limb if safety precautions are taken into account.
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Affiliation(s)
- M F Weiss
- Nuklearmedizin, Universität München, München
| | - R G H Baumeister
- Konsiliarius für Lymphologie und rekonstruktive Mikrochirurgie, Chirurgische Klinik München-Bogenhausen
| | - M J Zacherl
- Nuklearmedizin, Universität München, München
| | - A Frick
- Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Universität München (LMU), München
| | | | - A Rominger
- Nuklearmedizin, Universität München, München
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Weiss M, Schwarz F, Wallmichrath J, Baumeister R, Frick A, Bartenstein P, Rominger A. Chylothorax and chylous ascites. Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CT. Nuklearmedizin 2015; 54:231-40. [PMID: 26183818 DOI: 10.3413/nukmed-0723-15-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 02/06/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/CT-technique improves upon the diagnostic value of planar lymphoscintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders. PATIENTS, MATERIAL, METHODS From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECT-technique (n = 2). RESULTS Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%. CONCLUSIONS Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.
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Affiliation(s)
- M Weiss
- Mayo Weiss MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr.15, 81377 Muenchen, Germany, Tel. +49/(0)89/440 07 76 38, E-mail:
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Frick A, Ahs F, Linnman C, Jonasson M, Appel L, Lubberink M, Långström B, Fredrikson M, Furmark T. Increased neurokinin-1 receptor availability in the amygdala in social anxiety disorder: a positron emission tomography study with [11C]GR205171. Transl Psychiatry 2015; 5:e597. [PMID: 26151925 PMCID: PMC5068728 DOI: 10.1038/tp.2015.92] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/29/2015] [Accepted: 06/01/2015] [Indexed: 12/11/2022] Open
Abstract
The neurokinin-1 (NK1) receptor is abundantly expressed in the fear circuitry of the brain, including the amygdala, where it modulates stress and anxiety. Despite its proposed involvement in psychopathology, only a few studies of NK1 receptor availability in human subjects with anxiety disorders exist. Here, we compared NK1 receptor availability in patients with social anxiety disorder (SAD; n = 17) and healthy controls (n = 17) using positron emission tomography and the radiotracer [11C]GR205171. The Patlak Graphical plot using a cerebellar reference region was used to model the influx parameter, Ki measuring NK1 receptor availability. Voxel-wise statistical parametric mapping analyses revealed increased NK1 receptor availability specifically in the right amygdala in SAD patients relative to controls. Thus, we demonstrate that exaggerated social anxiety is related to enhanced NK1 receptor availability in the amygdala. This finding supports the contribution of NK1 receptors not only in animal models of stress and anxiety but also in humans with anxiety disorders.
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Affiliation(s)
- A Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden,Department of Psychology, Uppsala University, Box 1225, SE-751 42 Uppsala, Sweden. E-mail:
| | - F Ahs
- Department of Psychology, Uppsala University, Uppsala, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - C Linnman
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Jonasson
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - L Appel
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - M Lubberink
- Department of Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - B Långström
- Department of Chemistry, Uppsala University, Uppsala, Sweden
| | - M Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - T Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Weiss M, Burgard C, Baumeister R, Strobl F, Rominger A, Bartenstein P, Wallmichrath J, Frick A, Notohamiprodjo M. Magnetic resonance imaging versus lymphoscintigraphy for the assessment of focal lymphatic transport disorders of the lower limb: first experiences. Nuklearmedizin 2014; 53:190-6. [PMID: 24999013 DOI: 10.3413/nukmed-0649-14-03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 03/12/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of magnetic resonance imaging (MR-lymphangiography) and lymphoscintigraphy for assessment of focal lesions of the peripheral lymphatic system. Patients with focal lymphatic transport disorders might benefit from surgi-cal interventions. PATIENTS, METHODS We examined by lymphoscintigraphy and MR-lymphangiography a total of 85 lower limbs in 46 consecutive patients (33 women; mean age 41 years; range 9-79 years) presenting with uni- or bilateral lymphedema. MR-lymphangiographies were obtained at isotropic sub-millimeter resolution with a 3.0 Tesla magnet after injection of gadolinium contrast medium. MR-lymphangiography was