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Valika A, Sulemanjee N, Pedersen R, Heidenreich D. Reduction in 90 day readmission rates utilizing ambulatory pulmonary pressure monitoring. ESC Heart Fail 2022; 10:685-690. [PMID: 36436826 PMCID: PMC9871649 DOI: 10.1002/ehf2.14253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients with ambulatory pulmonary artery pressure (PAP) monitoring guidance. We investigated the effect of ambulatory haemodynamic monitoring on 90 day readmission rates after HFH. METHODS AND RESULTS We retrospectively analysed patients across the Advocate Aurora Health hospital network who had undergone PAP sensor implantation between 1 October 2015 and 31 October 2019. Patients with a ventricular assist device (VAD) or transplant prior to implantation were excluded. Rates of total HFH and 30 and 90 day all-cause readmission up to 12 months after implantation were collected, while censoring for an endpoint of heart transplantation, VAD, or death. Event rates were compared using Poisson regression. Of 459 patients included, there were 404 HFHs before and 179 after implantation. Compared with pre-implantation, 30 day all-cause readmission [incidence rate ratio (IRR): 0.55 (0.39-0.77), P = 0.0006] and 90 day all cause readmission rates were lower post-implantation [IRR: 0.45 (0.35-0.58), P < 0.0001]. The effect of PAP sensor implantation on 90 day all-cause readmission incidence rates was consistent across multiple subgroups. CONCLUSIONS Across a large hospital network, ambulatory haemodynamic monitoring was associated with lower HFH rates, as well as 30 and 90 day all-cause readmission rates. This supports the utility of ambulatory PAP monitoring to improve HF management in the era of value-based medicine.
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Affiliation(s)
- Ali Valika
- Advocate Heart InstituteAdvocate Good Samaritan Hospital, Advocate Aurora HealthTower 2, 3825 Highland Ave., Ste 400Downers GroveIL60515USA
| | - Nasir Sulemanjee
- Aurora Cardiovascular and Thoracic ServicesAurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health2801 W. Kinnickinnic River Parkway, Ste. 880MilwaukeeWI53215USA
| | - Rachel Pedersen
- Aurora Cardiovascular and Thoracic ServicesAurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health2801 W. Kinnickinnic River Parkway, Ste. 880MilwaukeeWI53215USA
| | - Debra Heidenreich
- Advocate Heart InstituteAdvocate Good Samaritan Hospital, Advocate Aurora HealthTower 2, 3825 Highland Ave., Ste 400Downers GroveIL60515USA
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Heidenreich D, Kreil S, Jawhar M, Müller N, Nolte F, Becker KP, Miethke T, Hofmann WK, Klein SA. Course of colonization by multidrug-resistant organisms after allogeneic hematopoietic cell transplantation. Ann Hematol 2018; 97:2501-2508. [PMID: 30121845 DOI: 10.1007/s00277-018-3475-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/10/2018] [Accepted: 08/09/2018] [Indexed: 01/28/2023]
Abstract
Multidrug-resistant organisms (MDRO) have been developing as an emerging problem in allogeneic hematopoietic cell transplantation (HCT). Since no data are available on the course of MDRO colonization after HCT, we investigated in this retrospective, single-center study, persistence and clearance of MDRO after HCT. From June 2010 to December 2015, 121 consecutive HCT patients were included. Patients received a MDRO screening before conditioning as well as surveillance cultures after HCT. In MDRO-colonized patients, surveillance specimens were taken until MDRO were no longer detectable. Thirty-three patients (27%) were found to be colonized by at least one MDRO at any time point until day 100 post HCT. Day 100 (2-year) non-relapse mortality (NRM) and overall survival (OS) of MDRO-colonized (MDRO+) versus non-colonized (MDRO-) patients were essentially the same. NRM is 15% (21%) versus 15% (24%). Two-year OS is 60 versus 55% for MDRO+ versus MDRO- patients. Out of the 33 MDRO+ patients, 21 cleared the MDRO. Median time to non-detectability of MDRO was 6 months. In 12 patients, the MDRO persisted. There was a significant (p < 0.0001) survival difference between patients who cleared the MDRO versus those with MDRO persistence (2-year OS 80 vs 40%). Except for the length of antibiotic therapy as a potential risk factor for MDRO persistence after HCT, no other conventional factors could be identified. (a) colonization by MDRO per se had no negative impact on the outcome, (b) MDRO can be cleared by the majority of patients after allogeneic HCT, and (c) to increase the probability to clear MDRO, the use of antibiotics in MDRO+ patients should be reviewed critically.
