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Özbaş B, Keskin O, Hecker H, Karahan I, Özbaş C, Kalkan Ç, Kartal A, Önder FO, Öncü BK, Gençdal G, Akyildiz M, Günşar F, Idilman R, Weissenborn K, Özütemiz Ö, Yurdaydin C. Determination of Turkish norms of psychometric tests for diagnosing minimal hepatic encephalopathy and proposal of a high sensitive screening test battery. Hepatol Int 2021; 15:1442-1455. [PMID: 34085147 DOI: 10.1007/s12072-021-10207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychometric hepatic encephalopathy score (PHES) needs local standardization. AIMS This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE. METHODS Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery. RESULTS PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES. CONCLUSIONS Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.
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Affiliation(s)
- Burak Özbaş
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Hartmut Hecker
- Department of Biometrics, Hannover Medical School, Hannover, Germany
| | - Irfan Karahan
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Cansu Özbaş
- Department of Public Health, Gazi University Medical School, Ankara, Turkey
| | - Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Aysun Kartal
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Fatih Oğuz Önder
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Burcu Kahveci Öncü
- Department of Psychiatry, Ankara University Medical School, Ankara, Turkey
| | - Genco Gençdal
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Fulya Günşar
- Department of Gastroenterology, Ege University Medical School, Izmir, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | | | - Ömer Özütemiz
- Department of Gastroenterology, Ege University Medical School, Izmir, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey.
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Dietrich DE, Bode L, Spannhuth CW, Hecker H, Ludwig H, Emrich HM. Antiviral treatment perspective against Borna disease virus 1 infection in major depression: a double-blind placebo-controlled randomized clinical trial. BMC Pharmacol Toxicol 2020; 21:12. [PMID: 32066504 PMCID: PMC7027224 DOI: 10.1186/s40360-020-0391-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/29/2019] [Accepted: 02/05/2020] [Indexed: 12/19/2022] Open
Abstract
Background Whether Borna disease virus (BDV-1) is a human pathogen remained controversial until recent encephalitis cases showed BDV-1 infection could even be deadly. This called to mind previous evidence for an infectious contribution of BDV-1 to mental disorders. Pilot open trials suggested that BDV-1 infected depressed patients benefitted from antiviral therapy with a licensed drug (amantadine) which also tested sensitive in vitro. Here, we designed a double-blind placebo-controlled randomized clinical trial (RCT) which cross-linked depression and BDV-1 infection, addressing both the antidepressant and antiviral efficacy of amantadine. Methods The interventional phase II RCT (two 7-weeks-treatment periods and a 12-months follow-up) at the Hannover Medical School (MHH), Germany, assigned currently depressed BDV-1 infected patients with either major depression (MD; N = 23) or bipolar disorder (BD; N = 13) to amantadine sulphate (PK-Merz®; twice 100 mg orally daily) or placebo treatment, and contrariwise, respectively. Clinical changes were assessed every 2–3 weeks by the 21-item Hamilton rating scale for depression (HAMD) (total, single, and combined scores). BDV-1 activity was determined accordingly in blood plasma by enzyme immune assays for antigens (PAG), antibodies (AB) and circulating immune complexes (CIC). Results Primary outcomes (≥25% HAMD reduction, week 7) were 81.3% amantadine vs. 35.3% placebo responder (p = 0.003), a large clinical effect size (ES; Cohen’s d) of 1.046, and excellent drug tolerance. Amantadine was safe reducing suicidal behaviour in the first 2 weeks. Pre-treatment maximum infection levels were predictive of clinical improvement (AB, p = 0.001; PAG, p = 0.026; HAMD week 7). Respective PAG and CIC levels correlated with AB reduction (p = 0,001 and p = 0.034, respectively). Follow-up benefits (12 months) correlated with dropped cumulative infection measures over time (p < 0.001). In vitro, amantadine concentrations as low as 2.4–10 ng/mL (50% infection-inhibitory dose) prevented infection with human BDV Hu-H1, while closely related memantine failed up to 100,000-fold higher concentration (200 μg/mL). Conclusions Our findings indicate profound antidepressant efficacy of safe oral amantadine treatment, paralleling antiviral effects at various infection levels. This not only supports the paradigm of a link of BDV-1 infection and depression. It provides a novel possibly practice-changing low cost mental health care perspective for depressed BDV-1-infected patients addressing global needs. Trial registration The trial was retrospectively registered in the German Clinical Trials Registry on 04th of March 2015. The trial ID is DRKS00007649; https://www.drks.de/drks_web/setLocale_EN.do
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Affiliation(s)
- Detlef E Dietrich
- Department of Psychiatry, Burghof-Clinic, Ritterstr. 19, 31737, Rinteln, Germany. .,Center for Systems Neuroscience, Bünteweg 2, 30559, Hanover, Germany. .,Department of Mental Health, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| | - Liv Bode
- Joint Senior Scientists, Freelance Bornavirus Workgroup, Beerenstr. 41, 14163, Berlin, Germany.
| | - Carsten W Spannhuth
- Department of Mental Health, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Hartmut Hecker
- Department of Biometrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Hanns Ludwig
- Joint Senior Scientists, Freelance Bornavirus Workgroup, Beerenstr. 41, 14163, Berlin, Germany
| | - Hinderk M Emrich
- Department of Mental Health, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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Ius F, Salman J, Knoefel AK, Sommer W, Nakagiri T, Verboom M, Siemeni T, Poyanmehr R, Bobylev D, Kuehn C, Avsar M, Erdfelder C, Hallensleben M, Boethig D, Hecker H, Schwerk N, Mueller C, Welte T, Falk C, Preissler G, Haverich A, Tudorache I, Warnecke G. Increased frequency of CD4 + CD25 high CD127 low T cells early after lung transplant is associated with improved graft survival - a retrospective study. Transpl Int 2020; 33:503-516. [PMID: 31903646 DOI: 10.1111/tri.13568] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 02/06/2019] [Revised: 05/04/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
In this retrospective study, we analyzed the presence of any association of three CD4+ CD25high regulatory T-cell subpopulations at 3 weeks after lung transplantation with the later incidence of chronic lung allograft dysfunction and graft survival. Among lung-transplanted patients between January 2009 and April 2018, only patients with sufficient T-cell measurements at 3 weeks after transplantation were included into the study. Putative regulatory T cells were defined as CD4+ CD25high T cells, detected in peripheral blood and further analyzed for CD127low , FoxP3+ , and CD152+ using fluorescence-activated cell sorting (FACS) analysis. Associations of regulatory T cells with chronic lung allograft dysfunction (CLAD) and graft survival were evaluated using Cox analysis. During the study period, 724 (71%) patients were included into the study. Freedom from chronic lung allograft dysfunction (CLAD) and graft survival amounted to 66% and 68% at 5 years. At the multivariable analysis, increasing frequencies of CD127low were associated with better freedom from CLAD (hazard ratio for each 1% increase of %CD127low , HR = 0.989, 95% CI = 0.981-0.996, P = 0.003) and better graft survival (HR = 0.991, 95% CI = 0.984-0.999, P = 0.026). A higher frequency of CD127low regulatory T cells in peripheral blood early after lung transplantation estimated a protective effect against chronic lung allograft dysfunction, mortality, and re-transplantation.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ann-Kathrin Knoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Tomoyuki Nakagiri
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murielle Verboom
- Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Dietmar Boethig
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hartmut Hecker
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Mueller
- Department of pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Gerhard Preissler
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Surgery, Munich Lung Transplant Group, Ludwig-Maximilian's University, Munich, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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Hecker H, Basler HD, Wolf E. Schwankungen der Mortalität in Beziehung zur Luftverschmutzung. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1635715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Es wird ein mathematisches Modell vorgestellt, welches die Abhängigkeit der Mortalität von der Jahreszeit, von äußeren Einflußgrößen (wie z.B. Luftverschmutzung, Temperatur) und von den Sterbezahlen der nahen Vergangenheit beschreibt. Das Modell ist auf Gebiete abgestimmt, in denen die Abweichungen der äußeren Variablen vom je\yeils aufgrund der Jahreszeit zu erwartenden Wertnicht extrem sind. Für den kurzzeitigen Einfluß solcher Schwankungen sowie für den Einfluß der Saisonkomponenten auf die Mortalität werden einfache Testverfahren angegeben. Das Modéll wird anschließend auf ein Beispiel aus Hannover angewandt, in dem als äußere Einfluß-große die SO2-Konzentration als Ladikator für die Luftverschmutzung betrachtet wird.
