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Amend S, Boutsiouki C, Winter J, Kloukos D, Frankenberger R, Krämer N. Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00876-9. [PMID: 38488955 DOI: 10.1007/s40368-024-00876-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up. METHODS A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA). RESULTS Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis. CONCLUSION Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children's permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.
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Affiliation(s)
- S Amend
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany.
| | - C Boutsiouki
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - J Winter
- Department of Operative Dentistry, Endodontics and Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Marburg), Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstr. 7, 3008, Bern, Switzerland
| | - R Frankenberger
- Department of Operative Dentistry, Endodontics and Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Marburg), Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - N Krämer
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
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O'Shea C, Winter J, Kabir SN, O'Reilly M, Wells SP, Baines O, Sommerfeld LC, Correia J, Lei M, Kirchhof P, Holmes AP, Fabritz L, Rajpoot K, Pavlovic D. Publisher Correction: High resolution optical mapping of cardiac electrophysiology in pre-clinical models. Sci Data 2024; 11:93. [PMID: 38238379 PMCID: PMC10796748 DOI: 10.1038/s41597-024-02941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - S Nashitha Kabir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Molly O'Reilly
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Simon P Wells
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Olivia Baines
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Laura C Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Joao Correia
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ming Lei
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, UK
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Petrich C, Dimroth A, Kraus KM, Winter J, Matejcek C, Butzek M, Natour G, Ravichandran M, Zimmermann M, Aulenbacher K, Galek M, Wilkens J, Combs SE, Bartzsch S. Towards Clinical Translation of Microbeam Radiation Therapy (MRT) with a Compact Source. Int J Radiat Oncol Biol Phys 2023; 117:S38-S39. [PMID: 37784488 DOI: 10.1016/j.ijrobp.2023.06.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MRT is an innovative concept of spatially fractionated radiation therapy that has demonstrated substantially improved normal tissue tolerance while achieving local tumor control in a wealth of preclinical studies. In MRT a collimator shapes a few micrometers wide planar x-ray beams with a spacing of a few 100 µm. MRT has the potential to improve cancer treatment substantially. However, until now, only a few large 3rd generation synchrotrons provide beam parameters that would allow patient treatments and therefore, MRT has not yet become clinically available. For a clinical translation, compact x-ray sources are required, that produce high dose rate orthovoltage x-rays from a micrometer sized emitter. MATERIALS/METHODS We developed and built a first prototype of a line focus x-ray tube (LFxT) dedicated to preclinical MRT research. By exploiting the heat capacity limit, the LFxT can deliver dose rates above 100 Gy/s from a just 50 µm-wide focal spot without destroying the rapidly (>200 Hz) rotating x-ray target. A bespoke collimator splits the homogeneous x-ray field into 50 µm wide high-dose peaks separated by 350 µm wide low-dose troughs (valleys). While the prototype in our lab is restricted to a power of 90 kW and 10 Gy/s at 300 kVp, we have started the development of the first clinically usable LFxT-2 at 1.5 MW power and >100 Gy/s at 600 kVp beam quality. We investigated the clinical applicability of the LFxT-2 by performing retrospective treatment planning studies. In particular, we were examining, whether 600 kVp photons would suffice to meet clinical dose constraints in MRT treatments treatment scenarios for first clinical use of MRT. We coupled the open source platform 3D Slicer with an in-house developed dose calculation algorithm for MRT treatment planning. For comparability of spatially fractionated MRT doses with conventional broad beam treatments, the MRT dose was converted to equivalent uniform dose (EUD) and equivalent doses in 2-Gy-fractions (EQD2). The 3D Slicer RT toolkit enabled the dosimetric analysis based on dose volume histograms (DVHs). RESULTS We installed a preclinical prototype of the LFxT that is currently put into operation and commissioned. Simulations show the feasibility of the next generation LFxT-2 with more than 100 Gy/s peak dose rate. Planned MRT dose distributions with the LFxT-2 meet established radiotherapy dose constraints in many of the investigated clinical cases. However, treatment planning procedures are not yet optimal and require improvement. CONCLUSION In a next step, we will build the LFxT-2 and aim for first clinical MRT trials at this source. In order to further improve calculated MRT dose distributions, we will implement inverse treatment planning techniques.
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Affiliation(s)
- C Petrich
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Neutron Source Heinz Maier-Leibnitz (FRM II), Munich, Germany
| | - A Dimroth
- Research Centre Juelich, Juelich, Germany
| | - K M Kraus
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU) GmbH German Research Center for Environmental Health, Neuherberg, Germany
| | - J Winter
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - C Matejcek
- Helmholtz Institute Mainz, Mainz, Germany
| | - M Butzek
- Research Centre Juelich, Juelich, Germany
| | - G Natour
- Research Centre Juelich, Juelich, Germany
| | - M Ravichandran
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Technical University of Munich, Munich, Germany
| | | | | | - M Galek
- University of Applied Sciences Munich, Munich, Germany
| | - J Wilkens
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - S E Combs
- Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany; Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - S Bartzsch
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Neutron Source Heinz Maier-Leibnitz (FRM II), Munich, Germany
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Al-Sheikhli J, Winter J, Luque IR, Lambiase PD, Orini M, Porta-Sánchez A, Dhanjal T. Optimization of decrementing evoked potential mapping for functional substrate identification in ischaemic ventricular tachycardia ablation. Europace 2023; 25:euad092. [PMID: 37032650 PMCID: PMC10228600 DOI: 10.1093/europace/euad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Jaffar Al-Sheikhli
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
| | - James Winter
- Electrophysiology Division, Abbott Laboratories, Solihull, UK
| | - Ivo Roca Luque
- Arrhythmia Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
- University of Warwick, Warwick Medical School, Coventry, CV4 7HL, UK
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O'Shea C, Winter J, Holmes A, Correia JN, Kirchhof P, Fabritz L, Rajpoot K, Pavlovic D. Sympathetic nervous stimulation promotes complex rotational ventricular fibrillation events in guinea pig hearts. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.055] [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: 01/01/2023]
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Padayachee J, Liu Z, Berlin A, Helou J, Winter J, Kong V, Glicksman R, Raman S, Weersink R, Chung P. HDR Focal Boost with Whole Gland SBRT in Localized Prostate Cancer: Assessment of Acute Toxicity and Early Quality of Life. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1205] [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: 10/31/2022]
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Chaussée A, Winter J, Ayres P. Approaches to Decolonising Forensic Curricula. Sci Justice 2022; 62:795-804. [DOI: 10.1016/j.scijus.2022.06.003] [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] [Received: 10/22/2021] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
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Winter J, Dang J, Fernando N, Malkov V, Kong V, Chung P, Craig T, Conroy L, Tadic T. PO-1708 Application of dose accumulation for PTV margin design in MR-guided adaptive prostate SBRT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03672-6] [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: 11/17/2022]