reviewed by radiologists, whereas lymphoscintigraphy was reviewed by nuclear medicine physicians. The images were examined for localization and distribution of any focal lesions of the lymphatic vessel system. Diagnostic accuracy of the MR-approach was calculated relative to the lymphoscintigraphy gold standard. RESULTS There was substantial correlation of results by the two modalities (κ = 0.62). MR-lymphangiography had sensitivity of 68%, specificity of 91%, positive predictive value of 82%, and negative predictive value of 83%. CONCLUSIONS Imaging findings of both lymphoscintigraphy and MR-lymphangiography showed good diagnostic accuracy. MR-lymphangiography proved more information about anatomic location of focal lesions of the lymphatic vessels, but use of MR-lymphangiography is currently constrained due to the requirement for off-label subcutaneous injection of gadolinium chelates. Consequently, and due to its superior sensitivity lymphoscintigraphy remains the most common imaging method to assess functional lymphatic disorders of the lower limb.
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Affiliation(s)
- M Weiss
- Mayo Weiss MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr.15, 81377 Muenchen, Germany, Tel. +49/(0)89/70 95 76 38, E-mail:
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Wallmichrath J, Knab R, Baumeister R, Volkmer E, Giunta R, Frick A. Protective effects of antithrombin on free groin flaps after secondary venous stasis in the rat model. J Plast Reconstr Aesthet Surg 2014; 67:707-11. [DOI: 10.1016/j.bjps.2014.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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Frick A, Tanneberger F, Bellebaum J. Model-based selection of areas for the restoration of Acrocephalus paludicola habitats in NE Germany. Environ Manage 2014; 53:728-738. [PMID: 24446053 DOI: 10.1007/s00267-014-0234-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/08/2014] [Indexed: 06/03/2023]
Abstract
The global Aquatic Warbler (Acrocephalus paludicola, Vieillot, 1817) population has suffered a major decline due to the large-scale destruction of its natural habitat (fen mires). The species is at risk of extinction, especially in NE Germany/NW Poland. In this study, we developed habitat suitability models based on satellite and environmental data to identify potential areas for habitat restoration on which further surveys and planning should be focused. To create a reliable model, we used all Aquatic Warbler presences in the study area since 1990 as well as additional potentially suitable habitats identified in the field. We combined the presence/absence regression tree algorithm Cubist with the presence-only algorithm Maxent since both commonly outperform other algorithms. To integrate the separate model results, we present a new way to create a metamodel using the initial model results as variables. Additionally, a histogram approach was applied to further reduce the final search area to the most promising sites. Accuracy increased when using both remote sensing and environmental data. It was highest for the integrated metamodel (Cohen's Kappa of 0.4, P < 0.001). The final result of this study supports the selection of the most promising sites for Aquatic Warbler habitat restoration.
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Affiliation(s)
- Annett Frick
- LUP, Große Weinmeisterstraße 3a, 14469, Potsdam, Germany,
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Wallmichrath J, Knab R, Baumeister RGH, Holzbach T, Giunta RE, Frick A. Protective effects of activated protein C (APC) on free groin flaps after secondary venous stasis in the rat model. Clin Hemorheol Microcirc 2013; 59:335-43. [PMID: 24254581 DOI: 10.3233/ch-131803] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goal of this study was to determine whether the focused delivery of APC by rinsing of free adipocutaneous groin flaps shows protective effects on flap survival following a fatal secondary venous stasis in a rat model. METHODS 36 Sprague Dawley rats were randomized to three groups and free microvascular groin flaps were transplanted to the neck in each animal. 20 hours postoperatively the flap pedicle was re-explored and the distal stump of the flap artery was catheterised. Animals in group I (n = 12) remained untreated, whereas animals of group II were treated with 1 ml of Ringer's solution. Those in group III received 1 ml of APC (2 mg/kg). Afterwards the flap vein was clamped for 35 minutes. The skin of the flaps and the native contralateral groin was examined by intravital video microscopy using FITC-Dextran and CFDA-SE-labelled thrombocytes. RESULTS APC-pretreatment significantly increased the functional capillary density (FCD) of the flaps. Flap viability was 8% in group I (n = 1/12), 9% in group II (n = 1/11) and 60% in group III (n = 6/10), respectively. No partial flap loss was detected. CONCLUSIONS The focused delivery of APC resulted in significantly improved flap salvage.
