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Abramovich I, Crisan I, Sobreira Fernandes D, De Hert S, Lukic A, Norte G, Matias B, Majić M, Berger-Estilita J. Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00074-X. [PMID: 38636795 DOI: 10.1016/j.redare.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/13/2023] [Indexed: 04/20/2024]
Abstract
BACKGROUND Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe. METHODS Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives. RESULTS Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK. CONCLUSION This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.
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Affiliation(s)
- I Abramovich
- Charité - Universitätsmedizin Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
| | - I Crisan
- Universitätsspital Zürich, Department of Emergency Medicine, Zürich, Switzerland
| | - D Sobreira Fernandes
- Centro Hospitalario de Póvoa de Varzim y Vila de Conde, Póvoa de Varzim, Portugal
| | - S De Hert
- Department of Anaesthsiology and Peri-operative Medicine, Ghent University, Ghent, Belgium
| | - A Lukic
- Department of Anaesthesiology, Reanimateology and Intensive Care, General Hospital Varaždin, Varaždin, Croatia
| | - G Norte
- Department of Anaesthesiology, Centro Hospitalar Trás-os-Montes y Alto Douro, Vila Real, Portugal
| | - B Matias
- Department of Anaesthesiology, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - M Majić
- Department of Anaesthesiology and ICU, University Hospital Centre Zagreb, Zagreb, Croatia
| | - J Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland; Institute of Anaesthsiology and Intensive Care, Salemspital, Hirslanden Medical Group, Bern, Switzerland; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
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Camilleri Podesta AM, Redfern N, Abramovich I, Mellin-Olsen J, Oremuš K, Kouki P, Guasch E, Novak-Jankovic V, Sabelnikovs O, Bilotta F, Grigoras I. Fatigue among anaesthesiologists in Europe: Findings from a joint EBA/NASC survey. Eur J Anaesthesiol 2024; 41:24-33. [PMID: 37962409 DOI: 10.1097/eja.0000000000001923] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Anaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness. 1. OBJECTIVE This study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists. DESIGN An online survey of specialist anaesthesiologists. PARTICIPANTS The survey was sent to anaesthesiologists in 42 European countries by electronic mail. MAIN OUTCOME MEASURES Responses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries. RESULTS Work-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being. CONCLUSION Work-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.
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Affiliation(s)
- Anne Marie Camilleri Podesta
- From the Department of Anaesthesia and Intensive Care, Mater Dei Hospital, Malta (AMCP), the Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK (NR), Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany (IA), the Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway (JMO), the Department of Anaesthesiology, AKROMION Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2,49217 Krapinske Toplice, Croatia (KO), the 6 Department of Anaesthesia, General Hospital Nikaia, Piraeus, Greece (PK), the Department of Anaesthesia and Reanimation. Hospital Universitario La Paz, Madrid, Spain (EG), the Medical Simulation Centre, University Medical Centre Ljubljana, Slovenia (VNJ), the Department of Anaesthesiology and Reanimatology, Riga; Riga Stradins University, Latvia (OS), the Department of Anaesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, Rome, Italy (FB), the Department of Anaesthesiology and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania (IG)
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Abramovich I, Matias B, Norte G, Zawadka M, Bilotta F, Buzincu I, Camilleri Podesta AM, De Hert S, Grigoras I, Pintilie G, Smallwood A, Trinks A, Redfern N. Fatigue amongst anaesthesiology and intensive care trainees in Europe: A matter of concern. Eur J Anaesthesiol 2023:00003643-990000000-00091. [PMID: 37166259 DOI: 10.1097/eja.0000000000001849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND There is a growing awareness of the effects of fatigue on trainee wellbeing and health. Trainees in anaesthesiology and intensive care work long hours, switching work schedules frequently with insufficient rest. This may have unwanted long-term effects on mental and physical health and emotional well being, resulting in burnout and affecting patient safety. OBJECTIVE The study aimed to evaluate the prevalence, severity, causes and effects of work-related fatigue in trainees in anaesthesiology and intensive care. DESIGN Online survey of trainees in anaesthesiology and intensive care. SETTINGS A total of 31 countries within Europe were included in the survey. PARTICIPANTS European anaesthesiology and intensive care trainees who responded to an invitation to take part by electronic mail or through social media. MAIN OUTCOME MEASURES Responses from a 29-item online survey to assess the realities within European countries with regards to work-related fatigue. RESULTS One thousand and two hundred trainees from 31 European countries answered the survey demonstrating that an alarming number of trainees were fatigued by their working patterns and night shifts. Trainees reported effects on personal well being, safe commuting and potential for clinical errors. Respondents described a lack of support from hospitals and management for recovery during and after night shifts. CONCLUSION Fatigue among trainees in anaesthesiology and intensive care has a significant impact on their well being and potentially, on the incidence of clinical errors. Current measures from authorities and hospital management are not sufficient to prevent serious fatigue, and therefore a fatigue risk management system should be considered. Failure to address this issue might lead to a further decline in trainees' wellbeing, their capacity to work in the speciality in the future, and potentially increase patient care errors.