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Boethig D, Hecker H. Multiply adjusted comparisons: A meta-analysis method to compare single-arm clinical-trial data to literature results regarding a competitor. Stat Methods Med Res 2017; 28:644-669. [PMID: 29027509 DOI: 10.1177/0962280217733776] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prospective randomized controlled trials are difficult to obtain if a promising new therapy has to be tested against seemingly obsolete alternatives. One method to address this problem is to compare the results of (multicentre) trials to literature results. However, previous treatment-era changes and population-dependent results complicate objective comparisons. The presented approach describes a method to objectify such comparisons in cases in which individual raw data regarding a new therapy have to be compared to summary results regarding a conventional alternative published in the literature. The chosen example is the introduction of bovine neck veins as a substitute for dysfunctional human pulmonary valves, and the conventional therapeutic alternative is pulmonary-artery homografts. Literature research, subgroup identification, filtering, endpoint remodelling, weighting and, if necessary, confidence-limit calculation yield adjusted comparisons. These individual comparisons are then aggregated, first by article and then over several articles (similar to meta-analyses), resulting in a differentiated panel of answers (Multiply Adjusted Comparisons). In situations in which extensive raw data regarding a new therapeutic alternative but no randomized controlled trials and no raw data from previous studies using the conventional therapeutic alternative are available, the proposed method identifies the best evidence and is by far superior to unadjusted direct comparisons or gut feelings.
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Affiliation(s)
- Dietmar Boethig
- 1 Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hartmut Hecker
- 2 Department of Biometry, Hannover Medical School, Hannover, Germany
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Dirks M, Pflugrad H, Haag K, Tillmann HL, Wedemeyer H, Arvanitis D, Hecker H, Tountopoulou A, Goldbecker A, Worthmann H, Weissenborn K. Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?! J Viral Hepat 2017; 24:541-550. [PMID: 28117537 DOI: 10.1111/jvh.12674] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 10/13/2016] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Abstract
One of the most disabling symptoms of hepatitis C virus (HCV) infection is chronic fatigue. While this is accepted for HCV polymerase chain reaction (PCR)-positive patients, a relationship between HCV infection and chronic fatigue is questioned after successful virus eradication. As fatigue is a subjective criterion, we aimed to evaluate in addition mood alterations and cognitive function in HCV-exposed patients with only mild liver disease and to assess a) possible interrelationships between these factors and health-related quality of life and b) the impact of viremia and former interferon treatment. One hundred and fifty-nine anti-HCV-positive individuals without advanced liver disease answered health-related quality of life (HRQoL), fatigue and depression questionnaires and underwent a battery of attention and memory tests. Accompanying diseases which could distort the results of the study such as HIV co-infection or drug addiction were exclusion criteria. The patients were subdivided into four groups according to their viremia status and interferon treatment history. Patients' data were evaluated with respect to norms given in the respective test manuals and in addition compared to those of 33 age-matched healthy controls. Eighty-five per cent of the patients had chronic fatigue, 50-60% mild depression or anxiety, 45% memory deficits and 30% attention deficits, irrespective of their HCV viremia status or treatment history. HRQoL correlated negatively with chronic fatigue (P<.001), while cognitive deficits-especially memory function-were independent from fatigue and depression. HCV infection may cause long-standing cerebral dysfunction that significantly impairs HRQoL and may even persist after clearance of the virus.
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Affiliation(s)
- M Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Pflugrad
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - K Haag
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H L Tillmann
- Division of Gastroenterology, Hepatology & Nutrition, East Carolina University, Greenville, NC, USA
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - D Arvanitis
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Hecker
- Department of Biometrics, Hannover Medical School, Hannover, Germany
| | - A Tountopoulou
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - A Goldbecker
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - K Weissenborn
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Raymondos K, Dirks T, Quintel M, Molitoris U, Ahrens J, Dieck T, Johanning K, Henzler D, Rossaint R, Putensen C, Wrigge H, Wittich R, Ragaller M, Bein T, Beiderlinden M, Sanmann M, Rabe C, Schlechtweg J, Holler M, Frutos-Vivar F, Esteban A, Hecker H, Rosseau S, von Dossow V, Spies C, Welte T, Piepenbrock S, Weber-Carstens S. Outcome of acute respiratory distress syndrome in university and non-university hospitals in Germany. Crit Care 2017; 21:122. [PMID: 28554331 PMCID: PMC5448143 DOI: 10.1186/s13054-017-1687-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 05/02/2017] [Indexed: 01/06/2023]
Abstract
Background This study investigates differences in treatment and outcome of ventilated patients with acute respiratory distress syndrome (ARDS) between university and non-university hospitals in Germany. Methods This subanalysis of a prospective, observational cohort study was performed to identify independent risk factors for mortality by examining: baseline factors, ventilator settings (e.g., driving pressure), complications, and care settings—for example, case volume of ventilated patients, size/type of intensive care unit (ICU), and type of hospital (university/non-university hospital). To control for potentially confounding factors at ARDS onset and to verify differences in mortality, ARDS patients in university vs non-university hospitals were compared using additional multivariable analysis. Results Of the 7540 patients admitted to 95 ICUs from 18 university and 62 non-university hospitals in May 2004, 1028 received mechanical ventilation and 198 developed ARDS. Although the characteristics of ARDS patients were very similar, hospital mortality was considerably lower in university compared with non-university hospitals (39.3% vs 57.5%; p = 0.012). Treatment in non-university hospitals was independently associated with increased mortality (OR (95% CI): 2.89 (1.31–6.38); p = 0.008). This was confirmed by additional independent comparisons between the two patient groups when controlling for confounding factors at ARDS onset. Higher driving pressures (OR 1.10; 1 cmH2O increments) were also independently associated with higher mortality. Compared with non-university hospitals, higher positive end-expiratory pressure (PEEP) (mean ± SD: 11.7 ± 4.7 vs 9.7 ± 3.7 cmH2O; p = 0.005) and lower driving pressures (15.1 ± 4.4 vs 17.0 ± 5.0 cmH2O; p = 0.02) were applied during therapeutic ventilation in university hospitals, and ventilation lasted twice as long (median (IQR): 16 (9–29) vs 8 (3–16) days; p < 0.001). Conclusions Mortality risk of ARDS patients was considerably higher in non-university compared with university hospitals. Differences in ventilatory care between hospitals might explain this finding and may at least partially imply regionalization of care and the export of ventilatory strategies to non-university hospitals. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1687-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Konstantinos Raymondos
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Tamme Dirks
- Department of Cardiology, KRH Klinikum Robert Koch Gehrden, Gehrden, Germany
| | - Michael Quintel
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen University Hospital, Göttingen, Germany
| | - Ulrich Molitoris
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jörg Ahrens
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Links der Weser, Bremen, Germany
| | - Thorben Dieck
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kai Johanning
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Dietrich Henzler
- Department of Anaesthesiology, Herford Hospital, Herford, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Bonn University Hospital, Bonn, Germany
| | - Hermann Wrigge
- Department of Anaesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Ralph Wittich
- Department of Anaesthesiology and Intensive Care Medicine, Carl Thieme Hospital, Cottbus, Germany
| | - Maximilian Ragaller
- Department of Anaesthesiology and Intensive Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Thomas Bein
- Department of Anaesthesiology, Regensburg University Hospital, Regensburg, Germany
| | - Martin Beiderlinden
- Department of Anaesthesiology and Intensive Care Medicine, Essen University Hospital, Essen, Germany
| | - Maxi Sanmann
- Department of Anaesthesiology, Dietrich-Bonhoeffer Hospital, Neubrandenburg, Germany
| | - Christian Rabe
- Department of Internal Medicine, Bonn University Hospital, Bonn, Germany
| | - Jörn Schlechtweg
- Department of Anaesthesiology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Monika Holler
- Department of Anaesthesiology and Intensive Care Medicine, Municipal Hospital Martha-Maria Halle-Dölau, Halle, Germany
| | - Fernando Frutos-Vivar
- Department of Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Andres Esteban
- Department of Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Hartmut Hecker
- Department of Biometry, Hannover Medical School, Hannover, Germany
| | - Simone Rosseau
- Department of Internal Medicine, Division Infectiology and Pulmonology, Charité University Hospital, Berlin, Germany
| | - Vera von Dossow
- Department of Anesthesiology and Intensive Care, Ludwig-Maximilians-Universität München, Geschwister-Scholl-Platz 1, 80539, München, Germany.