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Li W, Malkov V, Kong V, Dang J, Navarro I, Winter J, Padayachee J, Chung P. PD-0329 Impact of Bladder Volume Changes on Prostate Position during MR-Guided Online Adaptive SBRT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02822-5] [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: 11/26/2022]
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Hesketh LM, Sikkel MB, Mahoney-Sanchez L, Mazzacuva F, Chowdhury RA, Tzortzis KN, Firth J, Winter J, MacLeod KT, Ogrodzinski S, Wilder CDE, Patterson LH, Peters NS, Curtis MJ. OCT2013, an ischaemia-activated antiarrhythmic prodrug, devoid of the systemic side effects of lidocaine. Br J Pharmacol 2022; 179:2037-2053. [PMID: 34855992 DOI: 10.1111/bph.15764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/01/2021] [Revised: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Sudden cardiac death (SCD) caused by acute myocardial ischaemia and ventricular fibrillation (VF) is an unmet therapeutic need. Lidocaine suppresses ischaemia-induced VF, but its utility is limited by side effects and a narrow therapeutic index. Here, we characterise OCT2013, a putative ischaemia-activated prodrug of lidocaine. EXPERIMENTAL APPROACH The rat Langendorff-perfused isolated heart, anaesthetised rat and rat ventricular myocyte preparations were utilised in a series of blinded and randomised studies to investigate the antiarrhythmic effectiveness, adverse effects and mechanism of action of OCT2013, compared with lidocaine. KEY RESULTS In isolated hearts, OCT2013 and lidocaine prevented ischaemia-induced VF equi-effectively, but OCT2013 did not share lidocaine's adverse effects (PR widening, bradycardia and negative inotropy). In anaesthetised rats, i.v. OCT2013 and lidocaine suppressed VF and increased survival equi-effectively; OCT2013 had no effect on cardiac output even at 64 mg·kg-1 i.v., whereas lidocaine reduced it even at 1 mg·kg-1 . In adult rat ventricular myocytes, OCT2013 had no effect on Ca2+ handling, whereas lidocaine impaired it. In paced isolated hearts, lidocaine caused rate-dependent conduction slowing and block, whereas OCT2013 was inactive. However, during regional ischaemia, OCT2013 and lidocaine equi-effectively hastened conduction block. Chromatography and MS analysis revealed that OCT2013, detectable in normoxic OCT2013-perfused hearts, became undetectable during global ischaemia, with lidocaine becoming detectable. CONCLUSIONS AND IMPLICATIONS OCT2013 is inactive but is bio-reduced locally in ischaemic myocardium to lidocaine, acting as an ischaemia-activated and ischaemia-selective antiarrhythmic prodrug with a large therapeutic index, mimicking lidocaine's benefit without adversity.
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Affiliation(s)
- Louise M Hesketh
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
| | - Markus B Sikkel
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | - Laura Mahoney-Sanchez
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
| | | | - Rasheda A Chowdhury
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | - Konstantinos N Tzortzis
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | - Jahn Firth
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | - James Winter
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
| | - Kenneth T MacLeod
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | | | - Catherine D E Wilder
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
| | | | - Nicholas S Peters
- National Heart and Lung Institute, Faculty of Medicine, ICTEM, The Hammersmith Hospital, Imperial College London, London, UK
| | - Michael J Curtis
- Cardiovascular Division, Faculty of Life Sciences and Medicine, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK
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Khalifa A, Winter J, Navarro I, McIntosh C, Purdie T. PD-0894 atlas-based treatment planning models for magnetic resonance guided therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02973-5] [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: 10/18/2022]
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Kong V, Padayachee J, Winter J, Dang J, Li W, Navarro I, Glicksman R, Malkov V, Helou J, Berlin A, Chung P. OC-0784 Assessment of intraprostatic tumour motion in prostate radiotherapy on the MR-Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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O'Shea C, Winter J, Kabir SN, O'Reilly M, Wells SP, Baines O, Sommerfeld LC, Correia J, Lei M, Kirchhof P, Holmes AP, Fabritz L, Rajpoot K, Pavlovic D. High resolution optical mapping of cardiac electrophysiology in pre-clinical models. Sci Data 2022; 9:135. [PMID: 35361792 PMCID: PMC8971487 DOI: 10.1038/s41597-022-01253-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Abstract
Optical mapping of animal models is a widely used technique in pre-clinical cardiac research. It has several advantages over other methods, including higher spatial resolution, contactless recording and direct visualisation of action potentials and calcium transients. Optical mapping enables simultaneous study of action potential and calcium transient morphology, conduction dynamics, regional heterogeneity, restitution and arrhythmogenesis. In this dataset, we have optically mapped Langendorff perfused isolated whole hearts (mouse and guinea pig) and superfused isolated atria (mouse). Raw datasets (consisting of over 400 files) can be combined with open-source software for processing and analysis. We have generated a comprehensive post-processed dataset characterising the baseline cardiac electrophysiology in these widely used pre-clinical models. This dataset also provides reference information detailing the effect of heart rate, clinically used anti-arrhythmic drugs, ischaemia-reperfusion and sympathetic nervous stimulation on cardiac electrophysiology. The effects of these interventions can be studied in a global or regional manner, enabling new insights into the prevention and initiation of arrhythmia.
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Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - S Nashitha Kabir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Molly O'Reilly
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Simon P Wells
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Olivia Baines
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Laura C Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Joao Correia
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ming Lei
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre, University Medical Center Hamburg-Eppendorf, Germany and German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lubeck, Lubeck, Germany
- University Center of Cardiovascular Science, UKE, Hamburg, Germany
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, UK
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Winter J, Meeson RL, Egan P, Langley-Hobbs S, Belch A. Management of proximal metaphyseal curvilinear tibial fractures in 25 skeletally immature dogs (2009 to 2020). J Small Anim Pract 2022; 63:542-549. [PMID: 35137955 DOI: 10.1111/jsap.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the occurrence, management and outcome of proximal metaphyseal curvilinear tibial fractures in skeletally immature dogs. MATERIALS AND METHODS A multi-centre retrospective review was conducted, searching for skeletally immature dogs presenting with proximal metaphyseal curvilinear tibial fractures between January 2009 and September 2020. Signalment, fracture description and case management data were retrieved. Outcome was assessed by retrospectively evaluating follow-up radiographs, hospital records and an owner questionnaire. RESULTS Twenty-five dogs met the inclusion criteria. All but one fracture was a result of minimal trauma. Twenty fractures were managed with internal fixation, two with external fixation and three conservatively. All 25 fractures healed. Eight major complications occurred in seven of 25 (28%) dogs. Twelve minor complications occurred in 10 of 25 (40%) dogs. Owner questionnaire data were available for 12 of 25 dogs; 11 of 12 were reported as having full function and one of 12 as having acceptable function at the time of questioning (median 34.5 months following presentation). At final follow-up, either by clinical examination or owner questionnaire, full function was achieved in 22 of 25 patients and acceptable function in three of 25. CLINICAL SIGNIFICANCE This study reported a series of proximal metaphyseal tibial fractures in skeletally immature dogs. The most common fixation method was internal fixation, which frequently resulted in full limb function at final follow-up. Owners reported outcome as fully functional in all dogs that underwent surgery at first presentation and had owner follow-up available, though positive outcomes may have been affected by participation bias.