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Affiliation(s)
- Igor Abramovich
- From the Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany (IA), Department of Anaesthesiology, Centro Hospitalar de Setúbal, Setúbal, Portugal (BM), Department of Anaesthesiology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal (GN), 2 Department of Anaesthesia and Intensive Care, Medical University of Warsaw, Poland (MZ), Department of Anaesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, Rome, Italy (FB), Department of Anaesthesiology and Intensive Care, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania (IB), Department of Anaesthesia and Intensive Care, Mater Dei Hospital, Malta (AMCP), Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium (SDH), Department of Anaesthesiology and Intensive Care, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania (IG), Department of Anaesthesiology and Intensive Care, Regional Institute of Oncology Iasi, Romania (GP), Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK (AS), Department of Anaesthesiology, LMU Klinikum München (AT) and Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK (NR)
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Zawadka M, Wong A, Janiszewska A, Sanfilippo F, La Via L, Sobieraj P, Abramovich I, Andruszkiewicz P, Jammer I. Critical care echocardiography: barriers, competencies and solutions. A survey of over 600 participants. Anaesthesiol Intensive Ther 2023; 55:158-162. [PMID: 37728442 PMCID: PMC10496096 DOI: 10.5114/ait.2023.130294] [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] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Critical care echocardiography (CCE) is at the core of point-of-care ultrasound (POCUS), and although a list of the necessary competencies has been created, most European countries do not have established training programmes to allow intensivists to gain such competencies. To address barriers to the implementation of CCE, we conducted an online European survey, and analysed the current barriers to this with the aim of providing novel, modern solutions to them including environmental considerations. MATERIAL AND METHODS A 23-item survey was distributed via email with support from the European Society of Intensive Care Medicine, national societies, and social media. Questions focused on bedside CCE prevalence, competencies, and barriers to its implementation. An additional questionnaire was sent to recognised experts in the field of CCE. RESULTS A total of 644 responses were recorded. Most respondents were anaesthesia and intensive care physicians [79% ( n = 468)], and younger, with 56% in their first five years after specialization ( n = 358). Most respondents [92% ( n = 594)] had access to an ultrasound machine with a cardiac probe, and 97% ( n = 623) reported being able to acquire basic CCE windows. The most common barriers identified by respondents to the implementation of CCE in practice were a lack of sufficient experience/skill [64% ( n = 343)], absence of formal qualifications [46% ( n = 246)] and lack of a mentor [45% ( n = 243)]. Twenty-eight experts responded and identified a lack of allocated time for teaching as a main barrier [60% ( n = 17)]. CONCLUSIONS We found that bedside CCE is perceived as a crucial skill for intensive care medicine, especially by younger physicians; however, there remain several obstacles to training and implementation. The most important impediments reported by respondents were inadequate training, absence of formal qualifications and difficulties in finding a suitable mentor.