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Siegfried Piepenbrock
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Steffen Weber-Carstens
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Hospital, Berlin, Germany
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Affiliation(s)
| | - Hartmut Hecker
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Norbert Rückert
- Department of Psychology, University of Applied Sciences and Arts, Hannover, Germany
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Bernhardt M, Pflugrad H, Goldbecker A, Barg-Hock H, Knitsch W, Klempnauer J, Strassburg CP, Hecker H, Weissenborn K, Tryc AB. Central nervous system complications after liver transplantation: common but mostly transient phenomena. Liver Transpl 2015; 21:224-32. [PMID: 25369566 DOI: 10.1002/lt.24035] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 08/19/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 12/12/2022]
Abstract
Although central nervous system complications (CNSCs) are common after orthotopic liver transplantation (OLT), standardized prospective studies are still lacking. This prospective study was aimed at determining the incidence of CNSCs, describing their clinical presentations, and establishing predicting factors. One hundred thirty-six adult patients who underwent OLT at Hannover Medical School between December 2008 and June 2011 were included. Weekly examinations were performed by a neurologist during the hospital stay after OLT. Patient data, donor data, and operative and postoperative variables were collected. Patients with cerebral dysfunction after OLT underwent a diagnostic work-up, which included brain imaging and, if necessary, cerebrospinal fluid analysis. Patients with central nervous system (CNS) symptoms but negative imaging and cerebrospinal fluid results and patients with pontine myelinolysis or posterior reversible encephalopathy syndrome were placed in a metabolic-toxic CNSC group, and patients with strokes, intracranial hemorrhaging, or CNS infections were placed in a nonmetabolic CNSC group. Multiple regression analysis was used to identify independent risk factors for the development of metabolic-toxic CNSCs. After excluding two patients that died after OLT without regaining consciousness, forty-four (32.8%) patients developed CNSCs: 37 of these patients (27.6%) had metabolic-toxic CNSCs, and 7 (5.2%) had nonmetabolic CNSCs. Acute-on-chronic liver failure, the number of subsequent surgeries, and primary sclerosing cholangitis were identified as independent predictors for the development of metabolic-toxic CNSCs. Metabolic-toxic CNSCs were associated with prolonged hospital stays, and nonmetabolic CNSCs were associated with higher mortality. In conclusion, CNSCs are common and relevant complications after OLT. Patients after OLT, especially with risk factors, should undergo a regular standardized neurological examination that would allow early detection of these complications.
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Affiliation(s)
- Martina Bernhardt
- Integrated Research and Treatment Center Transplantation, University Hospital Bonn, Bonn, Germany; Clinic for Neurology, University Hospital Bonn, Bonn, Germany
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10
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Horke A, Bobylev D, Beck K, Meschenmoser L, Westhoff-Bleck M, Grosser U, Beerbaum P, Hecker H, Boethig D. Timing of repair and long-term perspectives in Fallot repair: a multistate-analysis of 469 patients aged ≤ 65 years. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Tryc AB, Pflugrad H, Goldbecker A, Barg-Hock H, Strassburg CP, Hecker H, Weissenborn K. New-onset cognitive dysfunction impairs the quality of life in patients after liver transplantation. Liver Transpl 2014; 20:807-14. [PMID: 24711070 DOI: 10.1002/lt.23887] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/09/2013] [Revised: 03/19/2014] [Accepted: 03/26/2014] [Indexed: 02/07/2023]
Abstract
Patients after orthotopic liver transplantation (OLT) may show cognitive dysfunction. To date, it has not been clear whether this dysfunction is due to residual hepatic encephalopathy (HE) or new-onset cognitive disturbances. Just as little is known about the course and clinical significance. In this prospective, observational study, 50 patients on the waiting list for OLT were examined in an outpatient setting before OLT and 6 and 12 months after OLT with the Psychometric Hepatic Encephalopathy Score, the Inhibitory Control Test, and the critical flicker frequency for the diagnosis of HE; in addition, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used as a tool for the measurement of global cognitive function. The Short Form 36 health survey was used to assess health-related quality of life. Twelve months after OLT, cognitive dysfunction characteristic of HE had resolved, but a secondary cognitive decline became apparent and had features different from those known with HE. Approximately 70% of the patients deteriorated in at least 1 cognitive domain of RBANS. This cognitive decline was related to neither a history of HE nor a history of alcohol abuse, but it was accompanied by a decline in the quality of life. In conclusion, OLT improves HE but is frequently followed by new-onset cognitive dysfunction, which can interfere with the quality of life.
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Affiliation(s)
- Anita Blanka Tryc
- Integrated Research and Treatment Center for Transplantation, Hannover Medical School, Hannover, Germany; Clinic for Neurology, Hannover Medical School, Hannover, Germany
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12
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Affiliation(s)
- Fr. Hein
- Institut für anorganische Chemie der Friedrich-Schiller-Universität, Jena
| | - H. Hecker
- Institut für anorganische Chemie der Friedrich-Schiller-Universität, Jena
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13
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Kuhnert R, Spila-Alegiani S, Tomba GS, Traversa G, Vennemann M, Hecker H. The association between multidose vaccinations and death: comparing case series methods when the first exposure changes the general risk of an event. STAT METHOD APPL-GER 2013. [DOI: 10.1007/s10260-013-0244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Goldbecker A, Weissenborn K, Hamidi Shahrezaei G, Afshar K, Rümke S, Barg-Hock H, Strassburg CP, Hecker H, Tryc AB. Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates. Gut 2013; 62:1497-504. [PMID: 23297006 DOI: 10.1136/gutjnl-2012-303262] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatic encephalopathy (HE) is a common complication of liver insufficiency. While there is widespread acceptance of its importance, there is no consensus on how best to diagnose and monitor HE. OBJECTIVE To compare the four most favoured methods for the diagnosis of HE. DESIGN 170 patients who were on the waiting list for liver transplantation as well as 86 healthy controls were included in the study. All patients and controls underwent the portosystemic encephalopathy syndrome test yielding the psychometric hepatic encephalopathy score (PHES), the repeatable battery for the assessment of neuropsychological status (RBANS), the inhibitory control test (ICT) and critical flicker frequency (CFF) measurement. RESULTS PHES and ICT targets had the best sensitivity (85.7% vs 85.7%) and specificity (96.5% vs 97.6%) for the diagnosis of overt HE. CFF showed inferior sensitivity (40.9%) for the diagnosis of HE and dependency from previous alcohol abuse (p=0.015). Multiple regression analysis showed that all test results apart from PHES were influenced by secondary diagnoses such as diabetes mellitus and renal insufficiency. CONCLUSIONS In the German population of patients awaiting liver transplantation, PHES is the most robust method for the diagnosis and follow-up of HE.