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Affiliation(s)
- J Winter
- Department of Veterinary Clinical Sciences, The Queen Mother Hospital for Animals, Royal Veterinary College, London University, Hawkshead Lane, Hatfield, Hertfordshire, UK
| | - R L Meeson
- Department of Veterinary Clinical Sciences, The Queen Mother Hospital for Animals, Royal Veterinary College, London University, Hawkshead Lane, Hatfield, Hertfordshire, UK
| | - P Egan
- Fitzpatrick Referrals, Surrey, GU72QQ, UK
| | - S Langley-Hobbs
- Langford Vets, Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
| | - A Belch
- Langford Vets, Small Animal Referral Hospital, University of Bristol, Langford, BS40 5DU, UK
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Bartzsch S, Dimroth A, Winter J, Petrich C, Matejcek C, Zhang Y, Rieser J, Rötzer S, Krämer KL, Zimmermann M, Galek M, Butzek M, Aulenbacher K, Wilkens J, Combs S. THE LINE FOCUS X-RAY TUBE: AN X-RAY SOURCE FOR FLASH AND SPATIALLY FRACTIONATED RADIATION THERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Schmid T, Nguyen M, Dombrowsky A, Bicher S, Treibel F, Winter J, Ahmed M, Combs S, Bartzsch S. RADIOBIOLOGICAL MECHANISMS IN MICROBEAM RADIATION THERAPY (MRT). Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01623-4] [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: 10/19/2022] Open
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Winter J, Kraus K, Ahmed M, Combs S, Wilkens J, Bartzsch S. PD-0933 Microbeam radiotherapy planning for a clinical lung tumor case. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ruan J, Zain JM, Palmer B, Jovanovic BB, Mi X, Swaroop A, Winter J, Gordon LI, Karmali R, Pro B. MULTI‐CENTER PHASE II STUDY OF ROMIDEPSIN PLUS LENALIDOMIDE FOR PATIENTS WITH PREVIOUSLY UNTREATED PERIPHERAL T‐CELL LYMPHOMA (PTCL). Hematol Oncol 2021. [DOI: 10.1002/hon.55_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Ruan
- Weill Cornell Medicine New York Presbyterian Hospital Medicine Hematology‐Oncology New York City, New York USA
| | - J. M Zain
- City of Hope Comprehensive Cancer Center, Medicine Duarte USA
| | - B. Palmer
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - B. Borko Jovanovic
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine Chicago USA
| | - X. Mi
- Northwestern University Feinberg School of Medicine Department of Preventive Medicine Chicago USA
| | - A. Swaroop
- Northwestern University Feinberg School of Medicine Department of Medicine Chicago USA
| | - J. Winter
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - L. I Gordon
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - R. Karmali
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
| | - B. Pro
- Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine, Medicine Chicago USA
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Gani C, Boeke S, McNair H, Ehlers J, Nachbar M, Mönnich D, Stolte A, Boldt J, Marks C, Winter J, Künzel LA, Gatidis S, Bitzer M, Thorwarth D, Zips D. Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clin Transl Radiat Oncol 2021; 26:55-61. [PMID: 33319073 PMCID: PMC7723999 DOI: 10.1016/j.ctro.2020.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac. METHODS Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5. RESULTS Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from "patient identity check" until "beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months). CONCLUSION Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT.
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Affiliation(s)
- Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S. Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H. McNair
- Department of Radiotherapy, The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | - J. Ehlers
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - M. Nachbar
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - D. Mönnich
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - A. Stolte
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - J. Boldt
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - C. Marks
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - J. Winter
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Luise A. Künzel
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - S. Gatidis
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University, Tübingen, Germany
| | - M. Bitzer
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology and Infectious Diseases, Eberhard Karls University, Tübingen, Germany
| | - D. Thorwarth
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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De Colle C, Nachbar M, Mönnich D, Boeke S, Gani C, Weidner N, Heinrich V, Winter J, Tsitsekidis S, Dohm O, Thorwarth D, Zips D. PO-0966: Partial breast irradiation at the 1.5T MR-Linac: treatment time and electron stream effect. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00984-1] [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: 10/22/2022]
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21
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Nachbar M, Dohm O, Friedlein M, Winter J, Mönnich D, Zips D, Thorwarth D. PD-0185: Development of a Monte-Carlo head model for a fast online validation of 1.5 T MR-linac plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Winter J, Wilkens J, Combs S, Bartzsch S. OC-0471: Optimization of a compact x-ray source for clinical microbeam radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00493-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Karadeniz Z, Winter J, Smeir E, Hartwig J, Na E, Kraenkel N, Kurreck J, Scheibenbogen C, Landmesser U, Skurk C. Novel effects of Foxo3a on immune system and cardiac remodeling after myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3643] [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: 11/13/2022] Open
Abstract
Abstract
Background
Fibroblast/myofibroblast transdifferentiation following acute cardiac injury (MI) is a major mechanism of scar formation and adverse remodeling regulated by TGFβ/SMAD3 signaling. Myofibroblasts represent phenotypically modulated cells characterized by α-smooth muscle actin (α-SMA) and constitute the main source of extracellular matrix proteins such as collagen type I in the healing infarct wound. Moreover, the recruitment of a specific monocyte/macrophages subset (Ly6Chigh and Ly6Clow) control the healing process in the infarcted wound. The forkhead transcription factor FOXO3a has recently been shown to inhibit cardiac hypertrophy by different stressors and is involved in the immune response following injury.
Purpose
We hypothesized that FOXO3a, a key regulator of cell differentiation, cell cycle and size as well as the stress response, might inhibit matricellular remodeling following myocardial infarction by regulating transdifferentiation of fibroblasts into myofibroblasts. Moreover, we hypothesized that Foxo3a−/− mice favor the recruitment of monocytes of the type Ly6Clow leading to an anti-inflammatory profile and thus the remodeling after injury.
Methods
Acute myocardial infarction was induced in FOXO3−/− and WT mice (FVB background) by permanent LAD ligation. The myocardial infarction size was determined via ECHO. Myofibroblast trans-differentiation and fibrosis markers were analyzed by QT-PCR and protein analysis. The differentiation of macrophages studied via FACS. IP/IF and Western blotting were used to test for a direct interaction between FOXO3a and SMAD3 in vitro.
Results
FOXO3a−/− mice showed significantly higher survival rates compared to WT littermates. Myocardial inflammation (Mac-1, LFA, CD3, CD45), injury markers such as Troponin T were similar in both groups on day 4 post-MI. Myocardial expression of alpha smooth muscle actin (ASMA) and Collagen1A1 (Col1A1), as well as numbers of cardiac CD11b+/F4–80+/Ly6clow macrophages was significantly enhanced in FOXO3a−/− mice 15 days post infarction. Moreover, Foxo3a−/− mice showed larger fibrotic areas following MI. Mechanistically, immunoprecipitation showed direct interaction of FOXO3a with SMAD3a that was enhanced following activation of the transcription factor leading to diminished SMAD3 downstream gene expression.
