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Gerwing M, Hoffmann E, Geyer C, Helfen A, Maus B, Schinner R, Wachsmuth L, Heindel W, Eisenblaetter M, Faber C, Wildgruber M. Intratumoral heterogeneity after targeted therapy in murine cancer models with differing degrees of malignancy. Transl Oncol 2023; 37:101773. [PMID: 37666208 PMCID: PMC10483060 DOI: 10.1016/j.tranon.2023.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Conventional morphologic and volumetric assessment of treatment response is not suitable for adequately assessing responses to targeted cancer therapy. The aim of this study was to evaluate changes in tumor composition after targeted therapy in murine models of breast cancer with differing degrees of malignancy via non-invasive magnetic resonance imaging (MRI). MATERIALS AND METHODS Mice bearing highly malignant 4T1 tumors or low malignant 67NR tumors were treated with either a combination of two immune checkpoint inhibitors (ICI, anti-PD1 and anti-CTLA-4) or the multi-tyrosine kinase inhibitor sorafenib, following experiments with macrophage-depleting clodronate-loaded liposomes and vessel-stabilizing angiopoietin-1. Mice were imaged on a 9.4 T small animal MRI system with a multiparametric (mp) protocol, comprising T1 and T2 mapping and diffusion-weighted imaging. Tumors were analyzed ex vivo with histology. RESULTS AND DISCUSSIONS All treatments led to an increase in non-viable areas, but therapy-induced intratumoral changes differed between the two tumor models and the different targeted treatments. While ICI treatment led to intratumoral hemorrhage, sorafenib treatment mainly induced intratumoral necrosis. Treated 4T1 tumors showed increasing and extensive areas of necrosis, in comparison to 67NR tumors with only small, but also increasing, necrotic areas. After either of the applied treatments, intratumoral heterogeneity, was increased in both tumor models, and confirmed ex vivo by histology. Apparent diffusion coefficient with subsequent histogram analysis proved to be the most sensitive MRI sequence. In conclusion, mp MRI enables to assess dedicated therapy-related intratumoral changes and may serve as a biomarker for treatment response assessment.
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Affiliation(s)
- M Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany.
| | - E Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - C Geyer
- Clinic of Radiology, University of Münster, Münster, Germany
| | - A Helfen
- Clinic of Radiology, University of Münster, Münster, Germany
| | - B Maus
- Clinic of Radiology, University of Münster, Münster, Germany
| | - R Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - L Wachsmuth
- Clinic of Radiology, University of Münster, Münster, Germany
| | - W Heindel
- Clinic of Radiology, University of Münster, Münster, Germany
| | - M Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - C Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - M Wildgruber
- Clinic of Radiology, University of Münster, Münster, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Crossley GH, Sanders P, De Filippo P, Tarakji KG, Hansky B, Shah M, Mason P, Maus B, Holloman K. Rationale and design of the Lead Evaluation for Defibrillation and Reliability study: Safety and efficacy of a novel ICD lead design. J Cardiovasc Electrophysiol 2023; 34:257-267. [PMID: 36378803 PMCID: PMC10107290 DOI: 10.1111/jce.15747] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are indicated for primary and secondary prevention of sudden cardiac arrest. Despite enhancements in design and technologies, the ICD lead is the most vulnerable component of the ICD system and failure of ICD leads remains a significant clinical problem. A novel, small-diameter, lumenless, catheter-delivered, defibrillator lead was developed with the aim to improve long-term reliability. METHODS AND RESULTS The Lead Evaluation for Defibrillation and Reliability (LEADR) study is a multi-center, single-arm, Bayesian, adaptive design, pre-market interventional pivotal clinical study. Up to 60 study sites from around the world will participate in the study. Patients indicated for a de novo ICD will undergo defibrillation testing at implantation and clinical assessments at baseline, implant, pre-hospital discharge, 3 months, 6 months, and every 6 months thereafter until official study closure. Patients may be participating for a minimum of 18 months to approximately 3 years. Fracture-free survival will be evaluated using a Bayesian statistical method that incorporates both virtual patient data (combination of bench testing to failure with in-vivo use condition data) with clinical patients. The clinical subject sample size will be determined using decision rules for number of subject enrollments and follow-up time based upon the observed number of fractures at certain time points in the study. The adaptive study design will therefore result in a minimum of 500 and a maximum of 900 patients enrolled. CONCLUSION The LEADR Clinical Study was designed to efficiently provide evidence for short- and long-term safety and efficacy of a novel lead design using Bayesian methods including a novel virtual patient approach.