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Affiliation(s)
- Annemarie Goldbecker
- Integrated Research and Treatment Center (IFB) Transplantation, Hannover Medical School, , Hannover, Germany
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15
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Affiliation(s)
- E. Hecker
- Klinik für Thoraxchirurgie, Thoraxzentrum Ruhrgebiet, Herne
| | - H. Hecker
- Rijksuniversiteit Groningen, Psychology and Statistic, Groningen (Niederlande)
| | - K. Hecker
- Universität Berlin - Charité, Medizinische Fakultät, Berlin
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16
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Worthmann H, Martens-Lobenhoffer J, Joumaah M, Li N, Lichtinghagen R, Hecker H, Kielstein JT, Ehrenreich H, Bode-Böger SM, Weissenborn K. Asymmetric dimethylarginine in response to recombinant tissue-type plasminogen activator and erythropoietin in acute stroke. Stroke 2013; 44:2128-33. [PMID: 23788583 DOI: 10.1161/strokeaha.113.001145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the German Multicenter Erythropoietin (EPO) Stroke Trial, patients not receiving thrombolysis most likely benefited from EPO on clinical recovery, whereas a combination of rtPA and EPO was associated with increased mortality. We investigated whether the combination of rtPA and EPO increased release of the endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA), and thereby potentially deteriorated ischemic stroke outcome, as suggested from experimental data. METHODS ADMA was determined in serum samples from 90 patients of the German Multicenter EPO Stroke Trial taken at days 1 (within 6 hours after symptom onset), 2, 3, 4, and 7 after stroke using high-performance liquid chromatography-tandem mass spectrometry. ADMA was analyzed for the different treatment groups (EPO, n=25; placebo, n=30; rtPA+placebo, n=18; EPO+rtPA, n=17). Clinical outcome was expressed as difference between National Institutes of Health Stroke Scale at baseline and 90 days. RESULTS ADMA levels significantly increased during the observation time in EPO, EPO+rtPA, and placebo groups (P<0.05). A treatment effect on ADMA levels was revealed by repeated measures ANOVA only in the rtPA+placebo group (P=0.027). Here, ADMA levels were decreased compared with the placebo group (P<0.05). Both the EPO and the rtPA+placebo groups in the Hannover subgroup of the EPO trial had better outcome than the placebo group (P<0.05). CONCLUSIONS Our data underscore the potential benefit of EPO in ischemic stroke. The hypothesis from experimental data, that EPO treatment increases ADMA in stroke patients, was disproved. Further studies are needed to clarify whether decreased ADMA might contribute to therapeutic rtPA effects.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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17
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Weissenborn K, Donnerstag F, Kielstein JT, Heeren M, Worthmann H, Hecker H, Schmitt R, Schiffer M, Pasedag T, Schuppner R, Tryc AB, Raab P, Hartmann H, Ding XQ, Hafer C, Menne J, Schmidt BMW, Bültmann E, Haller H, Dengler R, Lanfermann H, Giesemann AM. Neurologic manifestations of E coli infection-induced hemolytic-uremic syndrome in adults. Neurology 2012; 79:1466-73. [PMID: 22993286 DOI: 10.1212/wnl.0b013e31826d5f26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the neurologic and neuroradiologic complications of Shiga toxin producing Escherichia coli infection (STEC)-associated hemolytic-uremic syndrome (HUS) in adults. METHODS All 52 adult patients with STEC O104:H4 infection cared for at Hannover Medical School during the outbreak in Germany through May-July 2011 are considered in this observational study. Forty-three of the 52 patients underwent a standard neurologic diagnostic procedure including clinical examination, Mini-Mental State Examination, and Glasgow Coma Scale Score. Thirty-six patients underwent EEG, and 26 had cerebral MRI, 9 of them repeatedly. Case records of 9 patients who had not been seen by a neurologist were analyzed retrospectively. RESULTS Forty-eight of the 52 patients had HUS. All but 1 of these showed neurologic symptoms. Focal neurologic signs like double vision, difficulties in finding words, or hyperreflexia were present in 23, additional deficits in orientation, attention, memory, or constructive abilities in 9, and marked impairment of consciousness in 15. MRI showed brainstem, midbrain, thalamus, corpus callosum, and white matter lesions in half of the patients, predominantly in diffusion-weighted images. The extent of MRI lesions did not correlate with clinical symptoms. General slowing but no focal alteration was found in half of the patients examined by EEG. CONCLUSION Our findings suggest a toxic-metabolic pathology behind the neurologic impairment instead of multiple infarction due to microthrombosis. Future studies should aim to clarify if early antibiotic therapy or bowel cleansing might help to decrease the rate of neurologic complications in STEC-HUS.
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Badorrek P, Dick M, Emmert L, Schaumann F, Koch W, Hecker H, Murdoch R, Hohlfeld JM, Krug N. Pollen starch granules in bronchial inflammation. Ann Allergy Asthma Immunol 2012; 109:208-214.e6. [PMID: 22920077 DOI: 10.1016/j.anai.2012.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/05/2012] [Accepted: 06/24/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pollen grains with a diameter of more than 10 μm preferentially deposit in the upper airways. Their contribution to lower airway inflammation is unclear. One hypothesis is that lower airway inflammation is mainly caused by allergen containing pollen starch granules, which are released from the pollen grains and can easily enter the peripheral airways because of their smaller size. OBJECTIVE To investigate the differential effect of pollen grains and pollen starch granules on nasal symptoms and lower airway inflammation. METHODS In a 2-period crossover design, 30 patients with allergic rhinitis and mild intermittent asthma underwent 2 allergen challenges on consecutive days in an environmental challenge chamber with either a mixture of pollen grains plus starch granules or starch granules only. End points were the total nasal symptom score (TNSS), nasal secretion weight, nasal flow, spirometry, and exhaled nitric oxide (eNO). RESULTS The presence of pollen grains had a significant and considerable effect on increase in TNSS and secretion weight and on decrease in nasal flow. Starch granules alone only had minimal effects on nasal symptoms. Challenges with starch granules significantly increased eNO. Pollen had no effect on eNO. CONCLUSION Pollen grains cause nasal symptoms but do not augment lower airway inflammation, whereas starch granules trigger lower airway inflammation but hardly induce nasal symptoms.
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Affiliation(s)
- Philipp Badorrek
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
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19
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20
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Schirin-Sokhan R, Winograd R, Roderburg C, Bubenzer J, Ó NCD, Guggenberger D, Hecker H, Trautwein C, Tischendorf JJW. Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound. World J Gastroenterol 2012; 18:541-5. [PMID: 22363120 PMCID: PMC3280399 DOI: 10.3748/wjg.v18.i6.541] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/26/2010] [Accepted: 11/09/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether contrast enhanced ultrasound (CEUS) might also be used for response prediction and early response evaluation in patients receiving bevacizumab based chemotherapy for metastasized colorectal cancer.
METHODS: Thirty consecutive patients with non primary resectable liver metastases from colorectal cancer underwent CEUS before treatment (CEUS date 1) and before the second (CEUS date 2) and fourth (CEUS date 3) cycle of bevacizumab based chemotherapy. Three parameters [PEAK, Time to peak (TTP) and RISE RATE]were correlated with radiological response.
RESULTS: For neoadjuvant purpose a reduction of tumour mass was required to assume clinical response. Based on these response criteria there was a significant (P < 0.001) correlation in TTP between metastases of responders (9.08 s) and non-responders (14.76 s) archived on CEUS date 1. By calculating a standardized quotient (metastases divided by normal liver tissue) we were able to define a cut off, predicting response with a sensitivity of 92.3 % and a specificity of 100 %. To reflect a palliative intention only those patients with progressive disease were classified as non-responders. In this stetting TTP was also significantly (P < 0.01) different between responders and non-responders. In contrast, Peak and Rise rate did not show any significant difference between responder and non-responder.
CONCLUSION: CEUS might serve as a surrogate marker to predict treatment response in patients with metastasized colorectal cancer who receive antiangiogenic therapy.
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Kuhnert R, Schlaud M, Poethko-Müller C, Vennemann M, Fleming P, Blair PS, Mitchell E, Thompson J, Hecker H. Reanalyses of case-control studies examining the temporal association between sudden infant death syndrome and vaccination. Vaccine 2012; 30:2349-56. [PMID: 22289512 DOI: 10.1016/j.vaccine.2012.01.043] [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] [Received: 02/27/2011] [Revised: 04/14/2011] [Accepted: 01/16/2012] [Indexed: 10/14/2022]
Abstract
In this paper we examine different time periods after vaccinations and investigate whether the risk of sudden infant death is different during the post-vaccination period than at other times. Three already published case-control studies are re-examined in this context. Several evaluation approaches are presented. The recently developed self-controled case series (SCCS) method for terminal events, which only takes the cases into account, is used in addition. There is no increased or reduced risk of sudden infant death during the period after the vaccination. The previously reported protective effect seen in case contol studies is based on the inclusion of unvaccinated cases. The results of the case-control analysis of one study is affected by two confounders. The SCCS method for terminal events, in which all time-independent confounders are eliminated, is an alternative to case-control analysis when it comes to the temporal association between exposed time periods and SIDS after vaccination.
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Affiliation(s)
- Ronny Kuhnert
- Robert Koch-Institute, Division for Health of Children and Adolescents, Prevention Concepts, Seestr. 10, 13353 Berlin, Germany.