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Affiliation(s)
- D Heidenreich
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Kreil
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M Jawhar
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - N Müller
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F Nolte
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K-P Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsmedizin Mannheim, Mannheim, Germany
| | - T Miethke
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsmedizin Mannheim, Mannheim, Germany
| | - W-K Hofmann
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan A Klein
- Universitätsmedizin Mannheim, III. Medizinische Klinik, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Wottawa M, Naas S, Böttger J, van Belle GJ, Möbius W, Revelo NH, Heidenreich D, von Ahlen M, Zieseniss A, Kröhnert K, Lutz S, Lenz C, Urlaub H, Rizzoli SO, Katschinski DM. Hypoxia-stimulated membrane trafficking requires T-plastin. Acta Physiol (Oxf) 2017; 221:59-73. [PMID: 28218996 DOI: 10.1111/apha.12859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/25/2017] [Accepted: 02/15/2017] [Indexed: 12/30/2022]
Abstract
AIM Traffic between the plasma membrane and the endomembrane compartments is an essential feature of eukaryotic cells. The secretory pathway sends cargoes from biosynthetic compartments to the plasma membrane. This is counterbalanced by a retrograde endocytic route and is essential for cell homoeostasis. Cells need to adapt rapidly to environmental challenges such as the reduction of pO2 which, however, has not been analysed in relation to membrane trafficking in detail. Therefore, we determined changes in the plasma membrane trafficking in normoxia, hypoxia, and after reoxygenation. METHODS Membrane trafficking was analysed by using the bulk membrane endocytosis marker FM 1-43, the newly developed membrane probe mCLING, wheat germ agglutinin as well as fluorescently labelled cholera toxin subunit B. Additionally, the uptake of specific membrane proteins was determined. In parallel, a non-biased SILAC screen was performed to analyse the abundance of membrane proteins in normoxia and hypoxia. RESULTS Membrane trafficking was increased in hypoxia and quickly reversed upon reoxygenation. This effect was independent of the hypoxia-inducible factor (HIF) system. Using SILAC technology, we identified that the actin-bundling protein T-plastin is recruited to the plasma membrane in hypoxia. By the use of T-plastin knockdown cells, we could show that T-plastin mediates the hypoxia-induced membrane trafficking, which was associated with an increased actin density in the cells as determined by electron microscopy. CONCLUSION Membrane trafficking is highly dynamic upon hypoxia. This phenotype is quickly reversible upon reoxygenation, which suggests that this mechanism participates in the cellular adaptation to hypoxia.
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Affiliation(s)
- M. Wottawa
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - S. Naas
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - J. Böttger
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - G. J. van Belle
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - W. Möbius
- Department of Neurogenetics; Max Planck Institute of Experimental Medicine; Göttingen Germany
- Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB); Göttingen Germany
| | - N. H. Revelo
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - D. Heidenreich
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - M. von Ahlen
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - A. Zieseniss
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - K. Kröhnert
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - S. Lutz
- Institute of Pharmacology; UMG; Göttingen Germany
| | - C. Lenz
- Bioanalytical Mass Spectrometry; Max Planck Institute for Biophysical Chemistry; Göttingen Germany
- Bioanalytics Research Group; Institute of Clinical Chemistry; UMG; Göttingen Germany
| | - H. Urlaub
- Bioanalytical Mass Spectrometry; Max Planck Institute for Biophysical Chemistry; Göttingen Germany
- Bioanalytics Research Group; Institute of Clinical Chemistry; UMG; Göttingen Germany
| | - S. O. Rizzoli
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - D. M. Katschinski
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
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Henzler C, Henzler T, Buchheidt D, Nance JW, Weis CA, Vogelmann R, Benck U, Viergutz T, Becher T, Boch T, Klein SA, Heidenreich D, Pilz L, Meyer M, Deckert PM, Hofmann WK, Schoenberg SO, Reinwald M. Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients. Sci Rep 2017; 7:4483. [PMID: 28667276 PMCID: PMC5493648 DOI: 10.1038/s41598-017-04470-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 01/17/2017] [Accepted: 05/16/2017] [Indexed: 12/29/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is one of the major complications in immunocompromised patients. The mainstay of diagnostic imaging is non-enhanced chest-computed-tomography (CT), for which various non-specific signs for IPA have been described. However, contrast-enhanced CT pulmonary angiography (CTPA) has shown promising results, as the vessel occlusion sign (VOS) seems to be more sensitive and specific for IPA in hematologic patients. The aim of this study was to evaluate the diagnostic accuracy of CTPA in a larger cohort including non-hematologic immunocompromised patients. CTPA studies of 78 consecutive immunocompromised patients with proven/probable IPA were analyzed. 45 immunocompromised patients without IPA served as a control group. Diagnostic performance of CTPA-detected VOS and of radiological signs that do not require contrast-media were analyzed. Of 12 evaluable radiological signs, five were found to be significantly associated with IPA. The VOS showed the highest diagnostic performance with a sensitivity of 0.94, specificity of 0.71 and a diagnostic odds-ratio of 36.8. Regression analysis revealed the two strongest independent radiological predictors for IPA to be the VOS and the halo sign. The VOS is highly suggestive for IPA in immunocompromised patients in general. Thus, contrast-enhanced CTPA superior over non-contrast_enhanced chest-CT in patients with suspected IPA.