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Affiliation(s)
- Mateusz Zawadka
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Wong
- Department of Critical Care, King’s College Hospital, London, UK
| | - Anna Janiszewska
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco, site “Policlinico G. Rodolico”, Catania, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco, site “Policlinico G. Rodolico”, Catania, Italy
| | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Igor Abramovich
- Charité – Universitätsmedizin Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Paweł Andruszkiewicz
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Ib Jammer
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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Saragovi A, Zilberman T, Yasur G, Turjeman K, Abramovich I, Kuchersky M, Gottlieb E, Barenholz Y, Berger M. Analysis of cellular water content in T cells reveals a switch from slow metabolic water gain to rapid water influx prior to cell division. J Biol Chem 2022; 298:101795. [PMID: 35248530 PMCID: PMC9034303 DOI: 10.1016/j.jbc.2022.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Cell growth is driven by the acquisition and synthesis of both dry biomass and water mass. In this study, we examine the increase of water mass in T cell during cell growth. We found that T-cell growth is characterized by an initial phase of slow increase in cellular water, followed by a second phase of rapid increase in water content. To study the origin of the water gain, we developed a novel methodology we call cold aqua trap-isotope ratio mass spectrometry, which allows analysis of the isotope composition of intracellular water. Applying cold aqua trap-isotope ratio mass spectrometry, we discovered that glycolysis-coupled metabolism of water accounts on average for 11 fl out of the 20 fl of water gained per cell during the initial slow phase. In addition, we show that at the end of the rapid phase before initiation of cell division, a water influx occurs, increasing the cellular water mass by threefold. Thus, we conclude that activated T cells switch from metabolizing water to rapidly taking up water from the extracellular medium prior to cell division. Our work provides a method to analyze cell water content as well as insights into the ways cells regulate their water mass.
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Affiliation(s)
- A Saragovi
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel.
| | - T Zilberman
- Department of Geochemistry, Geological Survey of Israel, Jerusalem, Israel
| | - G Yasur
- Department of Geochemistry, Geological Survey of Israel, Jerusalem, Israel
| | - K Turjeman
- Laboratory of Membrane and Liposome Research, Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - I Abramovich
- The Ruth and Bruce Rappaport, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - M Kuchersky
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel
| | - E Gottlieb
- The Ruth and Bruce Rappaport, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Y Barenholz
- Laboratory of Membrane and Liposome Research, Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - M Berger
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel.
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Hommes F, van Loon W, Thielecke M, Abramovich I, Lieber S, Hammerich R, Gehrke-Beck S, Linzbach E, Schuster A, von dem Busche K, Theuring S, Gertler M, Equihua Martinez G, Richter J, Bergmann C, Bölke A, Böhringer F, Mall MA, Rosen A, Krannich A, Keller J, Bethke N, Kurzmann M, Kurth T, Kirchberger V, Seybold J, Mockenhaupt FP. SARS-CoV-2 Infection, Risk Perception, Behaviour and Preventive Measures at Schools in Berlin, Germany, during the Early Post-Lockdown Phase: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph18052739. [PMID: 33800392 PMCID: PMC7967466 DOI: 10.3390/ijerph18052739] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 12/24/2022]
Abstract
Briefly before the first peak of the COVID-19 pandemic in Berlin, Germany, schools closed in mid-March 2020. Following re-opening, schools resumed operation at a reduced level for nine weeks. During this phase, we aimed at assessing, among students and teachers, infection status, symptoms, individual behaviour, and institutional infection prevention measures. Twenty-four primary and secondary school classes, randomly selected across Berlin, were examined. Oro-nasopharyngeal swabs and capillary blood samples were collected to determine SARS-CoV-2 infection (PCR) and specific IgG (ELISA), respectively. Medical history, household characteristics, leisure activities, fear of infection, risk perception, hand hygiene, facemask wearing, and institutional preventive measures were assessed. Descriptive analysis was performed. Among 535 participants (385 students, 150 staff), one teenager was found to be infected with SARS-CoV-2 (0.2%), and seven individuals exhibited specific IgG (1.3%). Compared to pre-pandemic times, screen time (e.g., TV, gaming, social media) increased, and the majority of primary school students reported reduced physical activity (42.2%). Fear of infection and risk perception were relatively low, acceptance of adapted health behaviors was high. In this post-lockdown period of low SARS-CoV-2 incidence in Berlin, individual and school-level infection prevention measures were largely adhered to. Nevertheless, vigilance and continued preventive measures are essential to cope with future pandemic activity.