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22
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Boozari B, Soudah B, Rifai K, Schneidewind S, Vogel A, Hecker H, Hahn A, Schlue J, Dietrich CF, Bahr MJ, Kubicka S, Manns MP, Gebel M. Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography - a prospective study. Dig Liver Dis 2011; 43:484-90. [PMID: 21377941 DOI: 10.1016/j.dld.2011.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 01/01/2011] [Accepted: 01/04/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcome of patients with hepatocellular carcinoma is influenced by their histological grade. Invasive biopsy of the lesions is the gold standard in this regard. AIMS We therefore analysed the diagnostic accuracy of contrast enhanced ultrasound for non-invasive grading of hypervascular hepatocellular carcinoma in liver cirrhosis. METHODS According to the tumour perfusion kinetics on contrast enhanced ultrasound two grading groups were prospectively defined: well-differentiated hepatocellular carcinoma (US-G1) and higher grade hepatocellular carcinoma (US-G2/G3). Immediately after contrast enhanced ultrasound-grading, biopsies of hepatocellular carcinoma-lesions (n=95, 1.2-12.5 cm) were obtained and analysed for tumour grading (G). Descriptive statistics, sensitivity, specificity positive and negative predictive values, diagnostic likelihood ratios and interoperator reproducibility were calculated (κ). RESULTS Histologically 77 (81.1%) patients had G2-G3 and 18 (18.9%) had G1 tumours. Higher grade hepatocellular carcinoma showed more often a washout in the portal or late phase (p<0.0001). The sensitivity, specificity, positive predictive values and negative predictive values of contrast enhanced ultrasound for grading of hepatocellular carcinoma for all patients were 94% (CI: 72-99%), 95% (CI: 88-99%), 81% and 99% and for patients with tumours<5 cm 100%(95% CI: 79-100), 96% (95% CI: 80-99), 92% and 100%. Positive and negative diagnostic likelihood ratios' were 18 and 26 and 0.06 and 0, respectively. κ=0.941 (p<0.001). CONCLUSIONS Contrast enhanced ultrasound has a high diagnostic value and reproducibility for non-invasive grading of hypervascular hepatocellular carcinoma >1cm in patients with liver cirrhosis.
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Affiliation(s)
- Bita Boozari
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany.
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23
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Badorrek P, Dick M, Hecker H, Schaumann F, Sousa AR, Murdoch R, Hohlfeld JM, Krug N. Anti-allergic drug testing in an environmental challenge chamber is suitable both in and out of the relevant pollen season. Ann Allergy Asthma Immunol 2011; 106:336-41. [PMID: 21457883 DOI: 10.1016/j.anai.2010.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/04/2010] [Accepted: 12/29/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND An environmental challenge chamber (ECC) is a useful tool to expose allergic patients to relevant allergens in a controlled indoor setting and to test anti-allergic treatment. Hitherto, ECC studies with grass pollen are conducted primarily outside of the pollen season to avoid the influence of natural pollen exposure. OBJECTIVE To investigate whether an established anti-allergic treatment, a combination of cetirizine (CET) and pseudoephedrine (PSE), shows an equivalent treatment effect within and outside of the grass pollen season when tested in an ECC. METHODS In a randomized, placebo-controlled, double-blind, four-way crossover study, the effect of a combination of 10 mg CET and 120 mg PSE compared with placebo on nasal symptoms, nasal flow, and nasal secretion was investigated in 70 patients with seasonal allergic rhinitis. Subjects underwent four 6-hour pollen challenges in an ECC with administration of the drugs after 2 hours. Two challenges were conducted within the grass pollen season and two out of the grass pollen season. RESULTS The active treatment significantly improved nasal symptoms and nasal flow and significantly reduced the amount of nasal secretion compared with placebo both within and outside of the pollen season (P < .0001 each). The treatment effect was not different between the seasons (P > .05). CONCLUSION Controlled allergen provocation in an ECC can be used to test anti-allergic treatment both within and outside of the grass pollen season.
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Affiliation(s)
- Philipp Badorrek
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
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24
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Ewig S, Hecker H, Suttorp N, Marre R, Welte T. Moxifloxacin monotherapy versus ß-lactam mono- or combination therapy in hospitalized patients with community-acquired pneumonia. J Infect 2011; 62:218-25. [PMID: 21276814 DOI: 10.1016/j.jinf.2011.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this observational study, we compared the outcomes of moxifloxacin monotherapy as compared to ß-lactam monotherapy as well as ß-lactam combination therapy in patients with community-acquired pneumonia (CAP). METHODS Patients recruited within the German Competence Network for CAP (CAPNETZ) were evaluated for treatment regimen. Primary outcome variables were six months overall mortality, pneumonia-related mortality according to clinical judgment and treatment failures (necessity for treatment change and death). RESULTS Overall, 4091 patients (mean age 64.4±17.8 (range 18-101) years, 2433 male (59.5%)) were included. 2068 patients received moxifloxacin (n=365) or ß-lactam monotherapy (n=1703). 330 patients died within six months. After controlling for confounders in multivariate analysis, moxifloxacin monotherapy had higher survival as compared to ß-lactam monotherapy (hazard ratio for moxifloxacin 0.57, 95% CI 0.35-0.92). Multivariate analysis including interaction terms showed that the protective effect of moxifloxacin was not present for CRB-65 class 0 but increased with higher CRB-65 scores (HR 0.69, 95% CI 0.50-0.96). Regarding pneumonia-related death, moxifloxacin monotherapy was also protective in multivariate analysis (HR 0.36, 95% CI 0.13-0.99). Moxifloxacin was also significantly associated with less treatment failures (p<0.001). In addition, it was not inferior to combination ß-lactam treatment (p=0.062). CONCLUSIONS In CRB-65 class 0 moxifloxacin was equivalent to ß-lactams. Our observations are in support of a use of moxifloxacin monotherapy in hospitalized patients with moderate CAP (CRB-65 classes 1 and 2).
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Pneumology and Infectious Diseases, Herne und Bochum, Germany
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25
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Tryc AB, Alwan G, Bokemeyer M, Goldbecker A, Hecker H, Haubitz M, Weissenborn K. Cerebral metabolic alterations and cognitive dysfunction in chronic kidney disease. Nephrol Dial Transplant 2011; 26:2635-41. [DOI: 10.1093/ndt/gfq729] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Kuhnert R, Hecker H, Poethko-Müller C, Schlaud M, Vennemann M, Whitaker HJ, Farrington CP. A modified self-controlled case series method to examine association between multidose vaccinations and death. Stat Med 2010; 30:666-77. [DOI: 10.1002/sim.4120] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/19/2010] [Indexed: 11/07/2022]
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27
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Nellessen U, Zingel M, Hecker H, Bahnsen J, Borschke D. Effects of radiation therapy on myocardial cell integrity and pump function: which role for cardiac biomarkers? Chemotherapy 2010; 56:147-52. [PMID: 20407242 DOI: 10.1159/000313528] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 01/13/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radiation therapy to the mediastinum and breast can be associated with cardiac complications. Cardiac damage may manifest early during radiation therapy or occur late, years after radiation therapy has been finished. HYPOTHESIS Myocardial damage is associated with the release of both troponin I (TnI) and brain natriuretic peptide (BNP). The current study sought to determine whether radiation treatment to the mediastinum and breast leads to the release of cardiac biomarkers. METHODS The study comprised 23 patients: 18 with lung cancer and 5 with breast cancer. Radiation therapy was performed for up to 6 weeks. Total radiation dose was >45 Gy in each patient with a dose of 1.8 Gy per fraction. Blood samples to determine TnI and BNP were taken before and once a week during radiation therapy. Echocardiography was done before and after radiation had been finished. RESULTS Two patients died during the study. Both TnI and BNP levels increased significantly during the study (log(10) scale); however, absolute and mean values remained on a relatively low level (mean preradiation and postradiation TnI: 0.007 +/- 0.008, 0.014 +/- 0.01 ng/ml; mean preradiation and postradiation BNP: 123 +/- 147, 159 +/- 184 pg/ml). CONCLUSION Radiation therapy leads to cardiac cell damage and changes in the left ventricular loading conditions as suggested by a significant increase of the cardiac biomarkers TnI and BNP. Determination of serum levels seems to be superior to echocardiography in detecting radiation-induced cardiac damage. Serial measurements of cardiac biomarkers may facilitate the management of patients undergoing radiation therapy and may help to define subgroups at high risk of developing heart failure.
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Affiliation(s)
- Ulrich Nellessen
- Department of Cardiology, Johanniter-Krankenhaus Genthin-Stendal gGmbH, Stendal, Germany. kardio @ jksdl.de
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Tischendorf JJW, Gross S, Winograd R, Hecker H, Auer R, Behrens A, Trautwein C, Aach T, Stehle T. Computer-aided classification of colorectal polyps based on vascular patterns: a pilot study. Endoscopy 2010; 42:203-7. [PMID: 20101564 DOI: 10.1055/s-0029-1243861] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND STUDY AIMS Recent studies have shown that narrow-band imaging (NBI) is a powerful diagnostic tool for differentiating between neoplastic and nonneoplastic colorectal polyps. The aim of the present study was to develop and evaluate a computer-based method for automated classification of colorectal polyps on the basis of vascularization features. PATIENTS AND METHODS In a prospective pilot study with 128 patients who were undergoing zoom NBI colonoscopy, 209 detected polyps were visualized and subsequently removed for histological analysis. The proposed computer-based method consists of image preprocessing, vessel segmentation, feature extraction, and classification. The results of the automated classification were compared to those of human observers blinded to the histological gold standard. RESULTS Consensus decision between the human observers resulted in a sensitivity of 93.8 % and a specificity of 85.7 %. A "safe" decision, i. e., classifying polyps as neoplastic in cases when there was interobserver discrepancy, yielded a sensitivity of 96.9 % and a specificity of 71.4 %. The overall correct classification rates were 91.9 % for the consensus decision and 90.9 % for the safe decision. With ideal settings the computer-based approach achieved a sensitivity of approximately 90 % and a specificity of approximately 70 %, while the overall correct classification rate was 85.3 %. The computer-based classification showed a specificity of 61.2 % when a sensitivity of 93.8 % was selected, and a 53.1 % specificity with a sensitivity of 96.9 %. CONCLUSIONS Automated classification of colonic polyps on the basis of NBI vascularization features is feasible, but classification by observers is still superior. Further research is needed to clarify whether the performance of the automated classification system can be improved.
