1
|
Knipper S, Mehdi Irai M, Simon R, Köhler D, Isabel R, Eiber M, Van Leeuwen F, Van Leeuwen P, Budäus L, Steuber T, Graefen M, Tennstedt P, Heck M, Horn T, Maurer T. Cohort study of oligorecurrent prostate cancer patients: Oncological outcomes of patients treated with salvage lymph node dissection via PSMA radioguided surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
2
|
Dellweg D, Siemon K, Höhn E, Barchfeld T, Köhler D. [Early Pulmonary Rehabilitation after Long Term Mechanical Ventilation]. Pneumologie 2021; 75:432-438. [PMID: 34116576 PMCID: PMC8195616 DOI: 10.1055/a-0978-1035] [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] [Indexed: 11/28/2022]
Abstract
Einleitung
Unter Frührehabilitation versteht man eine frühzeitig bei- oder nach akuter Erkrankung einsetzende, rehabilitationsmedizinische Behandlung die im § 39SGB V verankert ist. Ziel dieser Untersuchung ist es, die Ergebnisqualität der pneumologischen Frührehabilitation zu untersuchen und darzustellen.
Methoden
Prospektive Erhebung von funktionellen Parametern, Beatmungsstatus und Entlass-Disposition in einer spezialisierten Abteilung für pneumologische Frührehabilitation über den Zeitraum von einem Jahr.
Ergebnisse
Von den 190 Patienten waren 179 (94,2 %) zuvor invasiv beatmet. Während einer Behandlungsdauer von 39 ± 17 Tagen stieg der FAM-Index von 84,4 ± 19,8 auf 118,5 ± 23,3 (Ci 30,9 – 37,3, Cohen’s d 1,58; p < 0,001), der Barthel-Index von 30,5 ± 13,8 auf 58,3 ± 16,2 (Ci 25,4 – 33,8, Cohen’s d 1,4; p < 0,001) und die Wegstrecke von 12,9 ± 40,1 m auf 131,4 ± 85,2 m (Ci 105,6 – 131,4 m, Cohen’s d 1,78; p < 0,001). Die Patienten wurden weniger häufig in eine weitere Anschlussheilbehandlung verlegt, wenn sie beatmet waren.
Diskussion
Patienten in der pneumologischen Frührehabilitation sind bei Aufnahme schwer kompromittiert, es lässt sich aber eine sehr gute Ergebnisqualität erzielen, die unabhängig davon zu sein scheint, ob der Patient eigenständig atmet oder mittels nicht-invasiver oder invasiver Beatmung versorgt wird. Die weitere Disposition dieser Patienten ist vor allem dann schwierig, wenn eine Beatmung vorliegt.
Collapse
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - K Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - E Höhn
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - T Barchfeld
- Klinikum Westfalen, Knappschaftskrankenhaus Dortmund; Medizinische Klinik 2
| | - D Köhler
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| |
Collapse
|
3
|
Unnewehr M, Schlesinger A, Stieglitz S, Köhler D. Greulich T, Fähndrich S, Clarenbach C et al. Alpha-1-Antitrypsin-Mangel (AATM) – Ein Expertenstatement. Pneumologie 2020; 74: 436-442, doi:10.1055/a-1143-8186. Pneumologie 2021; 75:69-71. [PMID: 33461236 DOI: 10.1055/a-1251-6424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M Unnewehr
- Innere Medizin V - Pneumologie, Infektiologie, Schlafmedizin, Allergologie St. Barbara-Klinik Hamm
| | - A Schlesinger
- Lungenklinik Köln-Nord, Betriebsteil St. Marien Hospital Köln
| | - S Stieglitz
- Medizinische Klinik I - Pneumologie, Allergologie, Schlaf- und Intensivmedizin Petrus Krankenhaus Wuppertal
| | - D Köhler
- Ehem. Krankenhaus Kloster Grafschaft, Schmallenberg
| |
Collapse
|
4
|
Köhler D, Hetzel M, Klingner M, Koch T, Ewig S, Becher G, Lindemann H, Voshaar T, Costabel U. Leserbrief zu M. Bitzer. Hohe Luftverschmutzung begünstigt das Auftreten von Lungenemphysemen. Pneumologie 2020; 74: 7–8 und F. Klein. Stickoxide schädigen Schulkinderlungen unabhängig von Vorerkrankungen. Pneumologie 2020: 74: 8–9. Pneumologie 2020; 74:240-241. [DOI: 10.1055/a-1114-5497] [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]
|
5
|
Köhler D, Hetzel M, Klingner M, Koch T, Ewig S, Becher G, Lindemann H, Voshaar T, Costabel U. [The Role of Air Pollutants for Health - A Reply to the Expert Opinion of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS)]. Pneumologie 2019; 73:274-287. [PMID: 30991436 DOI: 10.1055/a-0873-3574] [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: 10/26/2022]
Abstract
ZusammenfassungIn Deutschland gibt es regionale Fahrverbote für ältere Dieselfahrzeuge ohne SCR-Katalysator bei Überschreitung der Grenzwerte für NO2. Dies hat zu einer intensiven Diskussion über die Rolle der Luftschadstoffe für die Gesundheit geführt. In der Replik wird dargestellt, dass die Daten zur Wirkung von Stickstoffdioxid (NO2) und Feinstaub (PM10 und PM2,5) nicht ausreichen, um die Fahrverbote zu begründen.Für NO2 gibt es passagere Reaktionen bei unbehandelten Asthmatikern ab 500 µg/m3. Die deutschen Grenzwerte (Jahresmittelwert 40 µg/m3) fußen im Wesentlichen auf einer Metaanalyse von 9 Studien aus Innenraumbelastungen wobei nur in 4 Studien NO2 gemessen wurde. In der großen europäischen Escape-Studie von 2014 wurde kein Einfluss von NO2 auf die Mortalität gefunden.Als Surrogatparameter für andere Schadstoffe ist NO2 ebenfalls nicht mehr geeignet, da seit Einführung der Partikelfilter bei Dieselautos (etwa ab 2000) der KFZ-Anteil am Feinstaub an der Straße unter 10 % liegt. Der Feinstaub besteht im Wesentlichen aus Aufwirbelung von mineralischen, organischen Bodensubstanzen sowie Reifenabrieb und wird am stärksten durch Wetterphänomene, vor allen Dingen durch Sonneneinstrahlung beeinflusst.Die Grenzwerte für NO2 und Feinstaub werden errechnet aus epidemiologischen