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Affiliation(s)
- J Wallmichrath
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - R Knab
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - R G H Baumeister
- Consultant for Lymphology of the Surgical Clinic Munich Bogenhausen, Munich, Germany
| | - T Holzbach
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - R E Giunta
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - A Frick
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Wallmichrath J, Baumeister RGH, Gottschalk O, Giunta RE, Frick A. The free groin flap in the rat: a model for improving microsurgical skills and for microvascular perfusion studies. J Plast Surg Hand Surg 2013; 48:191-6. [DOI: 10.3109/2000656x.2013.852100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wallmichrath J, Birk C, Baumeister RGH, Engelhardt TO, Giunta RE, Frick A. Examination of the protective effects of heparin and recombinant tissue plasminogen activator (rtPA) in compromised adipocutaneous free flaps in the rat model using intravital video microscopy. Clin Hemorheol Microcirc 2013; 59:185-95. [PMID: 23813482 DOI: 10.3233/ch-131756] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the focused delivery of heparin or recombinant tissue plasminogen activator (rtPA) by rinsing accords protective effects which increases the survival of free groin flaps following fatal secondary venous stasis. METHODS Free microvascular groin flaps (n = 40) were transplanted to the necks of adult Sprague-Dawley rats 20 hours before the experiment. The study groups (each n = 10 animals) were: No adjunctive treatment (Group I), Ringer's solution (Group II), heparin solution (100 IU/kg, group III) and rtPA (2 mg/kg, group IV), respectively. The flap vein was then clamped for 35 minutes. Intravital video microscopy was applied and flap viability was assessed 14 days later. RESULTS Mean flap necrosis was 90% in group I and II, whereas the rate of flap survival was 80% in group III and 60% in group IV, respectively. CONCLUSIONS Even though clinical and microvascular flap perfusion parameters in both the rtPA-group and heparin group were initially similar, it has been demonstrated here in our investigations that the flaps treated with heparin showed a higher viability rate. Therefore, we can conclude that the focused delivery of heparin and rtPA resulted in a significantly improved flap salvage.
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Affiliation(s)
- J Wallmichrath
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | - C Birk
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | - R G H Baumeister
- Consultant for Lymphology of the Surgical Clinic Munich Bogenhausen, Munich, Germany
| | - T O Engelhardt
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | - R E Giunta
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | - A Frick
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
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Zerbe S, Steffenhagen P, Parakenings K, Timmermann T, Frick A, Gelbrecht J, Zak D. Ecosystem service restoration after 10 years of rewetting peatlands in NE Germany. Environ Manage 2013; 51:1194-1209. [PMID: 23636204 DOI: 10.1007/s00267-013-0048-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
The restoration of ecosystem services, i.e., production, regulation, and information, is a global challenge, which the federal state of Mecklenburg-Vorpommern in NE Germany addressed in 2000 by rewetting over 20,000 ha of degraded peatlands within the Mire Restoration Program. We evaluated ecosystem services in 23 rewetted sites by assessing the following mire parameters within a ten year period: (a) dominant vegetation at the ecosystem level, (b) peat formation potential at the landscape level, and (c) aboveground biomass and nutrient levels. Seven to 10 years after rewetting, the wetlands formed a mosaic of vegetation types with the highest potential for peat formation and several dominant, peat-forming species accumulated high levels of aboveground biomass and nutrients (C, N, P). Common reed (Phragmites australis) accumulated the most biomass (up to 24 t dry matter/ha), and N+P during the growing season. A future management option is to annually harvest aquatic and wetland plants to reduce nutrient levels in restored mire ecosystems.