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Affiliation(s)
- J J W Tischendorf
- Medical Department III (Gastroenterology, Hepatology and Metabolic Diseases), Aachen University Hospital, RWTH Aachen University, 52074 Aachen, Germany.
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Kümpers P, Hafer C, David S, Hecker H, Lukasz A, Fliser D, Haller H, Kielstein JT, Faulhaber-Walter R. Angiopoietin-2 in patients requiring renal replacement therapy in the ICU: relation to acute kidney injury, multiple organ dysfunction syndrome and outcome. Intensive Care Med 2009; 36:462-70. [PMID: 19956923 DOI: 10.1007/s00134-009-1726-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 09/25/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE Endothelial activation has emerged as an early event in the pathogenesis of microcirculatory dysfunction, capillary leakage and multi-organ dysfunction syndrome (MODS). Angiopoietin-2 (Ang-2), a circulating antagonistic ligand of the endothelial-specific Tie2 receptor, has been identified as a non-redundant gatekeeper of endothelial activation. On the basis of our previous report demonstrating release of Ang-2 in endotoxemia and sepsis, we aimed to study the utility of Ang-2 to serve as an outcome-specific biomarker in patients requiring renal replacement therapy (RRT) in the intensive care unit (ICU). METHODS We measured circulating Ang-2 by ELISA in 117 critically ill patients with AKI at inception of RRT in the ICU. Mortality, length of stay and renal recovery were prospectively assessed during a study period of 28 days after the inception of RRT. RESULTS Circulating Ang-2 levels were significantly higher in AKI patients with RIFLE category-Injury or -Failure, compared to patients with RIFLE category-Risk. Elevated levels of circulating Ang-2 correlated with impaired oxygenation, low mean arterial pressure, vasopressor dose and the sequential organ failure assessment (SOFA) score. Ang-2 concentrations were significantly higher in non-survivors than in survivors at day 0 and day 14 after initiation of RRT. Multivariate Cox regression and decision tree analyses confirmed a strong independent prognostic impact of elevated Ang-2 as a predictor of 28-day survival. CONCLUSIONS The results from this study indicate that circulating Ang-2 is as a strong and independent predictor of mortality in ICU patients with dialysis-dependent AKI.
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Affiliation(s)
- Philipp Kümpers
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
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Zitzmann NU, Krastl G, Hecker H, Walter C, Weiger R. Endodontics or implants? A review of decisive criteria and guidelines for single tooth restorations and full arch reconstructions. Int Endod J 2009; 42:757-74. [PMID: 19548936 DOI: 10.1111/j.1365-2591.2009.01561.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N U Zitzmann
- Clinic for Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland.
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Boethig D, Westhoff-Bleck M, Hecker H, Ono M, Goerler A, Sarikouch S, Breymann T. Bovine Jugular Veins in the Pulmonary Position in Adults – 5 Years' Experience with 64 Implantations. Thorac Cardiovasc Surg 2009; 57:196-201. [DOI: 10.1055/s-0029-1185394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Böthig D, Westhoff-Bleck M, Ono M, Hecker H, Goerler A, Sarikouch S, Breymann T. Bovine jugular veins as pulmonary valved conduits in adults – experience at 5 years with 64 implantations. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rahe-Meyer N, Winterhalter M, Hartmann J, Pattison A, Hecker H, Calatzis A, Solomon C. An Evaluation of Cyclooxygenase-1 Inhibition Before Coronary Artery Surgery: Aggregometry Versus Patient Self-Reporting. Anesth Analg 2008; 107:1791-7. [DOI: 10.1213/ane.0b013e3181865733] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ayerle G, Hecker H, Frömke C, Hillemanns P, Groß M. Zusammenhänge zwischen Anwesenheit der Hebamme, Interventionen und dem Outcome der Geburt. Z Geburtshilfe Neonatol 2008; 212:176-82. [DOI: 10.1055/s-2008-1076979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ruschulte H, Franke M, Gastmeier P, Zenz S, Mahr KH, Buchholz S, Hertenstein B, Hecker H, Piepenbrock S. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol 2008; 88:267-72. [DOI: 10.1007/s00277-008-0568-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 11/28/2022]
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Haeseler G, Karst M, Foadi N, Gudehus S, Roeder A, Hecker H, Dengler R, Leuwer M. High-affinity blockade of voltage-operated skeletal muscle and neuronal sodium channels by halogenated propofol analogues. Br J Pharmacol 2008; 155:265-75. [PMID: 18574460 DOI: 10.1038/bjp.2008.255] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Voltage-operated sodium channels constitute major target sites for local anaesthetic-like action. The clinical use of local anaesthetics is still limited by severe side effects, in particular, arrhythmias and convulsions. These side effects render the search for new local anaesthetics a matter of high interest. EXPERIMENTAL APPROACH We have investigated the effects of three halogenated structural analogues of propofol on voltage-operated human skeletal muscle sodium channels (Na(V)1.4) and the effect of one compound (4-chloropropofol) on neuronal sodium channels (Na(V)1.2) heterologously expressed in human embryonic kidney cell line 293. KEY RESULTS 4-Iodo-, 4-bromo- and 4-chloropropofol reversibly suppressed depolarization-induced whole-cell sodium inward currents with high potency. The IC(50) for block of resting channels at -150 mV was 2.3, 3.9 and 11.3 microM in Na(V)1.4, respectively, and 29.2 microM for 4-chloropropofol in Na(V)1.2. Membrane depolarization inducing inactivation strongly increased the blocking potency of all compounds. Estimated affinities for the fast-inactivated channel state were 81 nM, 312 nM and 227 nM for 4-iodopropofol, 4-bromopropofol and 4-chloropropofol in Na(V)1.4, and 450 nM for 4-chloropropofol in Na(V)1.2. Recovery from fast inactivation was prolonged in the presence of drug leading to an accumulation of block during repetitive stimulation at high frequencies (100 Hz). CONCLUSIONS AND IMPLICATIONS Halogenated propofol analogues constitute a novel class of sodium channel-blocking drugs possessing almost 100-fold higher potency compared with the local anaesthetic and anti-arrhythmic drug lidocaine. Preferential drug binding to inactivated channel states suggests that halogenated propofol analogues might be especially effective in suppressing ectopic discharges in a variety of pathological conditions.
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Affiliation(s)
- G Haeseler
- Department of Anesthesiology, Hannover Medical School, Hannover, Germany.