Beobachtungsstudien. Es findet sich zumeist eine schwache Assoziation zwischen der Konzentra-tion und zahlreichen Erkrankung sowie der Mortalität. Epidemiologische Beobachtungsstudien erlauben nur die Bildung einer Hypothese. Permanente Wiederholungen der Beobachtungsstudien betätigen nur, dass manche gefundenen Phänomene nicht zufällig sind. Eine Kausalität kann daraus nicht abgeleitet werden, da es zahlreiche Erklärungsmodelle neben dem NO2 und Feinstaub gibt. Dazu wären Interventionsstudien im Niedrigdosisbereich sowie Tierexperimente erforderlich. Diese Daten fehlen nahezu komplett bzw. sind, soweit vorhanden, allesamt negativ.Nie diskutiert wird eine starke Widerlegung der Hypothese der Gefährdung von NO2 und Feinstaub im Grenzwertbereich durch das Inhalationsrauchen. Die Raucher stellen quasi einen inhalationstoxikologischen Großversuch dar. Der Zigarettenrauch enthält sehr hohe Feinstaub-, Stickstoffmonoxid- (NO) und NO2-Konzentrationen, die vom Organismus erstaunlich gut toleriert werden. Das hängt damit zusammen, dass NO ein Naturstoff ist, der in den Zellen oder auch in den Nasennebenhöhlen in z. T. sehr hohen Konzentrationen (über 30 000 µg/m3) vorkommt. Eines der Abbauprodukte von NO ist NO2, was im Wasser zu Nitrat und Nitrit disproportioniert wird. Ein Teil von NO2 wird zur Synthese von Fettsäuren verwendet.Zigaretten haben ein Kondensat von ca. 7 – 10 mg. Nimmt man als Vergleich eine lebenslange Dauerbelastung durch Feinstaub und NO2 in den Grenzwertkonzentrationen an, müssten alle Raucher nach wenigen Tagen bis Monaten zahlreiche Erkrankungen entwickeln, die dem Feinstaub und NOx angelastet werden. Auch die Mortalität müsste drastisch erhöht sein; nahezu alle Raucher müssten bereits nach 1 packyear verstorben sein. Der Unterschied wird noch größer, wenn man die nachgewiesene Toxizität und Kanzerogenität des Zigarettenrauchs im Vergleich zu dem i. d. R. deutlich weniger gefährlichen Feinstaub an der Straße ins Verhältnis setzt.
Collapse
Affiliation(s)
| | - M Hetzel
- Klinik für Pneumologie, Internistische Intensivmedizin, Beatmungsmedizin und Allgemeine Innere Medizin, Krankenhaus vom Roten Kreuz, Stuttgart
| | - M Klingner
- Fraunhofer-Institut für Verkehrs- und Infrastruktursysteme IVI, Dresden
| | - T Koch
- Leiter des Instituts für Kolbenmaschinen, Karlsruher Institut für Technologie (KIT), Karlsruhe
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | | | - H Lindemann
- Ehemaliger Leiter des Selbständigen Funktionsbereichs für Pneumologie und Allergologie am Zentrum für Kinderheilkunde und Jugendmedizin der Justus-Liebig-Universität Gießen
| | - T Voshaar
- Lungenzentrum Pneumologie, Allergologie, Immunologie, Schlaf-und Beatmungsmedizin. Krankenhaus Bethanien, Moers
| | - U Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| |
Collapse
|
6
|
Köhler D. [Tremendous Increase of Home Care in Ventilated and Tracheostomized Patients - Reasons, Consequences, Solutions]. Pneumologie 2019; 73:181-184. [PMID: 30861544 DOI: 10.1055/a-0839-5893] [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]
|
7
|
Windisch W, Köhler D, Criée C. Prof. Dr. med. Bernd Schönhofer: Pionier des prolongierten Weanings. Pneumologie 2019. [DOI: 10.1055/a-0828-9493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- W. Windisch
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Medizinische Fakultät, Universität Witten/Herdecke
| | | | - C. Criée
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Pneumologie, Beatmung-medizin/Schlaflabor, Bovenden-Lenglern
| |
Collapse
|
8
|
Pott A, Shahid M, Köhler D, Pylatiuk C, Weinmann K, Just S, Rottbauer W. Therapeutic Chemical Screen Identifies Phosphatase Inhibitors to Reconstitute PKB Phosphorylation and Cardiac Contractility in ILK-Deficient Zebrafish. Biomolecules 2018; 8:biom8040153. [PMID: 30463267 PMCID: PMC6315389 DOI: 10.3390/biom8040153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022] Open
Abstract
Patients with inherited dilated cardiomyopathy (DCM) often suffer from severe heart failure based on impaired cardiac contractility leading to increased morbidity and mortality. Integrin-linked kinase (ILK) as a part of the cardiac mechanical stretch sensor was found to be an essential genetic regulator of cardiac contractility. Integrin-linked kinase localizes to z-disks and costameres in vertebrate hearts and regulates the activity of the signaling molecule protein kinase B (PKB/Akt) by controlling its phosphorylation. Despite identification of several potential drug targets in the ILK signaling pathway, pharmacological treatment strategies to restore contractile function in ILK-dependent cardiomyopathies have not been established yet. In recent years, the zebrafish has emerged as a valuable experimental system to model human cardiomyopathies as well as a powerful tool for the straightforward high-throughput in vivo small compound screening of therapeutically active substances. Using the ILK deficient zebrafish heart failure mutant main squeeze (msq), which shows reduced PKB phosphorylation and thereby impaired cardiac contractile force, we identified here, in an automated small compound screen, the protein phosphatase inhibitors calyculin A and okadaic acid significantly restoring myocardial contractile function by reconstituting PKB phosphorylation in msq ILK-deficient zebrafish embryos.