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Affiliation(s)
| | | | | | | | | | - Maully Shah
- The Children's HospitalPhiladelphiaPennsylvaniaUSA
| | - Pamela Mason
- University of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Baerbel Maus
- Bakken Research Center, Medtronic Inc.MaastrichtThe Netherlands
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Sterliński M, Zakrzewska-Koperska J, Maciąg A, Sokal A, Osca-Asensi J, Wang L, Spyropoulou V, Maus B, Lemme F, Okafor O, Stegemann B, Cornelussen R, Leyva F. Acute Hemodynamic Effects of Simultaneous and Sequential Multi-Point Pacing in Heart Failure Patients With an Expected Higher Rate of Sub-response to Cardiac Resynchronization Therapy: Results of Multicenter SYNSEQ Study. Front Cardiovasc Med 2022; 9:901267. [PMID: 35647062 PMCID: PMC9133424 DOI: 10.3389/fcvm.2022.901267] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
The aim of the SYNSEQ (Left Ventricular Synchronous vs. Sequential MultiSpot Pacing for CRT) study was to evaluate the acute hemodynamic response (AHR) of simultaneous (3P-MPP syn) or sequential (3P-MPP seq) multi-3-point-left-ventricular (LV) pacing vs. single point pacing (SPP) in a group of patients at risk of a suboptimal response to cardiac resynchronization therapy (CRT). Twenty five patients with myocardial scar or QRS ≤ 150 or the absence of LBBB (age: 66 ± 12 years, QRS: 159 ± 12 ms, NYHA class II/III, LVEF ≤ 35%) underwent acute hemodynamic assessment by LV + dP/dtmax with a variety of LV pacing configurations at an optimized AV delay. The change in LV + dP/dt max (%ΔLV + dP/dt max) with 3P-MPP syn (15.6%, 95% CI: 8.8%-22.5%) was neither statistically significantly different to 3P-MPP seq (11.8%, 95% CI: 7.6-16.0%) nor to SPP basal (11.5%, 95% CI:7.1-15.9%) or SPP mid (12.2%, 95% CI:7.9-16.5%), but higher than SPP apical (10.6%, 95% CI:5.3-15.9%, p = 0.03). AHR (defined as a %ΔLV + dP/dt max ≥ 10%) varied between pacing configurations: 36% (9/25) for SPP apical, 44% (11/25) for SPP basal, 54% (13/24) for SPP mid, 56% (14/25) for 3P-MPP syn and 48% (11/23) for 3P-MPP seq.Fifteen patients (15/25, 60%) had an AHR in at least one pacing configuration. AHR was observed in 10/13 (77%) patients with a LBBB but only in 5/12 (42%) patients with a non-LBBB (p = 0.11). To conclude, simultaneous or sequential multipoint pacing compared to single point pacing did not improve the acute hemodynamic effect in a suboptimal CRT response population.
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Affiliation(s)
- Maciej Sterliński
- First Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Joanna Zakrzewska-Koperska
- First Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
- *Correspondence: Joanna Zakrzewska-Koperska
| | - Aleksander Maciąg
- Second Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center of Heart Disease, Zabrze, Poland
| | - Joaquin Osca-Asensi
- Cardiology Department, University and Polytechnic Hospital la Fe, Valencia, Spain
| | - Lingwei Wang
- Section of Arrhythmias, Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Baerbel Maus
- Bakken Research Center, Medtronic plc, Maastricht, Netherlands
| | - Francesca Lemme
- Bakken Research Center, Medtronic plc, Maastricht, Netherlands
| | - Osita Okafor
- Queen Elisabeth Hospital, Birmingham University, Birmingham, United Kingdom
| | - Berthold Stegemann
- Aston Medical School, Aston Medical Research Institute, Aston University, Birmingham, United Kingdom
| | | | - Francisco Leyva
- Aston Medical School, Aston Medical Research Institute, Aston University, Birmingham, United Kingdom
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Tarakji KG, Zaidi AM, Zweibel SL, Varma N, Sears SF, Allred J, Roberts PR, Shaik NA, Silverstein JR, Maher A, Mittal S, Patwala A, Schoenhard J, Emert M, Molon G, Augello G, Patel N, Seide H, Porfilio A, Maus B, Di Jorio SL, Holloman K, Natera AC, Turakhia MP. Performance of first pacemaker to use smart device app for remote monitoring. Heart Rhythm O2 2021; 2:463-471. [PMID: 34667961 PMCID: PMC8505204 DOI: 10.1016/j.hroo.2021.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background High adherence to remote monitoring (RM) in pacemaker (PM) patients improves outcomes; however, adherence remains suboptimal. Bluetooth low-energy (BLE) technology in newer-generation PMs enables communication directly with patient-owned smart devices using an app without a bedside console. Objective To evaluate the success rate of scheduled RM transmissions using the app compared to other RM methods. Methods The BlueSync Field Evaluation was a prospective, international cohort evaluation, measuring the success rate of scheduled RM transmissions using a BLE PM or cardiac resynchronization therapy PM coupled with the MyCareLink Heart app. App transmission success was compared to 3 historical “control” groups from the Medtronic de-identified CareLink database: (1) PM patients with manual communication using a wand with a bedside console (PM manual transmission), (2) PM patients with wireless automatic communication with the bedside console (PM wireless); (3) defibrillator patients with similar automatic communication (defibrillator wireless). Results Among 245 patients enrolled (age 64.8±15.6 years, 58.4% men), 953 transmissions were scheduled through 12 months, of which 902 (94.6%) were successfully completed. In comparison, transmission success rates were 56.3% for PM manual transmission patients, 77.0% for PM wireless patients, and 87.1% for defibrillator wireless patients. Transmission success with the app was superior across matched cohorts based on age, sex, and device type (single vs dual vs triple chamber). Conclusion The success rate of scheduled RM transmissions was higher among patients using the smart device app compared to patients using traditional RM using bedside consoles. This novel technology may improve patient engagement and adherence to RM.