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Winterhalter M, Simon A, Fischer S, Rahe-Meyer N, Chamtzidou N, Hecker H, Zuk J, Piepenbrock S, Strüber M. Comparison of Inhaled Iloprost and Nitric Oxide in Patients With Pulmonary Hypertension During Weaning From Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial. J Cardiothorac Vasc Anesth 2008; 22:406-13. [PMID: 18503929 DOI: 10.1053/j.jvca.2007.10.015] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Indexed: 02/02/2023]
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Walter C, Krastl G, Izquierdo A, Hecker H, Weiger R. Replantation of three avulsed permanent incisors with complicated crown fractures. Int Endod J 2008; 41:356-64. [DOI: 10.1111/j.1365-2591.2007.01361.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Folprecht G, Seymour MT, Saltz L, Douillard JY, Hecker H, Stephens RJ, Maughan TS, Van Cutsem E, Rougier P, Mitry E, Schubert U, Köhne CH. Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2,691 patients in randomized controlled trials. J Clin Oncol 2008. [PMID: 18349394 DOI: 10.1200/jco.2007.14.0509]0] [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: 11/20/2022] Open
Abstract
PURPOSE Uncertainty exists about whether elderly patients benefit to the same extent as younger patients from combination therapy with irinotecan in the first-line treatment of metastatic colorectal cancer (CRC). PATIENTS AND METHODS Combined analysis was carried out with source data from the fluorouracil (FU)/folinic acid (FA) and the irinotecan/FU/FA arms of four first-line, phase III trials of CRC to investigate the efficacy and safety of combination and monotherapy in elderly (age > or = 70 years; n = 599) compared with younger (age < 70 years; n = 2,092) patients. RESULTS Response rates were improved with irinotecan-based combination therapy compared with FU/FA in patients both younger than 70 years and > or = 70 years (46.6% v 29.0% P < .0001; and 50.5% v 30.3%, P < .0001, respectively). With irinotecan/FU/FA, progression-free survival was better for both younger (hazard ratio [HR], 0.77; 95% CI, 0.70 to 0.85; P < .0001) and elderly patients (HR, 0.75; 95% CI, 0.61 to 0.90; P = .0026). In younger patients, overall survival was improved with combination therapy (HR, 0.83; 95% CI, 0.75 to 0.92; P = .0003). The same trend was observed in elderly patients (HR, 0.87; 95% CI, 0.72 to 1.05; P = .15). There was no significant interaction between treatment arm and age in the regression analysis. The expected differences in toxicity between combination and monotherapy in elderly and younger patients were observed. A significant interaction between treatment and age (cutoff, 70 years) for vomiting and hepatotoxicity was not confirmed by analysis that used age as a continuous variable. CONCLUSION Patients older than 70 years of age who were selected for inclusion in phase III trials derived similar benefits as younger patients from irinotecan-containing chemotherapy, and the risk of toxicity was similar.
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Affiliation(s)
- Gunnar Folprecht
- University Hospital Dresden, Fetscherstr 74, Dresden, Germany 01307.
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Folprecht G, Seymour MT, Saltz L, Douillard JY, Hecker H, Stephens RJ, Maughan TS, Van Cutsem E, Rougier P, Mitry E, Schubert U, Köhne CH. Irinotecan/Fluorouracil Combination in First-Line Therapy of Older and Younger Patients With Metastatic Colorectal Cancer: Combined Analysis of 2,691 Patients in Randomized Controlled Trials. J Clin Oncol 2008; 26:1443-51. [DOI: 10.1200/jco.2007.14.0509] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeUncertainty exists about whether elderly patients benefit to the same extent as younger patients from combination therapy with irinotecan in the first-line treatment of metastatic colorectal cancer (CRC).Patients and MethodsCombined analysis was carried out with source data from the fluorouracil (FU)/folinic acid (FA) and the irinotecan/FU/FA arms of four first-line, phase III trials of CRC to investigate the efficacy and safety of combination and monotherapy in elderly (age ≥ 70 years; n = 599) compared with younger (age < 70 years; n = 2,092) patients.ResultsResponse rates were improved with irinotecan-based combination therapy compared with FU/FA in patients both younger than 70 years and ≥ 70 years (46.6% v 29.0% P < .0001; and 50.5% v 30.3%, P < .0001, respectively). With irinotecan/FU/FA, progression-free survival was better for both younger (hazard ratio [HR], 0.77; 95% CI, 0.70 to 0.85; P < .0001) and elderly patients (HR, 0.75; 95% CI, 0.61 to 0.90; P = .0026). In younger patients, overall survival was improved with combination therapy (HR, 0.83; 95% CI, 0.75 to 0.92; P = .0003). The same trend was observed in elderly patients (HR, 0.87; 95% CI, 0.72 to 1.05; P = .15). There was no significant interaction between treatment arm and age in the regression analysis. The expected differences in toxicity between combination and monotherapy in elderly and younger patients were observed. A significant interaction between treatment and age (cutoff, 70 years) for vomiting and hepatotoxicity was not confirmed by analysis that used age as a continuous variable.ConclusionPatients older than 70 years of age who were selected for inclusion in phase III trials derived similar benefits as younger patients from irinotecan-containing chemotherapy, and the risk of toxicity was similar.
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Affiliation(s)
- Gunnar Folprecht
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Matthew T. Seymour
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Leonard Saltz
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Jean-Yves Douillard
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Hartmut Hecker
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Richard J. Stephens
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Timothy S. Maughan
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Eric Van Cutsem
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Philippe Rougier
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Emmanuel Mitry
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Ute Schubert
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
| | - Claus-Henning Köhne
- From the University Hospital Dresden; Medical School Hannover; and Klinikum Oldenburg, Germany; Cancer Research UK Clinical Centre, Cookridge Hospital, Leeds; Medical Research Council Clinical Trials Unit, London; and Velindre Hospital, Cardiff, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Centre R Gauducheau, St. Herblain; and Hôpital Ambroise Paré, Boulogne, France; and the University Hospital Gasthuisberg, Leuven, Belgium
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Mohammadi B, Schedel I, Graf K, Teiwes A, Hecker H, Haameijer B, Scheinichen D, Piepenbrock S, Dengler R, Bufler J. Role of endotoxin in the pathogenesis of critical illness polyneuropathy. J Neurol 2008; 255:265-72. [PMID: 18283402 DOI: 10.1007/s00415-008-0722-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/13/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
Critical illness polyneuropathy (CIP) occurs in association with sepsis and multiple organ failure; however, little is known about the pathomechanisms of CIP and its therapy. In order to determine the parameters which interfere with development of CIP, electrophysiological investigations of peripheral nerves and biochemical measures were correlated to each other. The present study includes 20 consecutive patients in an intensive care unit developing severe sepsis or septic shock. Nerve conduction studies and electromyography were performed with occurring sepsis (day 1, 7, 14) and neurophysiological parameters were correlated with biochemical measures, especially indicators of infection and inflammation. It was found that all patients developed neurophysiological signs of axonal motor polyneuropathy. There was a significant correlation between serum concentrations of endotoxin and interleukin-2 receptors (IL2-R) and reduction of the amplitude of the compound motor action potentials. Other clinical and biochemical parameters showed no significant correlations with neurophysiological data. This finding apparently indicates that endotoxin damages nerve axons directly or indirectly, e.g. by activation of inflammatory cascades (IL2-R). Endotoxin appears to be an essential factor in the pathogenesis of CIP in sepsis, and therapeutic options neutralizing endotoxin may prevent development of CIP.
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Affiliation(s)
- B Mohammadi
- Department of Neurology, Medical School Hannover, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Tischendorf JJW, Wasmuth HE, Koch A, Hecker H, Trautwein C, Winograd R. Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy 2007; 39:1092-6. [PMID: 18072061 DOI: 10.1055/s-2007-966781] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Chromoendoscopy in combination with magnifying endoscopy is useful in distinguishing neoplastic from non-neoplastic colorectal polyps. Narrow band imaging (NBI) has been developed as a new technique to differentiate tissue patterns in vivo. The aim of the present study was to directly compare the diagnostic values of chromoendoscopy and NBI for the differentiation of neoplastic from non-neoplastic colorectal polyps. PATIENTS AND METHODS In total, 200 colorectal polyps from 99 patients were distributed in a 1 : 1 ratio in order to analyze the surface according to the pit pattern classification and vascular patterns by either magnifying chromoendoscopy or NBI magnification. Histologic analysis was performed on all lesions. RESULTS Using the Kudo classification of mucosal patterns, NBI with magnification resulted in a sensitivity of 90.5 % and a specificity of 89.2 % for the differentiation of neoplastic vs. non-neoplastic lesions. This performance was comparable to magnifying chromoendoscopy with a sensitivity of 91.7 % and a specificity of 90 %, respectively. Using vascular patterns for differentiation, NBI with magnification correctly identified 93.7 % of neoplastic polyps and 89.2 % of non-neoplastic colorectal lesions, whereas magnifying chromoendoscopy had a specificity of 95 % but a sensitivity of only 66.7 %. CONCLUSION NBI in combination with magnifying endoscopy is a promising tool for the differentiation of neoplastic from non-neoplastic colorectal polyps in vivo without the necessity of using dye. The detection of capillary vessels with NBI allows the evaluation of colorectal lesions based on the vascular patterns with high diagnostic accuracy.