Collapse
Affiliation(s)
- Alexander Pott
- Department of Internal Medicine II, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Maryam Shahid
- Department of Internal Medicine II, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Doreen Köhler
- Department of Internal Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany.
| | - Christian Pylatiuk
- Institute of Applied Computer Science, Karlsruhe Institute of Technology, D-76344 Eggenstein-Leopoldshafen, Germany.
| | - Karolina Weinmann
- Department of Internal Medicine II, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Steffen Just
- Department of Internal Medicine II, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| |
Collapse
|
9
|
Köhler D, Dellweg D. Die überschätzte Beeinflussung der Exazerbationsrate bei COPD durch Inhalativa (LABA, LAMA, ICS). Pneumologie 2018; 72:132-137. [DOI: 10.1055/s-0043-118889] [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: 10/18/2022]
Abstract
ZusammenfassungDurch zahlreiche Studien ist belegt, dass inhalative, langwirksame Beta-2-Mimetika (LABA) und Anticholinergika (LAMA) sowie Steroide (ICS) die Exazerbationsrate bei COPD signifikant reduzieren. Allerdings konnte auch in aufwendigen und länger dauernden Studien nicht gezeigt werden, dass diese Reduktion der Exazerbation auch die Lebenserwartung reduziert. Im Gegensatz dazu zeigen zahlreiche Studien, dass die Lebenserwartung mit zunehmender Schwere und Häufigkeit der Exazerbation vermindert wird.In dieser Übersicht werden diese Studien gegenübergestellt und die Relevanz der Reduktion der Exazerbationsraten durch LABA, LAMA und ICS durch Bewertung ihrer Effektstärke mittels Cohen’s d bewertet. Dabei zeigt sich in den Studien ein gleiches Muster. Die Reduktion der Exazerbationsrate zeigt nur bei den geringen Schweregraden einen kleinen Effekt (Cohen’s d max. 0,21). Bei Exazerbation mit höherem Schweregrad und bei Vergleich der Substanzen untereinander fällt Cohen’s d unter 0,1, was zeigt, dass die Wirkung der Medikamente klinisch praktisch bedeutungslos ist. Die Wirkung von LABA, LAMA und ICS auf die Exazerbationsrate bei COPD ist deutlich überschätzt.
Collapse
Affiliation(s)
| | - D. Dellweg
- Fachkrankenhaus Kloster Grafschaft, Schmallenberg
| |
Collapse
|
10
|
Köhler D, Dellweg D. Die überschätzte Beeinflussung der Exazerbationsrate bei COPD durch Inhalativa (LABA, LAMA, ICS). Pneumologie 2018; 72:e1. [DOI: 10.1055/a-0580-4659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - D. Dellweg
- Fachkrankenhaus Kloster Grafschaft, Schmallenberg
| |
Collapse
|
11
|
Lampignano R, Neumann M, Behrens B, Köhler D, Niederacher D, Fehm T, Stoecklein NH, Neubauer H. How to isolate and characterize EpCAMnegative circulating tumor cells in metastatic breast cancer patients. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593005] [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
|
12
|
Frese KS, Meder B, Keller A, Just S, Haas J, Vogel B, Fischer S, Backes C, Matzas M, Köhler D, Benes V, Katus HA, Rottbauer W. RNA splicing regulated by RBFOX1 is essential for cardiac function in zebrafish. J Cell Sci 2015; 128:3030-40. [PMID: 26116573 PMCID: PMC4541041 DOI: 10.1242/jcs.166850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/10/2015] [Indexed: 12/21/2022] Open
Abstract
Alternative splicing is one of the major mechanisms through which the proteomic and functional diversity of eukaryotes is achieved. However, the complex nature of the splicing machinery, its associated splicing regulators and the functional implications of alternatively spliced transcripts are only poorly understood. Here, we investigated the functional role of the splicing regulator rbfox1 in vivo using the zebrafish as a model system. We found that loss of rbfox1 led to progressive cardiac contractile dysfunction and heart failure. By using deep-transcriptome sequencing and quantitative real-time PCR, we show that depletion of rbfox1 in zebrafish results in an altered isoform expression of several crucial target genes, such as actn3a and hug. This study underlines that tightly regulated splicing is necessary for unconstrained cardiac function and renders the splicing regulator rbfox1 an interesting target for investigation in human heart failure and cardiomyopathy. Summary: The zebrafish splicing regulator rbfox1 is necessary for tightly regulated splicing and unconstrained cardiac function, making it an interesting candidate for targeting during human cardiomyopathy.
Collapse
Affiliation(s)
- Karen S Frese
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | - Benjamin Meder
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, D-66123 Saarbrücken, Germany Department of Human Genetics, Saarland University, D-66123 Saarbrücken, Germany
| | - Steffen Just
- Department of Medicine II, University of Ulm, D-89081 Ulm, Germany
| | - Jan Haas
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | - Britta Vogel
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | - Simon Fischer
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | - Christina Backes
- Department of Human Genetics, Saarland University, D-66123 Saarbrücken, Germany
| | - Mark Matzas
- Comprehensive Biomarker Center, D-69120 Heidelberg, Germany
| | - Doreen Köhler
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Vladimir Benes
- EMBL, European Molecular Biology Laboratory, Genomics Core Facility, D-69117 Heidelberg, Germany
| | - Hugo A Katus
- Department of Medicine III, University of Heidelberg, D-69120 Heidelberg, Germany German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, D-69120 Heidelberg, Germany
| | | |
Collapse
|
13
|
Criée CP, Baur X, Berdel D, Bösch D, Gappa M, Haidl P, Husemann K, Jörres RA, Kabitz HJ, Kardos P, Köhler D, Magnussen H, Merget R, Mitfessel H, Nowak D, Ochmann U, Schürmann W, Smith HJ, Sorichter S, Voshaar T, Worth H. [Standardization of spirometry: 2015 update. Published by German Atemwegsliga, German Respiratory Society and German Society of Occupational and Environmental Medicine]. Pneumologie 2015; 69:147-64. [PMID: 25750095 DOI: 10.1055/s-0034-1391345] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.