Conclusion
Our results indicate that FOXO3a acts as a direct inhibitor of TGF-β regulated myofibroblast differentiation and matrix remodeling via FOXO3a-SMAD3 interaction following MI. Moreover, a Foxo3a deficiency might lead to the recruitment of monocytes type Ly6Clow leading to an anti-inflammatory profile in the infarct wound. Therefore, FOXO3a collectively regulates cardiac hypertrophy and fibrosis/scar formation following MI. Thus, targeting the FOXO3a-SMAD3 signaling axis might be of future therapeutic interest.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Resaerch Foundation
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Affiliation(s)
- Z Karadeniz
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - J Winter
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - E Smeir
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - J Hartwig
- Berlin-Brandenburg School for Regenerative Therapies, Berlin, Germany
| | - E Na
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - N Kraenkel
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - J Kurreck
- Technische Universitaet Berlin, Berlin, Germany
| | - C Scheibenbogen
- Berlin-Brandenburg School for Regenerative Therapies, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin, Berlin, Germany
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Gerhardy HJ, Weber R, Lux P, Klein RM, Winter J. [Autopneumonectomie. A Forgotten Disease]. Pneumologie 2020; 74:371-373. [PMID: 32557508 DOI: 10.1055/a-1148-8770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HISTORY An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.
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Affiliation(s)
- H J Gerhardy
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
| | - R Weber
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
| | - P Lux
- Röntgeninstitut Düsseldorf
| | - R M Klein
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf.,Lehrstuhl: Universität Witten/Herdecke
| | - J Winter
- Abteilung für Kardiologie, Rhythmologie und konservative Intensivmedizin, Augusta-Krankenhaus Düsseldorf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf
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Mendonca Costa C, Anderson GC, Meijborg VMF, O’Shea C, Shattock MJ, Kirchhof P, Coronel R, Niederer S, Pavlovic D, Dhanjal T, Winter J. The Amplitude-Normalized Area of a Bipolar Electrogram as a Measure of Local Conduction Delay in the Heart. Front Physiol 2020; 11:465. [PMID: 32508676 PMCID: PMC7248250 DOI: 10.3389/fphys.2020.00465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/16/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Re-entrant ventricular tachycardia may be non-inducible or haemodynamically compromising, requiring assessment of the electrophysiological properties of the myocardium during sinus rhythm (i.e., substrate mapping). Areas of heart tissue with slow conduction can act as a critical isthmus for re-entrant electrical excitation and are a potential target for ablation therapy. AIM To develop and validate a novel metric of local conduction delay in the heart, the amplitude-normalized electrogram area (norm_EA). METHODS A computational model of a propagating mouse action potential was used to establish the impact of altering sodium channel conductance, intracellular conductivity, fibrosis density, and electrode size/orientation on bipolar electrogram morphology. Findings were then validated in experimental studies in mouse and guinea pig hearts instrumented for the recording of bipolar electrograms from a multipolar linear mapping catheter. norm_EA was calculated by integrating the absolute area of a bipolar electrogram divided by the electrogram amplitude. Electrogram metrics were correlated with the local conduction delay during sodium channel block, gap junction inhibition, and acute ischemia. RESULTS In computational simulations, reducing sodium channel conductance and intracellular conductivity resulted in a decrease in signal amplitude and increase in norm_EA (reflecting a broadening of electrogram morphology). For larger electrodes (3 mm diameter/7.1 mm2 area), the change in norm_EA was essentially linear with the change in local conduction delay. Experimental studies supported this finding, showing that the magnitude of change in norm_EA induced by flecainide (1-4 μM), carbenoxolone (10-50 μM), and low-flow ischemia (25% of initial flow rate) was linearly correlated with the local conduction delay in each condition (r 2 = 0.92). Qualitatively similar effects were observed in guinea pig hearts perfused with flecainide. Increasing fibrosis density in the computational model also resulted in a decrease in signal amplitude and increase in norm_EA. However, this remains to be validated using experimental/clinical data of chronic infarct. CONCLUSION norm_EA is a quantitative measure of local conduction delay between the electrode pair that generates a bipolar electrogram, which may have utility in electrophysiological substrate mapping of non-inducible or haemodynamically compromising tachyarrhythmia.
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Affiliation(s)
- Caroline Mendonca Costa
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Grace C. Anderson
- School of Cardiovascular Medicine & Sciences, King’s College London, London, United Kingdom
| | | | - Christopher O’Shea
- Department of Cardiology, UHB NHS Foundation Trust, Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | - Michael J. Shattock
- School of Cardiovascular Medicine & Sciences, King’s College London, London, United Kingdom
| | - Paulus Kirchhof
- Department of Cardiology, UHB NHS Foundation Trust, Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology, SWBH NHS Trust, Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | - Ruben Coronel
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, Netherlands
- LIRYC, Heart Arrhythmia and Modeling Institute, Pessac, France
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Davor Pavlovic
- Department of Cardiology, UHB NHS Foundation Trust, Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - James Winter
- Department of Cardiology, UHB NHS Foundation Trust, Institute of Cardiovascular Science, University of Birmingham, Birmingham, United Kingdom
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Merbecks M, Weber P, Fonseca-Escalante E, Winter J, Springer W, Gorenflo M, Loukanov T. Management of Funnel-Type Tracheal Stenosis in a 4-Year-Old. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gehlen H, Jaburg N, Merle R, Winter J. How contributes the measurement of heart rate variability in pain assessment in horses? PFERDEHEILKUNDE 2020. [DOI: 10.21836/pem20200501] [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: 11/27/2022]
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O'Shea C, Pavlovic D, Rajpoot K, Winter J. Examination of the Effects of Conduction Slowing on the Upstroke of Optically Recorded Action Potentials. Front Physiol 2019; 10:1295. [PMID: 31681008 PMCID: PMC6798176 DOI: 10.3389/fphys.2019.01295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/30/2019] [Accepted: 09/26/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction The upstroke of optical action potentials (APs) recorded from intact hearts are generally recognized to be slower than those recorded with microelectrodes. This is thought to reflect spatial signal averaging within the volume of tissue that makes up the optical signal. However, to date, there has been no direct experimental study on the relationship between conduction velocity (CV) and optical AP upstroke morphology in the intact heart. Notably, it is known that sodium channel block and gap junction inhibition, which both slow CV, exert differential effects on the upstroke velocity of microelectrode-recorded APs. Whether such differences are evident in optical APs is not known. The present study sought to determine the relationship between tissue CV and optical AP upstroke velocity in intact mouse hearts. Materials and Methods Isolated, perfused mouse hearts were stained with the potentiometric dye Rh-237. Fluorescent signals were recorded from across the anterior surface of the left and right ventricles during constant pacing. Maximum rate of change in fluorescence (dF/dtmax) and tissue CV were assessed in control conditions, during an acute period of low-flow ischemia, and following perfusion of flecainide (1–3 μmol/L), a sodium channel blocker, or carbenoxolone (10–50 μmol/L), a gap junction inhibitor. Results During epicardial pacing, an anisotropic pattern was observed in both activation and dF/dtmax maps, with more rapid optical AP upstroke velocities orientated along the fastest conduction paths (and vice versa). Low-flow ischemia resulted in a time-dependent slowing of ventricular CV, which was accompanied by a concomitant reduction in optical AP upstroke velocity. All values returned to baseline on tissue reperfusion. Both flecainide and carbenoxolone were associated with a concentration-dependent reduction in CV and decrease in optical AP upstroke velocity, despite distinct mechanisms of action. Similar responses to carbenoxolone were observed for low- (156 μm pixel with) and high- (20 μm pixel width) magnification recordings. Comparison of data from all interventions revealed a linear relationship between CV and upstroke dF/dt. Conclusion In intact mouse hearts, slowing of optical AP upstroke velocity is directly proportional to the change in CV associated with low-flow ischemia, sodium channel block, and gap junction inhibition.