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Affiliation(s)
- J J W Tischendorf
- Medical Department III (Gastroenterology, Hepatology and Metabolic Diseases), University Hospital Aachen, Germany
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Weissenborn K, Ahl B, Fischer-Wasels D, van den Hoff J, Hecker H, Burchert W, Köstler H. Correlations between magnetic resonance spectroscopy alterations and cerebral ammonia and glucose metabolism in cirrhotic patients with and without hepatic encephalopathy. Gut 2007; 56:1736-42. [PMID: 17660226 PMCID: PMC2095692 DOI: 10.1136/gut.2006.110569] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatic encephalopathy is considered to be mainly caused by increased ammonia metabolism of the brain. If this hypothesis is true, cerebral glucose utilisation, which is considered to represent brain function, should be closely related to cerebral ammonia metabolism. The aim of the present study was to analyse whether cerebral ammonia and glucose metabolism in cirrhotic patients with early grades of hepatic encephalopathy are as closely related as could be expected from current hypotheses on hepatic encephalopathy. METHODS (13)N-ammonia and (18)F-fluorodesoxyglucose positron emission tomography, magnetic resonance imaging and magnetic resonance spectroscopy (MRS) were performed in 21 cirrhotic patients with grade 0-1 hepatic encephalopathy. Quantitative values of cerebral ammonia uptake and retention rate and glucose utilisation were derived for several regions of interest and were correlated with the MRS data of the basal ganglia, white matter and frontal cortex. RESULTS A significant correlation between plasma ammonia levels and cerebral ammonia metabolism, respectively, and MRS alterations could be shown only for white matter. In contrast, MRS alterations in all three regions studied were significantly correlated with the glucose utilisation of several brain regions. Cerebral ammonia and glucose metabolism were not correlated. CONCLUSION Increase of cerebral ammonia metabolism is an important but not exclusive causal factor for the development of hepatic encephalopathy.
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Affiliation(s)
- Karin Weissenborn
- Department of Neurology, Medizinische Hochschule Hannover, 30623 Hannover, Germany.
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Boozari B, Nashan B, Hecker H, Kubicka S, Klempnauer J, Strassburg C, Manns M, Gebel MJ. The type of arterial anastomosis influences hepatic hemodynamics and overall survival in liver graft recipients. Ultraschall Med 2007; 28:587-592. [PMID: 18074312 DOI: 10.1055/s-2007-963580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM Evaluation of the influence of arterial anastomoses on hepatic hemodynamics and overall survival in liver graft recipients using color Doppler ultrasound. METHOD 224 patients recruited retrospectively were divided into five groups according to arterial anastomoses: (1) common hepatic (CHA)/gastro duodenal, (2) CHA/CHA, (3) aorta/celiac trunc, (4) aorta/aorta, (5) more than one anastomosis. We compared maximum portal [(P)Vmax], systolic [(A)Vmax] and end diastolic [(A)Vmin] arterial velocities, resistance indexes(RI), spleen and liver size between the groups. We analyzed further in a multivariate analysis the influence of time elapsed since orthotopic liver transplantation, age of recipient and donor on significant parameters as well as the overall survival of the patients between the groups. RESULTS Significant differences were found for: (A) Vmax between groups 2/4 (p<0.007) and 2/5 (p<0.010), (A) Vmin between groups 1/3 (p<0.029) and 2/3 (p<0.015) and RI between the groups 1/3 (p<0.018) and 3/4 (p<0.006). (A)Vmax and RI were only dependent on the type of arterial anastomosis (p<0.008 and p<0.014). The overall survival of the patients between the groups was significantly different (p<0.047). CONCLUSION In this study we report the natural course of the mean values of portal and arterial velocities in different arterial reconstructions for the first time. (A) Vmax of the hepatic artery is identified as the most promising candidate prognostic parameter for the assessment of hemodynamic alterations after liver transplantation originating in the type of arterial anastomosis performed. The group of patients with more than one anastomosis had the lowest arterial (A) Vmax and simultaneously the lowest overall survival.
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Affiliation(s)
- B Boozari
- Gastroenterology and Hepatology and Endocrinology, Medical School Hannover, Hannover.
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Buesche G, Ganser A, Schlegelberger B, von Neuhoff N, Gadzicki D, Hecker H, Bock O, Frye B, Kreipe H. Marrow fibrosis and its relevance during imatinib treatment of chronic myeloid leukemia. Leukemia 2007; 21:2420-7. [PMID: 17805334 DOI: 10.1038/sj.leu.2404917] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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: 11/08/2022]
Abstract
In chronic myeloid leukemia (CML), imatinib may reverse bone marrow fibrosis (MF). Whether the unfavorable prognosis of MF is also reversed and whether imatinib guarantees against evolution of MF are unclear as yet. Fifty-nine patients with Ph+ CML treated with > or = 400 mg imatinib/day were examined for MF in 6- to 12-month intervals. Imatinib effectively reversed initial MF (P<0.0005). However, during a follow-up period of up to 4.8 years, small foci with abnormal fiber increase (FFI) emerged in 8 of 30 pretreated and 6 of 29 non-pretreated patients. Patients with FFI showed a significantly lower probability of achieving a complete cytogenetic or major molecular response (36 versus 81%; P<0.007). During the further follow up, 57% of patients with FFI but none of the other patients suffered from full-blown MF (P=0.00005). None of the patients with FFI or MF showed a Janus kinase-2 mutation (V617F). Evolutions of FFI and MF were independent significant predictors of imatinib failure (P=0.0031), accelerated phase and death of patients (P=0.0001; multivariate analyses). Imatinib effectively reverses initial MF in CML, but neither eliminates its unfavorable prognosis nor guarantees completely against new evolution of MF.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Biomarkers, Tumor/analysis
- Bone Marrow/drug effects
- Bone Marrow/pathology
- Disease Progression
- Follow-Up Studies
- Fusion Proteins, bcr-abl/analysis
- Humans
- Imatinib Mesylate
- Interferon-alpha/therapeutic use
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Pilot Projects
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Primary Myelofibrosis/drug therapy
- Primary Myelofibrosis/etiology
- Primary Myelofibrosis/pathology
- Prognosis
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Recurrence
- Remission Induction
- Salvage Therapy
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Affiliation(s)
- G Buesche
- Institut für Pathologie, Medizinische Hochschule, Hannover, Germany.
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Nowotzek A, Hecker H, Hillemanns P, Groß MM. Vergleich zwischen geburtshilflich-anästhesiologischen Klinikprofilen in Niedersachsen und anästhesiologischen Angaben in der ProGeb-Studie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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48
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Goetz GF, Hecker H, Haeseler G, Becker H, Münte S. Hyperintense Cerebrospinal Fluid on FLAIR Images Induced by Ventilation with 100% Oxygen. Clin Neuroradiol 2007. [DOI: 10.1007/s00062-007-7011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Breitmeier D, Seeland-Schulze I, Hecker H, Schneider U. The influence of blood alcohol concentrations of around 0.03% on neuropsychological functions--a double-blind, placebo-controlled investigation. Addict Biol 2007; 12:183-9. [PMID: 17508991 DOI: 10.1111/j.1369-1600.2007.00056.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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: 11/30/2022]
Abstract
There is a general agreement that blood alcohol concentrations (BACs) of about 0.05% result in impairment of the ability to drive. This fact has been supported by means of experiments. In addition, there are only a few studies to date investigating low BACs. The present study aims to investigate the extent and quality of cognitive changes in low BACs of around 0.03%. Sixteen healthy male subjects were examined in a double-blind, placebo-controlled study. During the trials the BAC was regulated to about 0.03%. As part of the study a record was made of the general level of intelligence, subjective impairments, possible depressive symptoms, general ability to perform, vigilance, divided attention, response times and performance of memory. Statistical analysis took place using the two-period crossover design. Verbal intelligence, general performance, vigilance (optical stimuli), divided attention, vigilance towards acoustic stimuli and the general response time to acoustic and visual-acoustic sequential stimuli, and memory were not impaired significantly by a BAC of around 0.03%. The total response and motor response time to optical stimuli as well as decision time about sequential optical stimuli were, however, significantly changed for BACs of around 0.03%. In conclusion, the present results show that already in BACs of around 0.03%, particular cognitive functions which rely on perception and processing of visual information, are significantly impaired. This was evident in the more complex and urgent tasks.
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Affiliation(s)
- Dirk Breitmeier
- Institute of Legal Medicine, Medical School Hannover, Hannover, Germany.
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50
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Winterhalter M, Adams HA, Engels T, Rahe-Meyer N, Zuk J, Hagl C, Hecker H, Piepenbrock S. Endocrine stress response and myocardial outcome under balanced anesthesia with sevoflurane or TIVA with propofol in patients undergoing CABG. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s00390-007-0771-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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