Collapse
Affiliation(s)
| | - X Baur
- Charité - Universitätsklinik Berlin, Berlin
| | | | - D Bösch
- Pneumologische Klinik Dingolfing - Deggendorf, Donau Isar Klinikum
| | | | - P Haidl
- Fachkrankenhaus Kloster Grafschaft, Schmallenberg
| | - K Husemann
- Robert-Bosch-Krankenhaus/Klinik Schillerhöhe, Gerlingen
| | - R A Jörres
- Arbeits-, Sozial-, Umweltmedizin, Klinikum Universität München
| | - H-J Kabitz
- II. Medizinische Klinik, Klinikum Konstanz
| | - P Kardos
- Internistische Facharztpraxis und Zentrum für Allergologie, Pneumologie Schlafmedizin an der Klinik Maingau, Frankfurt am Main
| | - D Köhler
- Klinik Kloster Grafschaft, Schmallenberg, seit Mitte 2013 Ruhestand
| | - H Magnussen
- Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf
| | - R Merget
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität-Bochum (IPA)
| | | | - D Nowak
- Arbeits-, Sozial-, Umweltmedizin, Klinikum Universität München
| | - U Ochmann
- Arbeits-, Sozial-, Umweltmedizin, Klinikum Universität München
| | | | | | - S Sorichter
- RKK-Klinikum, St. Josefskrankenhaus, Freiburg
| | | | | |
Collapse
|
14
|
Kerl J, Höhn E, Heyse DC, Köhler D, Dellweg D. Vergleich von spontaneous/timed und time adaptive Modus bei der Einleitung einer nichtinvasiven Beatmung. Prospektive randomisierte cross-over Studie. Pneumologie 2015. [DOI: 10.1055/s-0035-1544599] [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]
|
15
|
Heyse DC, Böckling S, Dellweg D, Siemon K, Köhler D, Barchfeld T, Höhn E. Vorbeatmungszeit, Verwirrtheit, Bicarbonat und Dauer des ersten Spontanatmungsversuches nach Übernahme von Patienten im prolongierten Weaning bestimmen hauptsächlich die Weaningzeit. Pneumologie 2015. [DOI: 10.1055/s-0035-1544597] [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]
|
16
|
Böckling S, Heyse DC, Siemon K, Schürholz G, Höhn E, Spiekermann D, Schauerte S, Dellweg D, Köhler D. Tubusentfernung oder stabile Eigenatmung (incl. NIV). Welche Weaningdefinition korreliert besser mit den pathophysiologischen Parametern? Pneumologie 2015. [DOI: 10.1055/s-0035-1544596] [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]
|
17
|
Böckling S, Heyse D, Siemon K, Höhn E, Schauerte S, Schuerholz G, Spiekermann D, Dellweg D, Köhler D. Kontrollierte Beatmung senkt die Sauerstoffaufnahme (V'O2) und erhöht die Kohlendioxidabgabe (V'CO2) im Vergleich zur Spontanatmung bei Patienten im prolongiertem Weaning. Pneumologie 2015. [DOI: 10.1055/s-0035-1544884] [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]
|
18
|
Siemon K, Graw W, Höhn E, Barchfeld T, Schönhofer B, Köhler D, Dellweg D. Frührehabilitation nach Langzeitbeatmung – Ergebnisse einer Modelleinrichtung. Pneumologie 2015. [DOI: 10.1055/s-0035-1544888] [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]
|
19
|
Köhler D. Wer profitiert von Sauerstoff-Langzeittherapie? – Keine Sauerstoff-Langzeittherapie ohne Phänotypisierung der COPD. Dtsch Med Wochenschr 2014; 139:2171-2. [DOI: 10.1055/s-0033-1353921] [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]
|
20
|
Haas J, Frese KS, Peil B, Kloos W, Keller A, Nietsch R, Feng Z, Müller S, Kayvanpour E, Vogel B, Sedaghat-Hamedani F, Lim WK, Zhao X, Fradkin D, Köhler D, Fischer S, Franke J, Marquart S, Barb I, Li DT, Amr A, Ehlermann P, Mereles D, Weis T, Hassel S, Kremer A, King V, Wirsz E, Isnard R, Komajda M, Serio A, Grasso M, Syrris P, Wicks E, Plagnol V, Lopes L, Gadgaard T, Eiskjær H, Jørgensen M, Garcia-Giustiniani D, Ortiz-Genga M, Crespo-Leiro MG, Deprez RHLD, Christiaans I, van Rijsingen IA, Wilde AA, Waldenstrom A, Bolognesi M, Bellazzi R, Mörner S, Bermejo JL, Monserrat L, Villard E, Mogensen J, Pinto YM, Charron P, Elliott P, Arbustini E, Katus HA, Meder B. Atlas of the clinical genetics of human dilated cardiomyopathy. Eur Heart J 2014; 36:1123-35a. [DOI: 10.1093/eurheartj/ehu301] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 12/18/2022] Open
|
21
|
Granja T, Köhler D, Mirakaj V, Nelson E, König K, Rosenberger P. Crucial role of Plexin C1 for pulmonary inflammation and survival during lung injury. Mucosal Immunol 2014; 7:879-91. [PMID: 24345803 DOI: 10.1038/mi.2013.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/25/2013] [Accepted: 10/26/2013] [Indexed: 02/04/2023]
Abstract
Acute pulmonary inflammation during lung injury is initiated by the migration of neutrophils into the alveolar space. The severity of these inflammatory changes within the pulmonary tissue determines the severity of lung injury and ultimately patient outcome. Recent work has demonstrated that the guidance protein Semaphorin 7A propagates the infiltration of neutrophils into an hypoxic tissue site, yet the role of its target receptor Plexin C1 (PLXNC1) during lung injury is to date unknown. We demonstrate here that PLXNC1(+) neutrophils are present within the alveolar space and that PLXNC1 is induced in vitro and in vivo during lung injury. In a model of high-pressure ventilation PLXNC1(-/-) animals show decreased signs of alveolar inflammation and improved survival compared with wild-type controls. Studies employing chimeric animals identified the hematopoietic expression of PLXNC1 to be of crucial importance for the observed results. Functional inhibition of PLXNC1 resulted in improved survival and ameliorated the signs of inflammation within the lung. Furthermore, the injection of a peptide binding to PLXNC1 resulted in improved survival and attenuated pulmonary inflammation. As such we demonstrate here, that previously unknown PLXNC1 holds significant importance for degree of pulmonary inflammation and determines outcome during experimental lung injury.