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Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,EPSRC Centre for Doctoral Training in Physical Sciences for Health, University of Birmingham, Birmingham, United Kingdom
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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Sodergren SC, Wheelwright SJ, Permyakova NV, Patel M, Calman L, Smith PWF, Din A, Richardson A, Fenlon D, Winter J, Corner J, Foster C. Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life-results from the ColoREctal Wellbeing (CREW) study. J Cancer Surviv 2019; 13:899-909. [PMID: 31512164 PMCID: PMC6881415 DOI: 10.1007/s11764-019-00805-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate unmet needs of patients with colorectal cancer (CRC) at the end of treatment and whether unmet needs improve over time. Identify predictors of need following treatment and whether unmet need is associated with worse health-related quality of life (HRQoL). Methods As part of the UK ColoREctal Wellbeing (CREW) cohort study, patients treated for CRC completed the Supportive Care Needs Survey Short Form-34 (SCNS SF-34) 15 and 24 months following surgery, along with questionnaires measuring HRQoL, wellbeing, life events, social support, and confidence to manage their cancer before surgery, 3, 9, 15, and 24 months post-surgery. Results The SCNS SF-34 was completed by 526 patients at 15 months and 510 patients at 24 months. About one-quarter of patients had at least one moderate or severe unmet need at both time points. Psychological and physical unmet needs were the most common and did not improve over time. Over 60% of patients who reported 5 or more moderate or severe unmet needs at 15 months experienced the same level of unmet need at 24 months. HRQoL at the beginning of treatment predicted unmet needs at the end of treatment. Unmet needs, specifically physical, psychological, and health system and information needs, were associated with poorer health and HRQoL at the end of treatment. Conclusions Unmet needs persist over time and are associated with HRQoL. Evaluation of HRQoL at the start of treatment would help inform the identification of vulnerable patients. Assessment and care planning in response to unmet needs should be integrated into person-centred care. Implications for Cancer Survivors Early identification of CRC patients at risk of unmet needs will help infrom personalised survivorship care plans. The implementation of personalised and tailored services are likely to confer HRQoL gains. Electronic supplementary material The online version of this article (10.1007/s11764-019-00805-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Sodergren
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - S J Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - N V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - M Patel
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - L Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - P W F Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - A Din
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - A Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Winter
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - C Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK.
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Tadic T, Croke J, Xie J, Stanescu T, Letourneau D, Bissonnette J, Breen S, Simeonov A, Dickie C, Hill C, Li W, Ellis C, Winter J, Velec M, Fyles A, Han K, Jaffray D, Milosevic M. In-Room MRI for Adaptive Radiotherapy for Cervical Cancer Using an Integrated MR-Guided Radiation Therapy System. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.834] [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: 11/15/2022]
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Reni M, Winter J, Tortora G, Pelzer U, Riess H, Chang H, O’Reilly E, Oh D, Diaz IA, Milella M, Bendell J, Garlipp B, Tempero M, Macarulla T, Van Cutsem E, Berlin J, Goldstein D, Lu B, Jeanes J, Philip P. Analysis of patient screening in the phase III, international, randomized, open-label APACT trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Shea C, Holmes AP, Yu TY, Winter J, Wells SP, Parker BA, Fobian D, Johnson DM, Correia J, Kirchhof P, Fabritz L, Rajpoot K, Pavlovic D. High-Throughput Analysis of Optical Mapping Data Using ElectroMap. J Vis Exp 2019. [PMID: 31233017 DOI: 10.3791/59663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Optical mapping is an established technique for high spatio-temporal resolution study of cardiac electrophysiology in multi-cellular preparations. Here we present, in a step-by-step guide, the use of ElectroMap for analysis, quantification, and mapping of high-resolution voltage and calcium datasets acquired by optical mapping. ElectroMap analysis options cover a wide variety of key electrophysiological parameters, and the graphical user interface allows straightforward modification of pre-processing and parameter definitions, making ElectroMap applicable to a wide range of experimental models. We show how built-in pacing frequency detection and signal segmentation allows high-throughput analysis of entire experimental recordings, acute responses, and single beat-to-beat variability. Additionally, ElectroMap incorporates automated multi-beat averaging to improve signal quality of noisy datasets, and here we demonstrate how this feature can help elucidate electrophysiological changes that might otherwise go undetected when using single beat analysis. Custom modules are included within the software for detailed investigation of conduction, single file analysis, and alternans, as demonstrated here. This software platform can be used to enable and accelerate the processing, analysis, and mapping of complex cardiac electrophysiology.
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Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham; EPSRC Centre for Doctoral Training in Physical Sciences for Health, School of Chemistry, University of Birmingham; School of Computer Science, University of Birmingham
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham; Institute of Clinical Sciences, University of Birmingham
| | - Ting Y Yu
- Institute of Cardiovascular Sciences, University of Birmingham
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham
| | - Simon P Wells
- Institute of Cardiovascular Sciences, University of Birmingham
| | - Beth A Parker
- Institute of Cardiovascular Sciences, University of Birmingham
| | - Dannie Fobian
- Institute of Cardiovascular Sciences, University of Birmingham
| | | | - Joao Correia
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham
| | | | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham;
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Sarishvili A, Winter J, Luhmann HJ, Mildenberger E. Probabilistic graphical model identifies clusters of EEG patterns in recordings from neonates. Clin Neurophysiol 2019; 130:1342-1350. [PMID: 31200241 DOI: 10.1016/j.clinph.2019.04.708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/11/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this paper we introduce a novel method for the evaluation of neonatal brain function via multivariate EEG (electroencephalography) signal processing and embedding into a probabilistic graph, the so called Chow-Liu tree. METHODS Using 28 EEG recordings of preterm and term neonate infants the complex features of the EEG signals were constructed in the form of a Chow-Liu tree. The trees were embedded into a 3 dimensional Euclidean space. Clustering of specific EEG patterns was done by complete linkage algorithm. RESULTS Our analytic tool was able to build clusters of patients with pathological EEG findings. In particular, we were able to make a visual proof on a 3d multidimensional scaling coordinate system with a good performance. The distances (graph edit distance) between Chow-Liu trees of different infants were proportional to the clinical findings of corresponding infants. CONCLUSION Our method may provide a basis for the future development of a diagnostic/prognostic non-invasive brain monitoring tool which will be able to differentiate between a variety of complex clinical findings. SIGNIFICANCE This model addresses relevant issues in neonatology and neuropediatrics in terms of identification of possible clinical factors which interfere with normal brain development and will allow fast unbiased recognition of infants with specific pathological EEG findings.
