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Erath JW, Buettner S, Weiler H, Vamos M, Von Jeinsen B, Heyl S, Schalk R, Mutlak H, Zeiher AM, Fichtlscherer S, Honold J. P2733Prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - S Buettner
- JW Goethe University, Nephrology, Frankfurt am Main, Germany
| | - H Weiler
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - B Von Jeinsen
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Heyl
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - R Schalk
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - H Mutlak
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - A M Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Fichtlscherer
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - J Honold
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
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Erath JW, Hodrius J, Bushoven P, Fichtlscherer S, Zeiher AM, Seeger FH, Honold J. [Early onset pneumonia after successful resuscitation : Incidence after mild invasive hypothermia therapy]. Med Klin Intensivmed Notfmed 2016; 112:519-526. [PMID: 27807612 DOI: 10.1007/s00063-016-0228-y] [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] [Received: 07/14/2016] [Revised: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Targeted temperature management (TTM) represents an effective therapy to improve neurologic outcome in patients who survive an out-of-hospital cardiac arrest (OHCA). First publications about this therapy reported a higher incidence of infections in patients who underwent TTM induced by external cooling devices. Whether intravascular cooling devices are also associated with an increased infection rate has not been investigated so far. METHODS In a single center retrospective study, the incidence of early onset pneumonia (EOP) in OHCA patients with or without intravascular TTM at 33 °C target temperature for 24 h who survived at least 24 h after admission was analyzed. RESULTS A total of 68 OHCA survivors (mean age 65 ± 15 years) were included in this analysis. The most common causes of OHCA were myocardial infarction (35 %), primary ventricular fibrillation (24 %), asystole (15 %), and pulmonary embolism (7 %). Of those, 32 patients (48 %) received TTM. The overall incidence of EOP was 38 %. Incidence of EOP did not differ significantly between groups, was more frequent in the group without TTM (42 % vs. 34 %, p = 0.57) and had no impact on mortality (hazard ratio = 1.02; 95 % confidence interval 0.25-4.16; p = 0.97). CONCLUSION Intravascular TTM at 33 °C with a cooling catheter is not associated with more infective complications in OHCA patients. This finding underscores the safety of TTM.
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Affiliation(s)
- J W Erath
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - J Hodrius
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - P Bushoven
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - S Fichtlscherer
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - A M Zeiher
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - F H Seeger
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland
| | - J Honold
- Medizinische Klinik III, Kardiologie, Nephrologie, Angiologie, Universitätsklinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland.
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Honold J, Hodrius J, Schwietz T, Bushoven P, Zeiher A, Fichtlscherer S, Seeger F. Aspirations- und Pneumonierisiko nach präklinischer invasiver Beatmung. Med Klin Intensivmed Notfmed 2015; 110:526-33. [DOI: 10.1007/s00063-015-0018-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
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Holzmann C, Honold J, Wippert PM. Bildungsstatus bei Rückenschmerzpatienten. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fischer-Rasokat U, Honold J, Lochmann D, Liebetrau C, Hamm CW, Fichtlscherer S, Moellmann H, Spyridopoulos I. Switching from beta-blockers to ivabradine: effects on cardiopulmonary function in patients with stable coronary artery disease and hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3373] [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: 11/12/2022] Open
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Fischer-Rasokat U, Honold J, Lochmann D, Liebetrau C, Leick J, Hamm CW, Fichtlscherer S, Moellmann H, Spyridopoulos I. Beta-Blockade does not exert heart rate-independent effects on pulse wave reflection in men with high cardiovascular risk. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p560] [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: 11/14/2022] Open
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Honold J, Thieme F, Zeuzem S, Serve H, Fichtlscherer S, Zeiher A, Walcher F, Marzi I, Lehmann R. Internistische Patienten in einer universitären Notaufnahme: Charakterisierung und ökonomische Bedeutung für das Gesamtklinikum. Dtsch Med Wochenschr 2013; 138:1401-5. [DOI: 10.1055/s-0033-1343231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J. Honold
- Medizinische Klinik III, Universitätsklinikum Frankfurt am Main
| | - F. Thieme
- Medizinische Klinik III, Universitätsklinikum Frankfurt am Main
| | - S. Zeuzem
- Medizinische Klinik I, Universitätsklinikum Frankfurt am Main
| | - H. Serve
- Medizinische Klinik II, Universitätsklinikum Frankfurt am Main
| | | | - A. Zeiher
- Medizinische Klinik III, Universitätsklinikum Frankfurt am Main
| | - F. Walcher
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt am Main
| | - I. Marzi
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt am Main
| | - R. Lehmann
- Medizinische Klinik III, Universitätsklinikum Frankfurt am Main
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Schächinger V, Assmus B, Honold J, Lehmann R, Hofmann WK, Martin H, Dimmeler S, Zeiher AM. Normalization of coronary blood flow in the infarct-related artery after intracoronary progenitor cell therapy: intracoronary Doppler substudy of the TOPCARE-AMI trial. Clin Res Cardiol 2006; 95:13-22. [PMID: 16598441 DOI: 10.1007/s00392-006-0314-x] [Citation(s) in RCA: 39] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 08/17/2005] [Indexed: 01/06/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction contributes to infarct extension and poor prognosis after an acute myocardial infarction (AMI). Recently, progenitor cell application has been demonstrated to improve neovascularization and myocardial function after experimental myocardial infarction. Therefore, we investigate coronary blood flow regulation in patients after AMI treated with intracoronary progenitor cell therapy. METHODS AND RESULTS In the TOPCARE-AMI trial, patients received either bone marrow-derived or circulating progenitor cells into the infarct-related artery 3-7 days after AMI. The present substudy investigates in 40 patients coronary blood flow regulation at the time of progenitor cell therapy and at 4-month follow-up by i.c. Doppler in the infarct artery as well as a reference vessel. At the initial measurement, coronary flow reserve (CFR) was reduced in the infarct artery compared to the reference vessel (median 2.5 vs. 3.4, p<0.001). At 4-month follow-up, intracoronary progenitor cell therapy was associated with a normalization of CFR in the infarct artery (median 3.9 vs. reference vessel 3.8, p=0.15). CFR also improved in the reference vessel, but mechanisms were different: reference vessel increase in CFR was secondary to an increased basal vascular resistance, probably due to reduced need for hypercontractility. In contrast, in the infarct artery, adenosine-induced minimal vascular resistance profoundly decreased, indicating an increased maximal coronary vascular conductance capacity. In addition, in a non-randomized matched control group (n=8), minimal vascular resistance in the infarct artery was significantly elevated compared to progenitor cell treated patients 4 months after AMI (p=0.012). CONCLUSIONS Intracoronary progenitor cell therapy after AMI is associated with complete restoration of coronary flow reserve due to a substantial improvement of maximal coronary vascular conductance capacity. The clinical importance of improved microcirculation by progenitor cell therapy in patients after AMI has to be established in further randomized trials.