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Affiliation(s)
- C Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - T Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - D Buchheidt
- Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - John W Nance
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - C A Weis
- Department of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - R Vogelmann
- Department of Gastroenterology and Infectious Diseases, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - U Benck
- Department of Nephrology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - T Viergutz
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - T Becher
- Department of Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - T Boch
- Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - S A Klein
- Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - D Heidenreich
- Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - L Pilz
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - M Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - P M Deckert
- Department of Hematology and Oncology, Medical University of Brandenburg (MHB) Theodor Fontane, Brandenburg an der Havel, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - S O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - M Reinwald
- Department of Hematology and Oncology, Medical University of Brandenburg (MHB) Theodor Fontane, Brandenburg an der Havel, Germany
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Budjan J, Klein SA, Heidenreich D, Attenberger U, Kreil S, Schönberg SO, Hofmann W, Michaely HJ. MR-Bildgebung bei akuter abdomineller Graft versus Host Disease. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Le HH, Ilisch S, Heidenreich D, Osswald K, Radusch HJ. PHASE SELECTIVE LOCALIZATION OF FILLER IN TERNARY RUBBER BLENDS. Rubber Chemistry and Technology 2011. [DOI: 10.5254/1.3524404] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
The present work introduces a new concept based on the analysis of the rubber–filler gel for the determination of the phase selective filler localization in ternary rubber blends. Natural rubber (NR)/styrene–butadiene rubber (SBR)/ethylene–propylene rubber (EPDM) blends filled with silica were the focus of the experimental investigations. Because of the higher wetting rate of the NR component to silica, in the first stage of the preparation of SBR/NR/EPDM blends, more silica is found in the NR phase than in the SBR and EPDM phase. In the subsequent stage, silica is transferred from the NR phase to the SBR phase until the loosely bound NR-layer at the silica surface is fully replaced by SBR molecules. An extremely low amount of silica was found in the EPDM phase because of the poor EPDM–silica interaction. After a long mixing time, a large amount of silica whose surface was not yet wetted by any rubber phase could be found in the composites that can lead to fatal effects on the mechanical performance of the composites.
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Affiliation(s)
- H. H. Le
- 1Center of Engineering Sciences, Martin Luther University Halle-Wittenberg, D-06099 Halle (Saale), Germany
| | - S. Ilisch
- 1Center of Engineering Sciences, Martin Luther University Halle-Wittenberg, D-06099 Halle (Saale), Germany
| | - D. Heidenreich
- 1Center of Engineering Sciences, Martin Luther University Halle-Wittenberg, D-06099 Halle (Saale), Germany
| | - K. Osswald
- 1Center of Engineering Sciences, Martin Luther University Halle-Wittenberg, D-06099 Halle (Saale), Germany
| | - H-J. Radusch
- 1Center of Engineering Sciences, Martin Luther University Halle-Wittenberg, D-06099 Halle (Saale), Germany
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Taubert H, Thamm B, Meye A, Bartel F, Rost AK, Heidenreich D, John V, Brandt J, Bache M, Würl P, Schmidt H, Riemann D. The p53 status in juvenile chronic arthritis and rheumatoid arthritis. Clin Exp Immunol 2000; 122:264-9. [PMID: 11091284 PMCID: PMC1905773 DOI: 10.1046/j.1365-2249.2000.01358.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the p53 status in two autoimmune diseases; juvenile chronic arthritis (JCA) and rheumatoid arthritis (RA). In a PCR-sequencing analysis of exons 4-9 of the p53 gene, no mutation was identified, except for the case of an RA synovectomy sample with two mutations of intron 7. p53 gene polymorphisms for codons 36, 47, and 213 were not detected. Codon 72 polymorphism showed an indication of an increased occurrence of the Pro/Pro allelotype in JCA. Expression of P53 protein was comparable for JCA and RA synovectomy samples. For all RA samples P53 protein was detectable, whereas one sample of a JCA patient failed to express P53 protein.
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Affiliation(s)
- H Taubert
- Institute of Pathology, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
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Heidenreich D. [New grinding instruments for the preparation of concave palatal sections]. ZWR 1981; 90:36-7. [PMID: 6954784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Beck L, Cassani S, Heidenreich D, Hirsch HA, Hohenfellner R, Richter K, Schreiter F, Stockamp K, K�ser O. Urologie. Arch Gynecol Obstet 1975. [DOI: 10.1007/bf00669050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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