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Affiliation(s)
- A Sarishvili
- Fraunhofer Institute for Industrial Mathematics, Kaiserslautern, Germany
| | - J Winter
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | - H J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - E Mildenberger
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Hoppe T, Kraus D, Probstmeier R, Jepsen S, Winter J. Stimulation with Porphyromonas gingivalis enhances malignancy and initiates anoikis resistance in immortalized oral keratinocytes. J Cell Physiol 2019; 234:21903-21914. [PMID: 31026063 DOI: 10.1002/jcp.28754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/21/2019] [Revised: 04/01/2019] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Abstract
The aim of this study was to get new insights into molecular processes involved in tumor propagation of immortalized oral keratinocytes induced by the keystone pathogen Porphyromonas gingivalis. Cell culture experiments with immortalized OKF6 cells were performed to analyze cellular effects caused by bacterial stimulation focusing on altered gene expression, signaling pathways, proliferation rate, cell viability, migration and invasion behavior, and on the development of antiapoptotic pathways. Gene and protein expression were analyzed using real-time polymerase chain reaction, enzyme-linked immunosorbent assay, western blot, and protein arrays. Trypan blue staining was used to analyze proliferation and viability, transwell assays for cellular migration, Matrigel assays for invasion, and anoikis-assays for evaluating anoikis resistance. Stimulation of OKF6 cells with Porphyromonas gingivalis led to an alteration in the molecular repertoire of proteins which are involved in cell proliferation, epithelial-mesenchymal transition, stem cell formation, migration, invasion, and anoikis resistance. Higher proliferation rates were detected in conjunction with an activation of PI3K/Akt signaling and the mTOR-pathway. Additionally, inhibition of glycogen-synthase-kinase3-β led to stabilization of β-catenin and Snail, which resulted in a switch from predominant E-cadherin to N-cadherin expression and increased expression of the stem cell markers Oct3/4, Sox2, and Nanog. Enhanced biosynthesis and enzyme activity of matrix metalloproteinase-9 was accompanied by elevated invasion behavior. Finally, anoikis resistance was detected in stimulated keratinocytes by decreased apoptosis of nonadherent cells and elevated expression of epidermal growth factor receptor and c-Met. Hence, Porphyromonas gingivalis is able to induce a more aggressive tumor-like phenotype in immortalized oral keratinocytes, thus contributing to enhanced tumor features.
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Affiliation(s)
- T Hoppe
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - D Kraus
- Department of Prosthodontics, Preclinical Education, and Material Sciences, University of Bonn, Bonn, Germany
| | - R Probstmeier
- Department of Nuclear Medicine, Neuro- and Tumor Cell Biology Group, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - J Winter
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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O’Shea C, Holmes AP, Winter J, Correia J, Ou X, Dong R, He S, Kirchhof P, Fabritz L, Rajpoot K, Pavlovic D. Cardiac Optogenetics and Optical Mapping - Overcoming Spectral Congestion in All-Optical Cardiac Electrophysiology. Front Physiol 2019; 10:182. [PMID: 30899227 PMCID: PMC6416196 DOI: 10.3389/fphys.2019.00182] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/14/2019] [Indexed: 12/30/2022] Open
Abstract
Optogenetic control of the heart is an emergent technology that offers unparalleled spatio-temporal control of cardiac dynamics via light-sensitive ion pumps and channels (opsins). This fast-evolving technique holds broad scope in both clinical and basic research setting. Combination of optogenetics with optical mapping of voltage or calcium fluorescent probes facilitates 'all-optical' electrophysiology, allowing precise optogenetic actuation of cardiac tissue with high spatio-temporal resolution imaging of action potential and calcium transient morphology and conduction patterns. In this review, we provide a synopsis of optogenetics and discuss in detail its use and compatibility with optical interrogation of cardiac electrophysiology. We briefly discuss the benefits of all-optical cardiac control and electrophysiological interrogation compared to traditional techniques, and describe mechanisms, unique features and limitations of optically induced cardiac control. In particular, we focus on state-of-the-art setup design, challenges in light delivery and filtering, and compatibility of opsins with fluorescent reporters used in optical mapping. The interaction of cardiac tissue with light, and physical and computational approaches to overcome the 'spectral congestion' that arises from the combination of optogenetics and optical mapping are discussed. Finally, we summarize recent preclinical work applications of combined cardiac optogenetics and optical mapping approach.
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Affiliation(s)
- Christopher O’Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
- EPSRC Centre for Doctoral Training in Physical Sciences for Health, School of Chemistry, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Joao Correia
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Xianhong Ou
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease/Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Ruirui Dong
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease/Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Shicheng He
- Key Laboratory of Medical Electrophysiology of Ministry of Education, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease/Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology, UHB NHS Trust, Birmingham, United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Cardiology, UHB NHS Trust, Birmingham, United Kingdom
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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O'Shea C, Holmes AP, Yu TY, Winter J, Wells SP, Correia J, Boukens BJ, De Groot JR, Chu GS, Li X, Ng GA, Kirchhof P, Fabritz L, Rajpoot K, Pavlovic D. ElectroMap: High-throughput open-source software for analysis and mapping of cardiac electrophysiology. Sci Rep 2019; 9:1389. [PMID: 30718782 PMCID: PMC6362081 DOI: 10.1038/s41598-018-38263-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/21/2018] [Indexed: 02/04/2023] Open
Abstract
The ability to record and analyse electrical behaviour across the heart using optical and electrode mapping has revolutionised cardiac research. However, wider uptake of these technologies is constrained by the lack of multi-functional and robustly characterised analysis and mapping software. We present ElectroMap, an adaptable, high-throughput, open-source software for processing, analysis and mapping of complex electrophysiology datasets from diverse experimental models and acquisition modalities. Key innovation is development of standalone module for quantification of conduction velocity, employing multiple methodologies, currently not widely available to researchers. ElectroMap has also been designed to support multiple methodologies for accurate calculation of activation, repolarisation, arrhythmia detection, calcium handling and beat-to-beat heterogeneity. ElectroMap implements automated signal segmentation, ensemble averaging and integrates optogenetic approaches. Here we employ ElectroMap for analysis, mapping and detection of pro-arrhythmic phenomena in silico, in cellulo, animal model and in vivo patient datasets. We anticipate that ElectroMap will accelerate innovative cardiac research and enhance the uptake, application and interpretation of mapping technologies leading to novel approaches for arrhythmia prevention.