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Affiliation(s)
- V Schächinger
- Dept. of Internal Medicine IV, J. W. Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Britten MB, Abolmaali ND, Assmus B, Lehmann R, Honold J, Schmitt J, Vogl TJ, Martin H, Schächinger V, Dimmeler S, Zeiher AM. Infarct remodeling after intracoronary progenitor cell treatment in patients with acute myocardial infarction (TOPCARE-AMI): mechanistic insights from serial contrast-enhanced magnetic resonance imaging. Circulation 2003; 108:2212-8. [PMID: 14557356 DOI: 10.1161/01.cir.0000095788.78169.af] [Citation(s) in RCA: 432] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Experimental and initial clinical studies suggest that transplantation of circulating blood- (CPC) or bone marrow-derived (BMC) progenitor cells may beneficially affect postinfarction remodeling processes after acute myocardial infarction (AMI). To relate functional characteristics of the infused cells to quantitative measures of outcome at 4-month follow-up, we performed serial contrast-enhanced MRI and assessed the migratory capacity of the transplanted progenitor cells immediately before intracoronary infusion. METHODS AND RESULTS In 28 patients with reperfused AMI receiving either BMCs or CPCs into the infarct artery 4.7+/-1.7 days after AMI, serial contrast-enhanced MRI performed initially and after 4 months revealed a significant increase in global ejection fraction (from 44+/-10% to 49+/-10%; P=0.003), a decrease in end-systolic volume (from 69+/-26 to 60+/-28 mL; P=0.003), and unchanged end-diastolic volumes (122+/-34 versus 117+/-37 mL; P=NS). Infarct size, measured as late enhancement (LE) volume, decreased significantly, from 46+/-32 to 37+/-28 mL (P<0.05). There was a significant correlation between the reduction in LE volume and global ejection fraction improvement. The migratory capacity of transplanted cells as assessed ex vivo toward a gradient of vascular endothelial growth factor for CPCs and stromal cell derived factor-1 for BMCs was closely correlated with the reduction of LE volume. By multivariate analysis, migratory capacity remained the most important independent predictor of infarct remodeling. CONCLUSIONS Analysis of serial contrast-enhanced MRI suggests that intracoronary infusion of adult progenitor cells in patients with AMI beneficially affects postinfarction remodeling processes. The migratory capacity of the infused cells is a major determinant of infarct remodeling, disclosing a causal effect of progenitor cell therapy on regeneration enhancement.
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Affiliation(s)
- M B Britten
- Department of Cardiology, J.W. Goethe-University Frankfurt, Frankfurt, Germany
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Honold J, Pusser NL, Nathan L, Chaudhuri G, Ignarro LJ, Sherman MP. Production and excretion of nitrate by human newborn infants: neonates are not little adults. Nitric Oxide 2000; 4:35-46. [PMID: 10733871 DOI: 10.1006/niox.1999.0267] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelium-derived relaxing factor, identified as nitric oxide or its adducts, is metabolized to nitrate and excreted in the urine. Since blood pressures are lower in newborn infants compared to adults, we hypothesized that newborn infants would have increased excretion of nitrate on the day of birth. Neonatal urine was collected before 24 h of age when exogenous intake of nitrate was low. Two different analytical methods showed that nitrate accounted for >99% of nitrogen oxides in urine of healthy neonates and adults. The absolute micromolar concentration of nitrate in urine from infants was significantly below that of adults. When nitrate content was standardized for the reduced renal function in the newborn infant (creatinine content) and body mass (kilogram weight), the concentration of nitrate in neonatal urine was significantly higher than that of adults. Nitrate concentrations in the urine of prematurely born infants were twice that of nitrate measured in urine from term infants. These findings suggested that nitric oxide is produced in larger intravascular quantities in newborn infants versus adults. Thus, we postulated that nitric oxide released from a nitrosothiol would be metabolized to nitrate more readily by neonatal erythrocytes compared to red blood cells obtained from adults. Neonatal erythrocytes, suspended at concentrations of 8, 12, or 16 g per deciliter of hemoglobin, produced 1.7- to 2.1-fold more nitrate than equivalent hemoglobin concentrations of adult erythrocytes that were each incubated with S-nitroso-N-acetylpenicillamine (100 microM) over a 2-h period. Taken together, the studies of urinary nitrate in newborn infants and the ability of neonatal erythrocytes to generate nitrate are consistent with a robust production of nitric oxide immediately after birth.
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Affiliation(s)
- J Honold
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA 95616, USA
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