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Affiliation(s)
- Franziska Hommes
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
- Correspondence:
| | - Welmoed van Loon
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Marlene Thielecke
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Igor Abramovich
- Clinic for Anesthesiology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.A.); (S.L.)
| | - Sascha Lieber
- Clinic for Anesthesiology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.A.); (S.L.)
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Ralf Hammerich
- Clinical Quality and Risk Management, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Sabine Gehrke-Beck
- Institute of General Practice, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (S.G.-B.); (A.S.)
| | - Elisabeth Linzbach
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Angela Schuster
- Institute of General Practice, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (S.G.-B.); (A.S.)
| | - Katja von dem Busche
- Department of Pediatric Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Maximilian Gertler
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Clara Bergmann
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Alisa Bölke
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Falko Böhringer
- Labor Berlin—Charité Vivantes Services GmbH, 13353 Berlin, Germany;
| | - Marcus A. Mall
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.A.M.); (A.R.)
| | - Alexander Rosen
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.A.M.); (A.R.)
| | - Alexander Krannich
- Clinical Study Center, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, 14195 Berlin, Germany;
| | - Norma Bethke
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Marco Kurzmann
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Tobias Kurth
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Valerie Kirchberger
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Joachim Seybold
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Frank P. Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
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Baskin P, Ben Jehuda R, Abramovich I, Agranovich B, Davidor M, Mekies L, Milman H, Shulman M, Arad M, Gottlieb E, Binah O. Bioenergetic and metabolic aberrations in induced pluripotent stem cell-derived cardiomyocytes generated from PRKAG2-mutated, WPW patient. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Familial hypertrophic cardiomyopathy (HCM) is caused by over 400 mutations affecting mostly key sarcomere components, such as titin and myosin. However, HCM also results from mutations in non-structural genes such as PRKAG2 which is involved directly in a variety of bioenergetic and metabolic pathways. When the metabolic processes fail to work properly or effectively, structural and functional aberrations resulting in cardiac dysfunction can occur. Thus, mutations in the human PRKAG2 gene lead to HCM, autosomal dominant ventricular pre-excitation - Wolff-Parkinson-White syndrome (WPW), a progressive conduction system disease and vacuolar glycogen accumulation in cardiomyocytes.
Purpose
To investigate the hypothesis that intervening with the bioenergetic and metabolic consequences of the R302Q mutation in the PRKAG2 gene causing inherited cardiomyopathy, will attenuate the cardiac impairments.
Methods
We generated mutated and isogenic induced Pluripotent Stem Cell-derived cardiomyocytes (iPSC-CMs) from a WPW patient carrying the R302Q mutation. As additional control, we used healthy volunteers' iPSC-CMs. Bioenergetic (Oxygen Consumption Rate, OCR) and metabolic status were measured using the Seahorse Flux Analyzer and LC-MS, respectively. To decipher the molecular basis underlying the bioenergetic and metabolic deficits, RNA-seq analysis was performed.
Results
The OCR results demonstrated in PRKAG2-mutated compared to isogenic and healthy iPSC-CMs, a 2-fold increase in maximal respiration rate and a 3.75-fold increase in spare respiratory capacity, while basal OCR parameters were similar in all groups. Importantly, when treated with the AMPK activator metformin (2.5 [mM]), all the abovementioned OCR parameters were similar in the three groups. RNA-seq analysis demonstrated that of the 553 differently expressed genes (DEGs), and of the 99 DEGs mutually differentially expressed, compared to isogenic and healthy cells, the most relevant altered pathways were glycolysis, carbon metabolism, biosynthesis of amino acids, HIF-1 signaling and fructose and mannose metabolism. These findings are consistent with the LC-MS results demonstrating in PRKAG2-mutated versus isogenic and healthy iPSC-CMs, at least a 3-fold decrease in metabolites linked to the abovementioned pathways: butyryl-carnitine, creatine, docosahexaenoic acid, GMP, IMP, myristoyl-carnitine, palmitoyl-carnitine, succinyl-Cys, UMP, UTP, UDP-GlcNAc.