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Affiliation(s)
- Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amir M Zaidi
- Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom
| | - Steven L Zweibel
- Hartford Healthcare and Vascular Institute, Hartford, Connecticut
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Abdul Maher
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom
| | | | - Ashish Patwala
- Royal Stoke University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | | | - Martin Emert
- University of Kansas Medical Center, Kansas City, Kansas
| | - Giulio Molon
- Ospedale Sacro Cuore don Calabria, Negrar, Italy
| | | | | | | | | | - Baerbel Maus
- Bakken Research Center, Medtronic plc, Maastricht, The Netherlands
| | | | | | | | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Miyazaki S, O'Connell H, Maus B. Parameters associated with acute morphometric lesion dimensions created by cryocatheters. J Interv Card Electrophysiol 2018; 54:109-118. [PMID: 30251226 DOI: 10.1007/s10840-018-0452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Despite the wide use of cryoenergy, there is a paucity of data regarding the impact of certain ablation parameters on lesion size. Specifically, this study sought to evaluate the impact of catheter type, ablation time, heat load, and tip orientation on lesion dimensions using a porcine thigh model with focal cryoablation catheters. METHODS In 6 pigs, 251 lesions were created on thigh muscle with parameter permutations to compare the acute impact of catheter type (electrode tip sizes 4, 6, and 8 mm), ablation time (2, 2 × 2, 3, 4, and 2 × 4 min), heat load (1 and 2 L/min), and tip orientation (perpendicular or parallel) on lesion dimensions (length, depth, and cross-sectional area) immediately post-ablation. As a sub-study to evaluate the importance of tissue contact during the cryoablation procedure, a 1-min freeze was performed without tissue contact until an ice ball formed, followed by an additional 2-3 min freeze. RESULTS The linear regression model revealed that catheter type (p < 0.0001) and the interaction between catheter orientation and catheter type (p = 0.027) were significantly associated with lesion cross-sectional area. Lesion length and depth, but not cross-sectional area, are significantly impacted by the catheter type (p < 0.0001; p = 0.003) and orientation (p < 0.0001; p < 0.0001), respectively. Compared to parallel catheter placement, lesions created with the perpendicular orientation were deeper using 4-mm (p = 0.136), 6-mm (p = 0.005), and 8-mm tip catheter (p = 0.004). Lesion creation with an ice ball significantly reduced lesion depth compared to lesions made without an ice ball (p < 0.05). In contrast, ablation time (p = 0.097) and heat load (p = 0.467) were not significantly associated with lesion size. Additionally, there was no statistical significant difference in lesion size between 2 × 2 and 4 min ablation times. CONCLUSIONS The present study demonstrated that lesion size was significantly impacted by catheter type and catheter tip orientation and that maintaining tissue contact prior to applying cryoenergy is essential.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | | | - Baerbel Maus
- Medtronic Bakken Research Center, Maastricht, The Netherlands
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De Greef E, Maus B, Smets F, Van Biervliet S, John JMM, Van Steen K, Veereman G. Diagnosing and treating pediatric Crohn's disease patients: is there a difference between adult and pediatric gastroenterologist's practices ? Results of the BELCRO cohort. Acta Gastroenterol Belg 2014; 77:25-29. [PMID: 24761688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Maus B, van Breukelen GJP, Goebel R, Berger MPF. Optimization of Blocked Designs in fMRI Studies. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vollmar T, Maus B, Wurtz RP, Gillessen-Kaesbach G, Horsthemke B, Wieczorek D, Boehringer S. Impact of geometry and viewing angle on classification accuracy of 2D based analysis of dysmorphic faces. Eur J Med Genet 2007; 51:44-53. [PMID: 18054308 DOI: 10.1016/j.ejmg.2007.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 10/06/2007] [Indexed: 11/16/2022]
Abstract
Digital image analysis of faces has been demonstrated to be effective in a small number of syndromes. In this paper we investigate several aspects that help bringing these methods closer to clinical application. First, we investigate the impact of increasing the number of syndromes from 10 to 14 as compared to an earlier study. Second, we include a side-view pose into the analysis and third, we scrutinize the effect of geometry information. Picture analysis uses a Gabor wavelet transform, standardization of landmark coordinates and subsequent statistical analysis. We can demonstrate that classification accuracy drops from 76% for 10 syndromes to 70% for 14 syndromes for frontal images. Including side-views achieves an accuracy of 76% again. Geometry performs excellently with 85% for combined poses. Combination of wavelets and geometry for both poses increases accuracy to 93%. In conclusion, a larger number of syndromes can be handled effectively by means of image analysis.