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Affiliation(s)
- Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- EPSRC Centre for Doctoral Training in Physical Sciences for Health, School of Chemistry, University of Birmingham, Birmingham, UK
- School of Computer Science, University of Birmingham, Birmingham, UK
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Ting Y Yu
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - James Winter
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Simon P Wells
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Physiology, University of Melbourne, Melbourne, Australia
| | - Joao Correia
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - Bastiaan J Boukens
- Amsterdam UMC, University of Amsterdam, Department of Anatomy and Physiology, Amsterdam, The Netherlands
| | - Joris R De Groot
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands
| | - Gavin S Chu
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Xin Li
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, UHB NHS Trust, Birmingham, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, UHB NHS Trust, Birmingham, UK
| | - Kashif Rajpoot
- School of Computer Science, University of Birmingham, Birmingham, UK.
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
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Loschelder J, Winter J, Gehlen H. A review of equine sarcoids and its treatment options. PFERDEHEILKUNDE 2019. [DOI: 10.21836/pem20190104] [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: 11/27/2022]
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Moraes F, Winter J, Atenafu E, Dasgupta A, Coolens C, Millar B, Laperriere N, Tsang D, Bernstein M, Kongkham P, Zadeh G, Conrad T, Berlin A, Shultz D. Comparison of Local Failure and Radionecrosis According to Dose Prescription for Small to Medium Sized Brain Metastasis treated with Radiosurgery. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1030] [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: 11/25/2022]
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Dasgupta A, Moraes F, Winter J, Coolens C, Millar B, Laperriere N, Tsang D, Bernstein M, Kongkham P, Zadeh G, Conrad T, Berlin A, Shultz D. Outcomes following Definitive Single Fraction Stereotactic Radiosurgery for Larger Brain Metastases. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.933] [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: 11/26/2022]
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Grothey A, Tabernero J, Arnold D, De Gramont A, Ducreux M, O'Dwyer P, Van Cutsem E, Bosanac I, Srock S, Mancao C, Gilberg F, Winter J, Schmoll HJ. Fluoropyrimidine (FP) + bevacizumab (BEV) + atezolizumab vs FP/BEV in BRAFwt metastatic colorectal cancer (mCRC): Findings from Cohort 2 of MODUL – a multicentre, randomized trial of biomarker-driven maintenance treatment following first-line induction therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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van de Locht M, Winter J, Conijn S, Ma W, Helmes M, Irving T, Donkervoort S, Mohassel P, Medne L, Quinn C, Neto O, Moore S, Foley A, Voermans N, Bönnemann C, Ottenheijm C. NEW GENES, FUNCTIONS AND BIOMARKERS. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Winter J, Barcena De Arrellano ML, Jansen J, Na E, Knueppel S, Regitz-Zagrosek V, Landmesser U. P945PCSK9 deficiency is not associated with impaired cardiac repair capacity early after myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- J Winter
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | | | - J Jansen
- Charite - Campus Mitte (CCM), Institute of Gender in Medicine, Berlin, Germany
| | - E Na
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - S Knueppel
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - V Regitz-Zagrosek
- Charite - Campus Mitte (CCM), Institute of Gender in Medicine, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
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Moraes F, Winter J, Dasgupta A, Razie H, Coolens C, Gelareh Z, Kongkham P, Bernstein M, Conrad T, Laperriere N, Millar B, Berlin A, Shultz D. EP-1400: Outcomes According to SRS Dose Prescription for Brain Metastases from Lung Cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Winter J, Ynoe de Moraes F, Chung C, Coolens C. PO-0982: Early MRI biomarkers changes following SRS of brain metastases: correlation with dose. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shattock MJ, Park KC, Yang HY, Lee AWC, Niederer S, MacLeod KT, Winter J. Restitution slope is principally determined by steady-state action potential duration. Cardiovasc Res 2018; 113:817-828. [PMID: 28371805 PMCID: PMC5437364 DOI: 10.1093/cvr/cvx063] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/22/2017] [Indexed: 12/02/2022] Open
Abstract
Aims The steepness of the action potential duration (APD) restitution curve and local tissue refractoriness are both thought to play important roles in arrhythmogenesis. Despite this, there has been little recognition of the apparent association between steady-state APD and the slope of the restitution curve. The objective of this study was to test the hypothesis that restitution slope is determined by APD and to examine the relationship between restitution slope, refractoriness and susceptibility to VF. Methods and results Experiments were conducted in isolated hearts and ventricular myocytes from adult guinea pigs and rabbits. Restitution curves were measured under control conditions and following intervention to prolong (clofilium, veratridine, bretylium, low [Ca]e, chronic transverse aortic constriction) or shorten (catecholamines, rapid pacing) ventricular APD. Despite markedly differing mechanisms of action, all interventions that prolonged the action potential led to a steepening of the restitution curve (and vice versa). Normalizing the restitution curve as a % of steady-state APD abolished the difference in restitution curves with all interventions. Effects on restitution were preserved when APD was modulated by current injection in myocytes pre-treated with the calcium chelator BAPTA-AM – to abolish the intracellular calcium transient. The non-linear relation between APD and the rate of repolarization of the action potential is shown to underpin the common influence of APD on the slope of the restitution curve. Susceptibility to VF was found to parallel changes in APD/refractoriness, rather than restitution slope. Conclusion(s) Steady-state APD is the principal determinant of the slope of the ventricular electrical restitution curve. In the absence of post-repolarization refractoriness, factors that prolong the action potential would be expected to steepen the restitution curve. However, concomitant changes in tissue refractoriness act to reduce susceptibility to sustained VF. Dependence on steady-state APD may contribute to the failure of restitution slope to predict sudden cardiac death.