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Affiliation(s)
- Stefan Zerbe
- Faculty of Science and Technology, Free University of Bozen-Bolzano, Piazza Università 5, 39100 Bozen, Italy.
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Wallmichrath J, Baumeister R, Giunta R, Notohamiprodjo M, Frick A. Die Vielfalt in der chirurgischen Therapie beim Lymphödem – was ist aktuell? HANDCHIR MIKROCHIR P 2012; 44:334-42. [DOI: 10.1055/s-0032-1323840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - R. Baumeister
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
| | - R. Giunta
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
| | - M. Notohamiprodjo
- Institut für Klinische Radiologie, alle Klinikum der Ludwig-Maximilians-Universität, München
| | - A. Frick
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie
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Frick A, Eriksson UK, van Oostrum J, Neutze R, de Grip W, Törnroth-Horsefield S. Nearly there: the structure of human aquaporin 2. Acta Crystallogr A 2012. [DOI: 10.1107/s010876731209695x] [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] Open
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Wallmichrath J, Baumeister R, Herrler T, Greiner A, Pieske O, Giunta R, Frick A. Experimental study on the microsurgical or spontaneous formation of lympho-lymphonodular anastomoses in the rat model. J Plast Reconstr Aesthet Surg 2012; 65:494-500. [DOI: 10.1016/j.bjps.2011.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/15/2011] [Accepted: 11/08/2011] [Indexed: 11/30/2022]
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Spanholtz T, Holzbach T, Wallmichrath J, Pototschnig A, Deglmann C, Frick A, Giunta R. Die Behandlung der Dupuytrenschen Kontraktur mittels Kollagenase- Erste klinische Erfahrungen *. HANDCHIR MIKROCHIR P 2011; 43:275-80. [DOI: 10.1055/s-0031-1286323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kaempfen A, Daigeler A, Largo R, Bader R, Arkudas A, Bleiziffer O, Frank J, Frick A, Huemer G, Kneser U, Scherrer D, Schwabegger A, Schaefer D, Pierer G, Hierner R. Bericht zum Workshop und Consensusmeeting zur Mikrochirurgischen Ausbildung an der 32ten Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) 2010 in Basel. HANDCHIR MIKROCHIR P 2011; 43:262-5. [DOI: 10.1055/s-0031-1284356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Springer S, Koller M, Baumeister RGH, Frick A. Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation. Lymphology 2011; 44:65-71. [PMID: 21949975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There are multiple treatment options for patients with chronic lymphedema, and one successful approach is lymph vessel transplantation. As quality of life assessments are frequently not utilized in standard treatment regimes, we investigated the change in quality of life for patients with chronic lymphedema (total = 212) who had undergone lymphatic vessel transplantation and conservative therapy for at least 6 months prior to operation. Quality of life was assessed by a modified standard questionnaire examining the physiological and psychological status of the patients. Results document a significant improvement in quality of life and underscore success of autologous lymphatic vessel transplantation as a therapy for lymphedema.