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Affiliation(s)
- Tobias Vollmar
- Institut für Humangenetik, Universität Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Schmolling J, Maus B, Rezek D, Fimmers R, Höller T, Schüller H, Krebs D. Breast preservation versus mastectomy--recurrence and survival rates of primary breast cancer patients treated at the UFK Bonn. EUR J GYNAECOL ONCOL 1997; 18:29-33. [PMID: 9061318] [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: 02/03/2023]
Abstract
The aim of this retrospective long-term analysis was to evaluate the approach of breast conservation in the light of the results obtained, on the basis of mastectomy, in patients with early breast carcinoma. Additionally, the effect of internal mammary and supraclavicular radiotherapy was analyzed. Therefore, local-regional recurrence (LRR) and survival rates were examined in 411 patients with T1 and T2 stages who had undergone either breast-preserving surgery with radiation or mastectomy. Individual risk factors such as nodal status, lymphangiosis carcinomatosa and age of the patients were evaluated, too. The rate of local-regional recurrence in patients who were treated by mastectomy and conservative surgery was 9.2% and 11.0%, respectively, with relapse happening earlier in the latter group (median of 16 vs. 24 months). Survival rates, however, were not different in the two groups. Tumour stage and nodal status had no influence on the local-regional recurrence rate in either group. In connection with lymphangiosis carcinomatosa, however, the rate increased to 14.5% (mastectomy) and 19.0% (breast-preserving surgery), respectively. Patients < or = 40 years had an even higher risk of LRR, with 20.6% when they underwent mastectomy and 30.8% following breast conservation. Internal mammary and supraclavicular radiotherapy had no positive effect on the survival rates, neither in the mastectomy nor in the breast conservation group. As a conclusion, in more than 60% of all T1 stages. and more than 50% of all T2 stages, the therapeutic concept of breast preservation seems to be justified.
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Affiliation(s)
- J Schmolling
- Department of Obstetrics and Gynaecology, University of Bonn, Germany
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Overlack A, Maus B, Ruppert M, Lennarz M, Kolloch R, Stumpe KO. [Potassium citrate versus potassium chloride in essential hypertension. Effects on hemodynamic, hormonal and metabolic parameters]. Dtsch Med Wochenschr 1995; 120:631-5. [PMID: 7750429 DOI: 10.1055/s-2008-1055388] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A study was conducted on 25 patients (18 men, seven women; mean age 48 [24-70] years) with essential hypertension (EH) to see whether an increase in potassium supply influences blood pressure as well as metabolic and hormonal parameters, and whether the anion administered together with potassium affects the results. In a randomized, cross-over trial sequence the patients daily received 120 mmol potassium chloride, 120 mmol potassium citrate or a placebo, each for 8 weeks. Between each of the three periods there was a "wash-out" phase of 4 weeks each. After 8 weeks of potassium citrate intake the systolic and diastolic pressures were reduced significantly, by a mean of 6.2/3.8 mm Hg (P < 0.05). But after potassium chloride there was only a small, not significant, reduction. Metabolic and hormonal parameters (fasting glucose concentration, glucose tolerance test, lipid electrophoresis; plasma renin activity, plasma concentration of aldosterone, noradrenaline and insulin) were not significantly changed.--These findings suggest that an increased supply of potassium has a favourable haemodynamic effect, but this varies markedly between different potassium salts. An increase in potassium supply should thus be considered as an additional measure in the treatment of EH. As long as renal function is normal no unfavourable metabolic effect need be feared.
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Affiliation(s)
- A Overlack
- Medizinische Universitäts-Poliklinik Bonn
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