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Affiliation(s)
- Michael J Shattock
- Cardiovascular Division, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kyung Chan Park
- Cardiovascular Division, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Hsiang-Yu Yang
- NHLI, ICTEM Building, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Angela W C Lee
- Biomedical Engineering, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Steven Niederer
- Biomedical Engineering, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kenneth T MacLeod
- NHLI, ICTEM Building, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - James Winter
- Cardiovascular Division, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Letsas KP, Xydonas S, Karamichalakis N, Efremidis M, Manolatos D, Bazoukis G, Asvestas D, Vlachos K, Georgopoulos S, Saplaouras A, Winter J, Sideris A. Intermuscular implantation technique for subcutaneous cardioverter-defibrillators. Herz 2018; 44:541-545. [PMID: 29468258 DOI: 10.1007/s00059-018-4688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/02/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The conventional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation has been associated with pocket complications. The aim of this study was to evaluate the efficacy and safety of an alternative intermuscular technique for S‑ICD implantation. METHODS S-ICDs were implanted in ten consecutive patients (ten males, mean age: 46.8 ± 14.7 years). The pocket for the pulse generator was made above the serratus anterior muscular fascia and beneath the latissimus dorsi muscle by detaching the fibrous tissue between the muscles. Electrode implantation was performed using the three- (n = 4) or the two-incision technique (n = 6). RESULTS All S‑ICDs were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, apart from one patient with Brugada syndrome who needed device repositioning more dorsally. During a mean follow-up of 16.5 ± 7.3 months, no major complications requiring surgical repair were encountered, while patients demonstrated high levels of comfort and satisfaction with the cosmetic result. One patient experienced an inappropriate shock due to noise detection, which was resolved after reprogramming to a different sensing vector. CONCLUSION The intermuscular technique is a safe and efficacious approach for S‑ICD implantation. This technique could lead to fewer pocket-related complications and better cosmetic results.
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Affiliation(s)
- K P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Xydonas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - N Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - M Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - D Manolatos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - G Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece.
| | - D Asvestas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - K Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - S Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - A Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
| | - J Winter
- Division of Cardiac Surgery, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - A Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece
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Stein MA, Winter J. System Design of a Computer Based Library Circulation System for the Radiology File Room. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636120] [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
The operation and configuration of a reliable and inexpensive computer based system for locating X-ray film jackets are proposed. Card-dialer Touch-Tone telephones are used to accurately inform the computer of loans, to reserve film jackets, and to inquire about their locations. Computerassisted identification and recall of overdue and reserved film jackets increases their availability and the efficiency of file room personnel.
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Winter J, Bishop MJ, Wilder CDE, O'Shea C, Pavlovic D, Shattock MJ. Sympathetic Nervous Regulation of Calcium and Action Potential Alternans in the Intact Heart. Front Physiol 2018; 9:16. [PMID: 29410631 PMCID: PMC5787134 DOI: 10.3389/fphys.2018.00016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/27/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022] Open
Abstract
Rationale: Arrhythmogenic cardiac alternans are thought to be an important determinant for the initiation of ventricular fibrillation. There is limited information on the effects of sympathetic nerve stimulation (SNS) on alternans in the intact heart and the conclusions of existing studies, focused on investigating electrical alternans, are conflicted. Meanwhile, several lines of evidence implicate instabilities in Ca handling, not electrical restitution, as the primary mechanism underpinning alternans. Despite this, there have been no studies on Ca alternans and SNS in the intact heart. The present study sought to address this, by application of voltage and Ca optical mapping for the simultaneous study of APD and Ca alternans in the intact guinea pig heart during direct SNS. Objective: To determine the effects of SNS on APD and Ca alternans in the intact guinea pig heart and to examine the mechanism(s) by which the effects of SNS are mediated. Methods and Results: Studies utilized simultaneous voltage and Ca optical mapping in isolated guinea pig hearts with intact innervation. Alternans were induced using a rapid dynamic pacing protocol. SNS was associated with rate-independent shortening of action potential duration (APD) and the suppression of APD and Ca alternans, as indicated by a shift in the alternans threshold to faster pacing rates. Qualitatively similar results were observed with exogenous noradrenaline perfusion. In contrast with previous reports, both SNS and noradrenaline acted to flatten the slope of the electrical restitution curve. Pharmacological block of the slow delayed rectifying potassium current (IKs), sufficient to abolish IKs-mediated APD-adaptation, partially reversed the effects of SNS on pacing-induced alternans. Treatment with cyclopiazonic acid, an inhibitor of the sarco(endo)plasmic reticulum ATPase, had opposite effects to that of SNS, acting to increase susceptibility to alternans, and suggesting that accelerated Ca reuptake into the sarcoplasmic reticulum is a major mechanism by which SNS suppresses alternans in the guinea pig heart. Conclusions: SNS suppresses calcium and action potential alternans in the intact guinea pig heart by an action mediated through accelerated Ca handling and via increased IKs.
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Affiliation(s)
- James Winter
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom.,Institute of Cardiovascular Sciences, College of Medicine and Dental Sciences, University of Birmingham, United Kingdom
| | - Martin J Bishop
- Biomedical Engineering Department, King's College London, United Kingdom
| | - Catherine D E Wilder
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Christopher O'Shea
- Institute of Cardiovascular Sciences, College of Medicine and Dental Sciences, University of Birmingham, United Kingdom
| | - Davor Pavlovic
- Institute of Cardiovascular Sciences, College of Medicine and Dental Sciences, University of Birmingham, United Kingdom
| | - Michael J Shattock
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
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Kershaw O, Schmitz R, Gehlen H, Winter J. Das equine leukämische Lymphom – eine seltene Unterart des equinen Lymphoms. Tierarztl Prax Ausg G Grosstiere Nutztiere 2018. [DOI: 10.1055/s-0038-1623240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDas equine leukämische Lymphom ist eine selten vorkommende Erkrankung des hämatopoetischen Gewebes. Es entsteht durch neoplastische Entartung von B- und T-Lymphozyten im Lymphgewebe und deren Auftreten in der Blutbahn. Die klinischen Symptome sind häufig unspezifisch und umfassen chronischen Gewichtsverlust, Ödeme an Unterbrust und Unterbauch sowie regionale Lymphadenopathien. Häufig werden die Pferde erst spät im Krankheitsverlauf vorgestellt und die Behandlung führt selten zum Erfolg. Die Übersichtsarbeit beschreibt klinische Symptome des equinen leukämischen Lymphoms, Befunde der labordiagnostischen sowie anderer weiterführender Untersuchungen und stellt die bisher aus der Literatur bekannten Therapieansätze dar.
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Hoppe T, Göser V, Kraus D, Probstmeier R, Frentzen M, Wenghoefer M, Jepsen S, Winter J. Response of MG63 osteoblasts on bacterial challenge is dependent on the state of differentiation. Mol Oral Microbiol 2017; 33:133-142. [DOI: 10.1111/omi.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Affiliation(s)
- T. Hoppe
- Department of Periodontology, Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | - V. Göser
- Department of Periodontology, Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | - D. Kraus
- Department of Prosthodontics, Preclinical Education and Dental Materials Sciences; University of Bonn; Bonn Germany
| | - R. Probstmeier
- Department of Nuclear Medicine; Neuro- and Tumor Cell Biology Group; University of Bonn; Bonn Germany
| | - M. Frentzen
- Department of Periodontology, Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | - M. Wenghoefer
- Department of Oral & Maxillofacial Plastic Surgery; University Hospital Bonn, University of Bonn; Bonn Germany
| | - S. Jepsen
- Department of Periodontology, Operative and Preventive Dentistry; University of Bonn; Bonn Germany
| | - J. Winter
- Department of Periodontology, Operative and Preventive Dentistry; University of Bonn; Bonn Germany
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