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Affiliation(s)
- S Springer
- Division of Plastic-, Hand- and Microsurgery, Department of Surgery, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Germany
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Robins Wahlin TB, Frick A, Wahlin Å, Byrne G. G06 Verbal learning and memory in preclinical Huntington's disease. J Neurol Neurosurg Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222646.6] [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: 11/04/2022]
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Frick A, Wahlin Å, Graff C, Byrne G, Robins Wahlin TB. G05 Memory for object locations in preclinical Huntington's disease. J Neurol Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222646.5] [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: 11/03/2022]
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Daigeler A, Kaempfen A, Beier JP, Arkudas A, Horch RE, Schaefer DJ, Frick A, Huemer GM. [Microsurgical training - report on the consensus workshop of the 31st annual meeting of the German-language group for microsurgery of the peripheral nerves and vessels 2009 in Erlangen]. HANDCHIR MIKROCHIR P 2010; 42:273-6. [PMID: 20603787 DOI: 10.1055/s-0030-1255061] [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: 10/19/2022] Open
Abstract
Based on the increasing importance of microsurgical procedures in the field of plastic and hand surgery, as well as in other related fields, a consensus workshop was held during the 31st annual meeting of the German-language working group for microsurgery of the nerves and vessels (DAM). The current state of microsurgical training and possible ways of optimisation were discussed. Furthermore, a trinational task force was established in order to develop quality criteria for a future certification of microsurgical training centres under the auspices of the DAM.
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Affiliation(s)
- A Daigeler
- Klinik für Plastische Chirurgie und Handchirurgie an der Rupprecht-Karls-Universität Heidelberg, BG-Unfallklinik Ludwigshafen, Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Ludwigshafen.
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Pytel A, Damasdi M, Frick A, Schmidt E, Zambo K, Farkas L. MP-05.05: Surgical Management of Low and Medium Risk Penile Cancers, with Isotope Guided Sentinel Lymphnode Biopsy Technic. Urology 2009. [DOI: 10.1016/j.urology.2009.07.1008] [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: 11/15/2022]
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Bruce D, Frick A, Rymer J, Robinson J, Ylikorkala O. A comparison of hormone therapies on the urinary excretion of prostacyclin and thromboxane A2. Climacteric 2009; 11:447-53. [DOI: 10.1080/13697130802387619] [Citation(s) in RCA: 2] [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: 10/21/2022]
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Förster M, Frick A, Walentowski H, Kleinschmit B. Approaches to utilising QuickBird data for the monitoring of NATURA 2000 habitats. COMMUNITY ECOL 2008. [DOI: 10.1556/comec.9.2008.2.4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Luque Moreno A, Duran Núñez A, Bergadà Masó A, Frick A, Gallés C. Osteomielitis aguda y neumonía comunitaria por Staphylococcus aureus resistente a meticilina. An Pediatr (Barc) 2008; 68:373-6. [DOI: 10.1157/13117710] [Citation(s) in RCA: 4] [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: 11/21/2022] Open
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Safidine Z, Fellahi S, Frick A. Crystallization behavior of PP/PP-g-MAH/GFR PA66 blends: Establishment of their continuous-cooling-transformation of relative crystallinity diagrams. J Appl Polym Sci 2007. [DOI: 10.1002/app.25768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
In the last eight years we performed 63 re-interventions because of recurrent carpal tunnel syndromes. Intact parts of the retinaculum were the reason for persistent symptoms in 38 patients. 21 patients suffered from scar tethering, two patients from circumferential fibrosis of the nerve. In one patient a ganglion and in another patient a direct injury to the median nerve was detected. In 21 patients short incisions were performed in the primary procedures. Since the introduction of endoscopic carpal tunnel release, an open decompression via a short incision is recommended as an alternative. Since then we encounter an increase of necessary operative revisions after short incisions. Optical tools may increase the survey especially in short incisions. In extended teno-synovialitis of the flexor tendons, a longer incision over the wrist enables adequate conditions for a safe teno-synovialectomy. The length of the incision has to be chosen according to the pathologic-anatomic situation, the disposable equipment and the experience of the surgeon.
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Affiliation(s)
- A Frick
- Plastische, Hand-, Mikrochirurgie, Chirurgische Klinik und Poliklinik-Grosshadern, Klinikum der Universität München, München.