Collapse
Affiliation(s)
- T Granja
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital; Eberhard-Karls University, Tübingen, Germany
| | - D Köhler
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital; Eberhard-Karls University, Tübingen, Germany
| | - V Mirakaj
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital; Eberhard-Karls University, Tübingen, Germany
| | - E Nelson
- Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K König
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital; Eberhard-Karls University, Tübingen, Germany
| | - P Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital; Eberhard-Karls University, Tübingen, Germany
| |
Collapse
|
22
|
Heyse DC, Dellweg D, Barchfeld T, Böckling S, Köhler D. Lungenfunktionsdaten von 314 erfolgreich entwöhnten Langzeitbeatmungspatienten. Pneumologie 2014. [DOI: 10.1055/s-0034-1367803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Al-Kharouf A, Sarma N, Höhn E, Siemon K, Haidl P, Köhler D, Dellweg D. CO2 Rückatmung in den Atemschlauch unter NIV – gefährden wir unsere Patienten? Pneumologie 2014. [DOI: 10.1055/s-0034-1368062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Dellweg D, Barchfeld T, Böckling S, Schürholz G, Figge M, Conze S, Kloske K, Köhler D. Monozentrische Outcomedaten von der prolongierten Beatmung von 2007 bis 2011. Pneumologie 2014. [DOI: 10.1055/s-0034-1367799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
25
|
Reißig K, Sassmannshausen C, Clement C, Köhler D, Haidl P. Endoskopische Kontrastmittelgabe und Thorax-CT zur Beurteilung der kollateralen Ventilation bei Lungenemphysem – eine neue Methode. Pneumologie 2014. [DOI: 10.1055/s-0034-1367869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
Köhler D, Arnold R, Loukanov T, Gorenflo M. Right ventricular failure and pathobiology in patients with congenital heart disease - implications for long-term follow-up. Front Pediatr 2013; 1:37. [PMID: 24400283 PMCID: PMC3864255 DOI: 10.3389/fped.2013.00037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/04/2013] [Indexed: 11/13/2022] Open
Abstract
Right ventricular dysfunction represents a common problem in patients with congenital heart defects, such as Tetralogy of Fallot or pulmonary arterial hypertension. Patients with congenital heart defects may present with a pressure or volume overloaded right ventricle (RV) in a bi-ventricular heart or in a single ventricular circulation in which the RV serves as systemic ventricle. Both subsets of patients are at risk of developing right ventricular failure. Obtaining functional and morphological imaging data of the right heart is technically more difficult than imaging of the left ventricle. In contrast to findings on mechanisms of left ventricular dysfunction, very little is known about the pathophysiologic alterations of the right heart. The two main causes of right ventricular dysfunction are pressure and/or volume overload of the RV. Until now, there are no appropriate models available analyzing the effects of pressure and/or volume overload on the RV. This review intends to summarize clinical aspects mainly focusing on the current research in this field. In future, there will be increasing attention to individual care of patients with right heart diseases. Hence, further investigations are essential for understanding the right ventricular pathobiology.
Collapse
Affiliation(s)
- Doreen Köhler
- Department of Pediatric Cardiology, University of Heidelberg , Heidelberg , Germany
| | - Raoul Arnold
- Department of Pediatric Cardiology, University of Heidelberg , Heidelberg , Germany
| | - Tsvetomir Loukanov
- Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, University of Heidelberg , Heidelberg , Germany
| | - Matthias Gorenflo
- Department of Pediatric Cardiology, University of Heidelberg , Heidelberg , Germany
| |
Collapse
|
27
|
Barchfeld T, Dellweg D, Böckling S, Conze S, Kloske K, Schürholz G, Figge M, Köhler D. [Weaning from long-term mechanical ventilation: data of a single weaning center from 2007 to 2011]. Dtsch Med Wochenschr 2013; 139:527-33. [PMID: 24203587 DOI: 10.1055/s-0033-1349650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Regional weaning centers play a more and more important role in the weaning process of long-term ventilated patients. The medical center Kloster Grafschaft is one of the oldest and largest centers in Germany. There is very little published data from larger weaning centers in Europe. METHODS From 2007 to 2011 all weaning patients were registered in a database. Additional information of the transferring hospitals was inquired. Prolonged weaning was defined by a period of at least 7 days of mechanical ventilation as well as three unsuccessful weaning trials. RESULTS Data from 867 of 916 registered patients could be analyzed. 71.1% could be successfully weaned from mechanical ventilation. All patients were suffering from a hypercapnic insufficiency as well as a variety of secondary diagnoses, on average 15.1 per patient. The median of age was 70 years, 62 % were male. Prior to hospital transfer patients had been ventilated for a median of 41 days. Time to successful removal of the artificial airway was 8 days according to the DRG code directive and 13.4 days when non-invasive ventilation (NIV) time was included. Of the 616 patients who could be successfully weaned, 42 % were discharged on NIV. Out of the 251 patients who could not be weaned, 107 were discharged. The remaining 144 (16.7 %) patients died, 33 % due to the primary underlying disease or a complication. 66 % of the deceased patients received palliative care. Patients with successful and unsuccessful weaning did not differ by age, by duration of mechanical ventilation or time until tracheostomy. Postoperative patients could be weaned more often than medical patients (p < 0.05). Discrimination between patients with successful and unsuccessful weaning was not possible by the point in time of the first spontaneous breathing trial in regard to the duration of ventilation but only by the duration of this trial after transfer to our unit (150 vs. 60 min; p < 10-6). The TISS-28 and the SAPS-II-Score did not differ between the two groups. Patients with successful weaning had less agitation according to the RASS-Score (0.47 vs. 0.15; p < 0.005). CONCLUSION It becomes apparent that in a specialized weaning center the majority of difficult to wean patients can be liberated in short time from mechanical ventilation.