Conclusion
PRKAG2-mutated iPSC-CMs exhibit bioenergetic and metabolic aberrations, which contribute to the cardiac pathological aspects of WPW syndrome. Importantly, treatment with the AMPK activator metformin eliminated the bioenergetic abnormalities in the mutated cells, while isogenic and healthy control cells remained unaffected. Based on these novel findings, a new therapeutic modality in WPW patients may be considered.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Israel Science Foundation (ISF)
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Affiliation(s)
- P Baskin
- Technion - Israel Institute of Technology, Haifa, Israel
| | - R Ben Jehuda
- Technion - Israel Institute of Technology, Haifa, Israel
| | - I Abramovich
- Technion - Israel Institute of Technology, Haifa, Israel
| | - B Agranovich
- Technion - Israel Institute of Technology, Haifa, Israel
| | - M Davidor
- Technion - Israel Institute of Technology, Haifa, Israel
| | - L.N Mekies
- Technion - Israel Institute of Technology, Haifa, Israel
| | - H Milman
- Technion - Israel Institute of Technology, Haifa, Israel
| | - M Shulman
- Technion - Israel Institute of Technology, Haifa, Israel
| | - M Arad
- Sheba Medical Center, Ramat Gan, Israel
| | - E Gottlieb
- Technion - Israel Institute of Technology, Haifa, Israel
| | - O Binah
- Technion - Israel Institute of Technology, Haifa, Israel
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Willi L, Agranovich B, Abramovich I, Freimark D, Arad M, Gottlieb E, Binah O. Bioenergetic and metabolic impairments in Duchenne Muscular Dystrophy (DMD) patients' iPSC-derived cardiomyocytes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
DMD, an X-linked muscle degenerative fatal disease, is caused by mutations in the dystrophin gene. Dilated cardiomyopathy (DCM) is a major cause of morbidity and mortality in DMD patients. Treatments for DCM in DMD are limited to steroids and standard heart failure medications such as β-blockers and ACE-inhibitors, and therefore novel therapeutic modalities are urgently needed.
Purpose
We hypothesized that dystrophin mutations in DMD lead to cardiomyopathy-causing bioenergetic/metabolic impairments, which can be therapeutically targeted for improving cardiac function.
Methods
Induced Pluripotent Stem Cell-derived cardiomyocytes (iPSC-CMs) were generated from healthy volunteer and 3 DMD patients: young male (YM), adult male (AM) and adult female (AF). We investigated the bioenergetics, electrophysiology, mitochondrial and metabolic features of healthy and DMD iPSC-CMs using the Seahorse Flux analyzer, patch clamp, confocal fluorescence microscopy and Liquid chromatography mass spectrometry (LC-MS) technologies, respectively.
Results
To test the hypothesis, we measured respiration and glycolytic rates of healthy and DMD iPSC-CMs. Compared to healthy iPSC-CMs, in both AM and AF DMD, but not in YM DMD cardiomyocytes, there was a 75% decrease in ATP production, and 80% and 45% decrease in basal respiration, respectively. In agreement with the healthy-like bioenergetic status of YM, the iPSC-CMs showed no arrhythmias, in contrast to the prominent arrhythmias in AM and AF cardiomyocytes. To determine whether the impairment in the phosphorylation pathway (OXPHOS) affects glycolysis, we measured the cardiomyocytes' response to glycolytic stress test. These experiments showed that the glycolytic rates were similar in healthy and DMD iPSC-CMs. In agreement with impaired OXPHOS, mitochondrial activity measured by 3D life confocal microscopy was attenuated in the DMD male by 35%, compared to healthy cardiomyocytes. Furthermore, the metabolomic LC-MS analyses demonstrated significant differences in metabolite levels in YM, AM and AF DMD iPSC-CMs relative to healthy iPSC-CMs. For example, compared to healthy iPSC-CMs, there was a dramatic fall to undetected levels in phosphocreatine in both AM and AF, but not in YM DMD, indicating a dysfunctional phosphocreatine energy system.