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Wallmichrath J, Baumeister R, Frick A. Lympho-lymphonodular anastomoses, proof of patency by injection of patent blue dye – A study in the rat model. J Plast Reconstr Aesthet Surg 2006. [DOI: 10.1016/j.bjps.2006.03.033] [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: 11/16/2022]
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Baumeister RGH, Frick A. Kurz oder lang – ist das die Frage? Zur Problematik des Zugangswegs bei der Karpaldachspaltung. HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2004-862450] [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] Open
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Frick A, Hornung H, Baumeister RGH. Mikrochirurgie im Spannungsfeld von ambulantem Operieren und stationsersetzenden Eingriffen im Krankenhaus und vollpauschaliertem Entgeltsystem (Diagnosis-Related Groups – DRG). HANDCHIR MIKROCHIR P 2005. [DOI: 10.1055/s-2005-864864] [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] Open
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Bergemann N, Kress KR, Abu-Tair F, Frick A, Kopitz J. Increase in Plasma Concentrations of Amisulpride after Receiving Co-Medication with Lithium. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-862621] [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: 10/19/2022]
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Bergemann N, Kress KR, Abu-Tair F, Frick A, Kopitz J. Valproate Lowers Plasma Concentrations of Olanzapine. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-862622] [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: 10/19/2022]
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Bergemann N, Frick A, Kress KR, Kopitz J. Therapeutic drug monitoring data: No influence of amisulpride on clozapine plasma concentration. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825274] [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: 10/25/2022]
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Bergemann N, Kopitz J, Kress KR, Frick A. Plasma amisulpride levels in schizophrenia or schizoaffective disorder. Eur Neuropsychopharmacol 2004; 14:245-50. [PMID: 15056484 DOI: 10.1016/j.euroneuro.2003.09.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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] [Received: 11/12/2002] [Revised: 09/11/2003] [Accepted: 09/11/2003] [Indexed: 11/27/2022]
Abstract
The atypical antipsychotic drug amisulpride is a benzamide with specific antagonistic properties, which target dopamine D(2) and D(3) receptors, preferentially in the limbic system. Amisulpride is readily absorbed from the gastrointestinal tract, distributed to all body systems with little binding to plasma proteins. Elimination occurs mainly through the kidneys as unchanged drug. In contrast, hepatic metabolism is of minor significance and primarily yields two inactive metabolites. Very little is known about the plasma concentrations of amisulpride in patients at varying oral doses or about clinically relevant interactions with co-medication. The aim of the present investigation was to elucidate the factors, which affect amisulpride levels in schizophrenic patients. The plasma amisulpride levels of 85 patients with schizophrenia or schizoaffective disorder (mean age: 34.0+/-11.4 years; 40 women, 45 men) were assessed by high-performance liquid chromatography (HPLC) with fluorometric detection. The average daily dose of amisulpride was 772.3 mg (S.D. 346.7 mg) and the mean amisulpride plasma concentration was 424.4 ng/ml (S.D. 292.8 ng/ml). The interindividual variance of the amisulpride plasma concentration was high; furthermore, the plasma concentration increased linearly with the daily oral dose (r=0.50, p<0.001). Age and gender showed a significant effect on the dose-corrected amisulpride plasma concentrations-older patients and women had higher dose-corrected amisulpride plasma concentrations than younger patients and men. However, cigarette consumption had no effect on the amisulpride plasma concentrations. Regarding co-medication with lithium and/or clozapine, significantly higher amisulpride plasma concentrations were found as compared to monotherapy, whereas other co-medications such as benzodiazepines and various conventional antipsychotics had no effect on the amisulpride plasma concentrations. The results, the possible pathomechanisms and the clinical relevance are discussed. The findings need to be confirmed in larger patient samples and with a wider range of co-medications.
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Affiliation(s)
- N Bergemann
- Department of Psychiatry, University of Heidelberg, Voss-Str. 4, D-69115, Heidelberg, Germany.
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