Collapse
Affiliation(s)
- T Barchfeld
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - D Dellweg
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - S Böckling
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - S Conze
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - K Kloske
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - G Schürholz
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - M Figge
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - D Köhler
- Krankenhaus Kloster Grafschaft, Schmallenberg
| |
Collapse
|
28
|
Köhler D. Kann ein automatisiertes Weaning die Beatmungsdauer verkürzen? Dtsch Med Wochenschr 2013; 138:1876. [DOI: 10.1055/s-0032-1329165] [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]
|
29
|
Haas J, Frese KS, Park YJ, Keller A, Vogel B, Lindroth AM, Weichenhan D, Franke J, Fischer S, Bauer A, Marquart S, Sedaghat-Hamedani F, Kayvanpour E, Köhler D, Wolf NM, Hassel S, Nietsch R, Wieland T, Ehlermann P, Schultz JH, Dösch A, Mereles D, Hardt S, Backs J, Hoheisel JD, Plass C, Katus HA, Meder B. Alterations in cardiac DNA methylation in human dilated cardiomyopathy. EMBO Mol Med 2013; 5:413-29. [PMID: 23341106 PMCID: PMC3598081 DOI: 10.1002/emmm.201201553] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 11/15/2012] [Accepted: 11/29/2012] [Indexed: 12/25/2022] Open
Abstract
Dilated cardiomyopathies (DCM) show remarkable variability in their age of onset, phenotypic presentation, and clinical course. Hence, disease mechanisms must exist that modify the occurrence and progression of DCM, either by genetic or epigenetic factors that may interact with environmental stimuli. In the present study, we examined genome-wide cardiac DNA methylation in patients with idiopathic DCM and controls. We detected methylation differences in pathways related to heart disease, but also in genes with yet unknown function in DCM or heart failure, namely Lymphocyte antigen 75 (LY75), Tyrosine kinase-type cell surface receptor HER3 (ERBB3), Homeobox B13 (HOXB13) and Adenosine receptor A2A (ADORA2A). Mass-spectrometric analysis and bisulphite-sequencing enabled confirmation of the observed DNA methylation changes in independent cohorts. Aberrant DNA methylation in DCM patients was associated with significant changes in LY75 and ADORA2A mRNA expression, but not in ERBB3 and HOXB13. In vivo studies of orthologous ly75 and adora2a in zebrafish demonstrate a functional role of these genes in adaptive or maladaptive pathways in heart failure.
Collapse
MESH Headings
- Adult
- Aged
- Animals
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Biopsy
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/metabolism
- Cardiomyopathy, Dilated/physiopathology
- Case-Control Studies
- Cluster Analysis
- DNA Methylation
- Epigenesis, Genetic
- Female
- Gene Expression Regulation
- Gene Knockdown Techniques
- Genetic Predisposition to Disease
- HEK293 Cells
- Humans
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- Male
- Mass Spectrometry
- Middle Aged
- Minor Histocompatibility Antigens
- Molecular Sequence Data
- Myocardium/metabolism
- Phenotype
- RNA, Messenger/metabolism
- Rats
- Receptor, Adenosine A2A/genetics
- Receptor, Adenosine A2A/metabolism
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Reproducibility of Results
- Sequence Analysis, DNA/methods
- Sequence Analysis, Protein
- Transfection
- Zebrafish/genetics
- Zebrafish/metabolism
- Zebrafish Proteins/genetics
- Zebrafish Proteins/metabolism
Collapse
Affiliation(s)
- Jan Haas
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Karen S Frese
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Yoon Jung Park
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ)Heidelberg, Germany
- Department of Nutritional Science and Food Management, Ewha Womans UniversitySeoul, South Korea
| | - Andreas Keller
- Department of Human Genetics, Saarland UniversityGermany
| | - Britta Vogel
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Anders M Lindroth
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Dieter Weichenhan
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Jennifer Franke
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Simon Fischer
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Andrea Bauer
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Sabine Marquart
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | | | - Elham Kayvanpour
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Doreen Köhler
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Nadine M Wolf
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
- Medical Faculty Mannheim, Institute of Experimental and Clinical Pharmacology and Toxicology, Heidelberg UniversityMannheim, Germany
| | - Sarah Hassel
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Rouven Nietsch
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Thomas Wieland
- Medical Faculty Mannheim, Institute of Experimental and Clinical Pharmacology and Toxicology, Heidelberg UniversityMannheim, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/MannheimMannheim, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University Hospital HeidelbergHeidelberg, Germany
| | - Andreas Dösch
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Stefan Hardt
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
| | - Johannes Backs
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/MannheimHeidelberg, Germany
| | - Jörg D Hoheisel
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Christoph Plass
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ)Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/MannheimHeidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/MannheimHeidelberg, Germany
| | - Benjamin Meder
- Department of Internal Medicine III, University of HeidelbergHeidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/MannheimHeidelberg, Germany
| |
Collapse
|
30
|
Haas J, Frese KS, Park YJ, Keller A, Vogel B, Lindroth AM, Weichenhan D, Franke J, Fischer S, Bauer A, Marquart S, Sedaghat-Hamedani F, Kayvanpour E, Köhler D, Wolf NM, Hassel S, Nietsch R, Wieland T, Ehlermann P, Schultz JH, Dösch A, Mereles D, Hardt S, Backs J, Hoheisel JD, Plass C, Katus HA, Meder B. Alterations in cardiac DNA methylation in human dilated cardiomyopathy. EMBO Mol Med 2013. [PMID: 23341106 DOI: 10.1002/emmm.20120155] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Dilated cardiomyopathies (DCM) show remarkable variability in their age of onset, phenotypic presentation, and clinical course. Hence, disease mechanisms must exist that modify the occurrence and progression of DCM, either by genetic or epigenetic factors that may interact with environmental stimuli. In the present study, we examined genome-wide cardiac DNA methylation in patients with idiopathic DCM and controls. We detected methylation differences in pathways related to heart disease, but also in genes with yet unknown function in DCM or heart failure, namely Lymphocyte antigen 75 (LY75), Tyrosine kinase-type cell surface receptor HER3 (ERBB3), Homeobox B13 (HOXB13) and Adenosine receptor A2A (ADORA2A). Mass-spectrometric analysis and bisulphite-sequencing enabled confirmation of the observed DNA methylation changes in independent cohorts. Aberrant DNA methylation in DCM patients was associated with significant changes in LY75 and ADORA2A mRNA expression, but not in ERBB3 and HOXB13. In vivo studies of orthologous ly75 and adora2a in zebrafish demonstrate a functional role of these genes in adaptive or maladaptive pathways in heart failure.