Conclusions
DMD iPSC-CMs exhibit bioenergetic/metabolic impairments, which constitute novel targets for alleviating the cardiomyopathy in DMD patients.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): ISF - Israel Science Foundation
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Affiliation(s)
- L Willi
- Technion - Israel Institute of Technology, Department of Physiology, Biophysics and Systems Biology, Haifa, Israel
| | - B Agranovich
- Technion - Israel Institute of Technology, Department of Cell Biology and Cancer Science, Haifa, Israel
| | - I Abramovich
- Technion - Israel Institute of Technology, Department of Cell Biology and Cancer Science, Haifa, Israel
| | - D Freimark
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - M Arad
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - E Gottlieb
- Technion - Israel Institute of Technology, Department of Cell Biology and Cancer Science, Haifa, Israel
| | - O Binah
- Technion - Israel Institute of Technology, Department of Physiology, Biophysics and Systems Biology, Haifa, Israel
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Ben Jehuda R, Abramovich I, Mekies L, Willi L, Eisen B, Shemer Y, Baskin P, Arad M, Gottlieb E, Binah O. Metabolism and Ca2+ handling abnormalities in PRKAG2-mutated induced pluripotent stem cells-derived cardiomyocytes. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.095] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mekies L, Ben Jehuda R, Eisen B, Willi L, Abramovich I, Shemer Y, Baskin P, Michele D, Arad M, Gottlieb E, Binah O. Depressed beta-adrenergic inotropic responsiveness, altered intracellular calcium handling and metabolic deficits in Duchenne Muscular Dystrophy patients’ induced pluripotent stem cell-derived cardiomyocytes. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aliperti V, Aragone S, Abramovich I, Figar S, Camera M, de Quiros FGB. P2-7 Mortality and cardiovascular events in patients under treatment with clopidogrel and omeprazole. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976h.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gross M, Abramovich I, Weiss EI. Microleakage at the abutment-implant interface of osseointegrated implants: a comparative study. Int J Oral Maxillofac Implants 1999; 14:94-100. [PMID: 10074758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Microleakage can occur at the abutment-implant (A-I) interface in osseointegrated implants and may cause malodor and inflammation of peri-implant tissues. The degree of microleakage at the A-I interface of 5 implant systems was comparatively assessed at varying closing torques. Using colored tracing probes driven by a 2-atm pressure system, the interface microleakage of Brånemark, Sulzer Calcitek, 3i, ITI, and Steri-Oss implants was determined spectrophotometrically. Microleakage through the A-I interface occurred in all systems, with variability between systems, samples, and closing torques. As closing torque increased from 10 Ncm to 20 Ncm to manufacturers' recommended closing torques, microleakage decreased significantly (P < .005) for all systems. Analysis of variance showed significant interaction between closing torques and the time course of microleakage, and between systems and the time course of microleakage (P < .001). The results indicate that fluids and small molecules are capable of passing through the interface of all the A-I assemblies studied. Presumably in an in situ situation, fluids containing bacterial byproducts and nutrients required for bacterial growth may pass through the interface gap, contributing in part to clinically observed malodor and peri-implantitis.
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Affiliation(s)
- M Gross
- Department of Oral Rehabilitation, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel.
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Grossmann RM, Abramovich I, Lefèvre AB. [Epileptic headache: study of a case with electroencephalographic registration during a crisis]. Arq Neuropsiquiatr 1971; 29:198-206. [PMID: 5159767 DOI: 10.1590/s0004-282x1971000200008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
É relatado o caso de uma paciente com 9 anos de idade, na qual foi feito o EEG durante 3 crises de cefaléia sem caráter de enxaqueca. Simultaneamente com as crises foram observadas, no EEG, anormalidades caracterizadas por ondas agudas ritmadas de projeção difusa no hemisfério cerebral direito, predominando na região occipital. São feitos comentários sobre a raridade do relato de anormalidades do tipo irritativo durante crises de cefaléia, sendo ressaltado o valor de tais achados para a classificação dessas cefaléias dentro do conceito de epilepsia.
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