Collapse
Affiliation(s)
- Jan Haas
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kerl J, Dellweg D, Köhler D. Möglichkeiten und Grenzen der Interpretation von Pulswellen bei der Untersuchung physiologischer Parameter im Schlaflabor. Somnologie 2012. [DOI: 10.1007/s11818-012-0596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
32
|
Jaminet P, Schäufele M, Geuna S, Schaller HE, Rosenberger P, Köhler D. [Scope and limitations of the median nerve mouse model in research on peripheral nerve regeneration]. HANDCHIR MIKROCHIR P 2012; 44:204-8. [PMID: 22878893 DOI: 10.1055/s-0032-1321771] [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: 10/28/2022] Open
Abstract
INTRODUCTION Peripheral nerve regeneration is usually studied in rat animal models (N. medianus or N. ischiadicus). In this article, we further evaluate the mouse median nerve model with its advantages and possible pitfalls. MATERIALS AND METHODS 24 mice (C57BL/6) were operated. The median nerve was exposed in the left axilla. After transection, immediate microsurgical repair followed using 11/0 sutures. In the contralateral axilla, 1 cm of median nerve was resected. After the operation, functional regeneration of the median nerve was assessed using the grasping test. Histological analysis was performed after staining with toluidine blue. RESULTS All animals survived the procedure. Grip strength increased starting at day 10 and reached its maximum at day 35. Myelinated fibres in the regenerated nerves showed a smaller diameter and a thinner myelin sheath and the typical microfasciculation of regenerated nerve fibres in comparison to the uninjured nerve. CONCLUSION The mouse median nerve model is technically demanding but opens a wide field of possible research options using genetically modified mice.
Collapse
Affiliation(s)
- P Jaminet
- Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen.
| | | | | | | | | | | |
Collapse
|
33
|
Kerl J, Dellweg D, Köhler D. Flusslimitierung, UARS und RERAs: Klare Begriffe im Schlaflabor? Pneumologie 2012. [DOI: 10.1055/s-0032-1306398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Köhler D. Ist Sauerstoff auch bei COPD und nur milder Hypoxämie sinnvoll? Dtsch Med Wochenschr 2012; 137:355. [DOI: 10.1055/s-0032-1301773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Leising D, Krause S, Köhler D, Hinsen K, Clifton A. Assessing interpersonal functioning: Views from within and without. Journal of Research in Personality 2011. [DOI: 10.1016/j.jrp.2011.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
36
|
Köhler D, Dellweg D, Kerl J. Eingeschränkte Leistungsfähigkeit bei pneumologischen Erkrankungen. Somnologie 2011. [DOI: 10.1007/s11818-011-0536-7] [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: 11/29/2022]
|
37
|
|
38
|
Hämäläinen N, Köhler D, Rabe K, Wirtz H. Institut für Lungenforschung - ein neues Organ zur Entwicklungsförderung der Pneumologie. Dtsch Med Wochenschr 2011; 136:651-2. [DOI: 10.1055/s-0031-1274559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
39
|
Kerl J, Körber D, Dellweg D, Köhler D. Kritische Anmerkungen zur Methodik der Staudruckmessung. Pneumologie 2011. [DOI: 10.1055/s-0031-1273039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Ay M, Siemon K, Haidl P, Köhler D. Lungenödem und Mediastinalemphysem als Folge einer Intubationsnarkose. Pneumologie 2011. [DOI: 10.1055/s-0031-1272267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
41
|
Barchfeld T, Dellweg D, Böckling S, Köhler D. Liberales versus restriktives Transfusionsregime beim prolongierten Weaning von langzeitbeatmeten Patienten (WeanTrans-Trial) Vorstellung einer prospektiven, randomisierten Studie. Pneumologie 2011. [DOI: 10.1055/s-0031-1272274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
42
|
Dellweg D, Haidl P, Pape B, Köhler D. Der Transferkoeffizient ist prädiktiv für die Zunahme der Wegstrecke unter Sauerstoff in Patienten mit COPD und Lungenfibrose. Pneumologie 2011. [DOI: 10.1055/s-0031-1272212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Barchfeld T, Dellweg D, Siemon K, Köhler D. Therapiebegrenzung und -rückzug am Lebensende bei invasiv beatmeten Patienten; Daten aus einem großen Weaningzentrum. Pneumologie 2011. [DOI: 10.1055/s-0031-1272016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
44
|
Criée CP, Sorichter S, Smith HJ, Kardos P, Merget R, Heise D, Berdel D, Köhler D, Magnussen H, Marek W, Mitfessel H, Rasche K, Rolke M, Worth H, Jörres RA. Body plethysmography--its principles and clinical use. Respir Med 2011; 105:959-71. [PMID: 21356587 DOI: 10.1016/j.rmed.2011.02.006] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [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: 09/30/2010] [Revised: 01/07/2011] [Accepted: 02/06/2011] [Indexed: 01/14/2023]
Abstract
Body plethysmography allows to assess functional residual capacity (FRC(pleth)) and specific airway resistance (sRaw) as primary measures. In combination with deep expirations and inspirations, total lung capacity (TLC) and residual volume (RV) can be determined. Airway resistance (Raw) is calculated as the ratio of sRaw to FRC(pleth). Raw is a measure of airway obstruction and indicates the alveolar pressure needed to establish a flow rate of 1 L s(-1). In contrast, sRaw can be interpreted as the work to be performed by volume displacement to establish this flow rate. These measures represent different functional aspects and should both be considered. The measurement relies on the fact that generation of airflow needs generation of pressure. Pressure generation means that a mass of air is compressed or decompressed relative to its equilibrium volume. This difference is called "shift volume". As the body box is sealed and has rigid walls, its free volume experiences the same, mirror image-like shift volume as the lung. This shift volume can be measured via the variation of box pressure. The relationship between shift volume and alveolar pressure is assessed in a shutter maneuver, by identifying mouth and alveolar pressure under zero-flow conditions. These variables are combined to obtain FRC(pleth), sRaw and Raw. This presentation aims at providing the reader with a thorough and precise but non-technical understanding of the working principle of body plethysmography. It also aims at showing that this method yields significant additional information compared to spirometry and even bears a potential for further development.
Collapse
Affiliation(s)
- C P Criée
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Department of Pneumology, Respiratory Care, Sleep Medicine, Pappelweg 5, D-37120 Bovenden-Lenglern, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Köhler D, Haidl P. [Oxygen in medicine]. Pneumologie 2011; 65:25-35; quiz 36. [PMID: 21243562 DOI: 10.1055/s-0030-1255783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Köhler
- Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg.
| | | |
Collapse
|
46
|
Baur X, Clasen M, Fisseler-Eckhoff A, Heger M, Hering KG, Hofmann-Preiss K, Köhler D, Kranig A, Kraus T, Letzel S, Neumann V, Tannapfel A, Schneider J, Sitter H, Teschler H, Voshaar T, Weber A. [Diagnostics and expert opinion of asbestos-induced occupational diseases]. Pneumologie 2011; 65:e1-47. [PMID: 21246483 DOI: 10.1055/s-0030-1255992] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- X Baur
- Ordinariat für Arbeitsmedizin, Universitätsklinikum Hamburg-Eppendorf.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Polycythemia is defined by the increase of hematocrit and haemoglobin respectively. Possible causes might be neoplastic diseases like polycythemia vera with proliferation of a cell clone. More often one will find reactive forms resulting from chronic hypoxemia. A physiologic form of polycythemia can be found in highlanders and athletes training at high altitude. With increasing frequency erytrhopoetin and it's analoga are being used as doping substances to induce Polycythemia. Red cell proliferation induced by chronic hypoxemia is the most common form in patients. In this instance the lung itself can be the cause (hypoxemia with hypocapnea in blood gas analysis) or hypoventilation caused by an insufficient respiratory pump (hypercapnea with hypoxemia in blood gas analysis) induces a compensatory Polycythemia. The former form can be treated with long term oxygen therapy and the latter by non-invasive ventilation, either approach corrects hypoxemia and reduces Polycythemia within some weeks.
Collapse
Affiliation(s)
- D Köhler
- Fachkrankenhaus Kloster Grafschaft, Schmallenberg.
| | | |
Collapse
|
48
|
Dellweg D, Kerl J, Höhn E, Köhler D. Komplexe Schlafapnoe: Head to head Vergleich von Bilevel und Somnovent CR Ventilation. Pneumologie 2010. [DOI: 10.1055/s-0030-1267756] [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]
|
49
|
Körber D, Kerl J, Dellweg D, Klauke M, Köhler D. Aufzeichnung und Auswertung der Staudruckmessung im Hinblick auf die Anwendung der AASM-Richtlinien. Pneumologie 2010. [DOI: 10.1055/s-0030-1267743] [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]
|
50
|
Schönhofer B, Pfeifer M, Köhler D. [Protracted respiratory insufficiency - epidemiology and network on respiratory weaning after prolonged ventilation]. Pneumologie 2010; 64:595-9. [PMID: 20827645 DOI: 10.1055/s-0030-1255624] [Citation(s) in RCA: 2] [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: 10/19/2022]
Abstract
The prevalence of difficult or prolonged weaning from the ventilator is increasing due to a growing number of multi-morbid, elderly and pulmonary deficient patients being mechanically ventilated. Intensive care units (ICU) tend to refer difficult to wean patients to specialised weaning facilities. A survey of 38 centres - performed in 2006 - included a total number of 2718 patients with difficult or prolonged weaning. Almost three quarters of the patients were transferred to a weaning centre from an external ICU. The weaning success rate was 66.3 %. After weaning in 31.9 % of the patients, home mechanical ventilation was started. The overall hospital mortality rate was 20.8 %. Recently the task force "WeanNet" - a network of weaning units - was founded under the auspices of the German Thoracic Society. The main aim of WeanNet is to improve cooperation among the weaning centres and the quality of patient management. Important tools of WeanNet are (i) the register of weaning patients and (ii) accreditation of the weaning centres. To develop the register an intensive cooperation between the task force and the Institute for Lung Research (ILF) was necessary. The finished register is now logistically run by ILF. In less than 1 year after the official start, already 70 weaning units with ca. 3000 patients are registered. In future "WeanNet", in particular in terms of the register and the accreditation, will stand for the quality of weaning centres in Germany.
Collapse
Affiliation(s)
- B Schönhofer
- Abteilung Pneumologie und Intern, Intensivmedizin, Klinikum Region Hannover, Hannover.
| | | | | |
Collapse
|