1
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Baumgartner P, Reiner MF, Wiencierz A, Coslovsky M, Bonetti NR, Filipovic MG, Aeschbacher S, Kühne M, Zuern CS, Rodondi N, Oberle J, Moschovitis G, Lüscher TF, Camici GG, Osswald S, Conen D, Beer JH. Omega-3 Fatty Acids and Heart Rhythm, Rate, and Variability in Atrial Fibrillation. J Am Heart Assoc 2023:e027646. [PMID: 37259986 PMCID: PMC10381984 DOI: 10.1161/jaha.122.027646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Previous randomized control trials showed mixed results concerning the effect of omega-3 fatty acids (n-3 FAs) on atrial fibrillation (AF). The associations of n-3 FA blood levels with heart rhythm in patients with established AF are unknown. The goal of this study was to assess the associations of total and individual n-3 FA blood levels with AF type (paroxysmal versus nonparoxysmal), heart rate (HR), and HR variability in patients with AF. Methods and Results Total n-3 FAs, eicosapentaenoic acid, docosahexaenoic acid, docosapentaenoic acid, and alpha-linolenic acid blood levels were determined in 1969 patients with known AF from the SWISS-AF (Swiss Atrial Fibrillation cohort). Individual and total n-3 FAs were correlated with type of AF, HR, and HR variability using standard logistic and linear regression, adjusted for potential confounders. Only a mild association with nonparoxysmal AF was found with total n-3 FA (odds ratio [OR], 0.97 [95% CI, 0.89-1.05]) and docosahexaenoic acid (OR, 0.93 [95% CI, 0.82-1.06]), whereas other individual n-3 FAs showed no association with nonparoxysmal AF. Higher total n-3 FAs (estimate 0.99 [95% CI, 0.98-1.00]) and higher docosahexaenoic acid (0.99 [95% CI, 0.97-1.00]) tended to be associated with slower HR in multivariate analysis. Docosapentaenoic acid was associated with a lower HR variability triangular index (0.94 [95% CI, 0.89-0.99]). Conclusions We found no strong evidence for an association of n-3 FA blood levels with AF type, but higher total n-3 FA levels and docosahexaenoic acid might correlate with lower HR, and docosapentaenoic acid with a lower HR variability triangular index.
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Affiliation(s)
- Philipp Baumgartner
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
| | - Martin F Reiner
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, University Hospital of Basel Basel Switzerland
| | - Michael Coslovsky
- Clinical Trial Unit, University Hospital of Basel Basel Switzerland
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Nicole R Bonetti
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
- Center for Molecular Cardiology, Laboratory for Platelet Research University of Zurich Schlieren Switzerland
| | - Mark G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital Bern University Hospital, University of Bern Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Michael Kühne
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Christine S Zuern
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine Bern University Hospital, University of Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Jolanda Oberle
- Department of General Internal Medicine Bern University Hospital, University of Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ende Ospedaliero Cantonale (EOC) Ospedale Regionale di Lugano Lugano Switzerland
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals London UK
- National Heart and Lung Institute Imperial College London UK
- Center for Molecular Cardiology University of Zurich Schlieren Switzerland
| | - Giovanni G Camici
- Center for Molecular Cardiology University of Zurich Schlieren Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital of Basel Basel Switzerland
- Cardiovascular Research Institute Basel University Hospital of Basel Basel Switzerland
| | - David Conen
- Population Health Research Institute McMaster University Hamilton Canada
| | - Jürg H Beer
- Department of Internal Medicine Cantonal Hospital of Baden Baden Switzerland
- Center for Molecular Cardiology, Laboratory for Platelet Research University of Zurich Schlieren Switzerland
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2
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Ravioli S, Oberle J, Haidinger M, Lindner G. Gender equality in national cardiology societies: a cross-sectional study. Am J Med 2023; 136:585-591. [PMID: 36906170 DOI: 10.1016/j.amjmed.2023.02.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Higher productivity and team stability has been shown for gender diverse teams. However, there is a relevant and well-known gender gap in clinical and academic cardiovascular medicine. So far, no data concerning gender distribution in presidents and executive boards of national cardiology societies exist. METHODS In this cross-sectional analysis, gender equality in presidents and representatives of all national cardiology societies, which are members of or affiliated with the European Society of Cardiology (ESC) in 2022 was analyzed. In addition, representatives of the American Heart Association (AHA) were evaluated. RESULTS A total of 106 national societies were screened of which 104 were included in the final analysis. Overall, in these 104 societies, 90 out of 106 (85%) presidents were men while 14 (13%) were women. In the analysis of board members and executives, a total of 1128 individuals were included. Overall, 809 (72%) board members were men, 258 (23%) women and 61 (5%) of unknown gender. Except for society presidents in Australia, women were relevantly outnumbered by men in all world regions. CONCLUSION Women were globally underrepresented in leading positions of national cardiology societies in all world regions. As national societies are important regional stakeholders, improving gender equality in executive boards might create women role models, help foster careers and narrow the global cardiology gender gap.
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Affiliation(s)
- Svenja Ravioli
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jolanda Oberle
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Michael Haidinger
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Switzerland.
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Lyko C, Blum MR, Abolhassani N, Stuber MJ, Del Giovane C, Feller M, Moutzouri E, Oberle J, Jungo KT, Collet TH, den Elzen WPJ, Poortvliet RKE, Du Puy RS, Dekkers OM, Trompet S, Jukema JW, Aujesky D, Quinn T, Westendorp R, Kearney PM, Gussekloo J, Van Heemst D, Mooijaart SP, Bauer DC, Rodondi N. Thyroid antibodies and levothyroxine effects in subclinical hypothyroidism: A pooled analysis of two randomized controlled trials. J Intern Med 2022; 292:892-903. [PMID: 35894851 PMCID: PMC9796496 DOI: 10.1111/joim.13544] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Antithyroid antibodies increase the likelihood of developing overt hypothyroidism, but their clinical utility remains unclear. No large randomized controlled trial (RCT) has assessed whether older adults with subclinical hypothyroidism (SHypo) caused by autoimmune thyroid disease derive more benefits from levothyroxine treatment (LT4). OBJECTIVE To determine whether older adults with SHypo and positive antibodies derive more clinical benefits from LT4 than those with negative antibodies. METHODS We pooled individual participant data from two RCTs, Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism and IEMO 80+. Participants with persistent SHypo were randomly assigned to receive LT4 or placebo. We compared the effects of LT4 versus placebo in participants with and without anti-thyroid peroxidase (TPO) at baseline. The two primary outcomes were 1-year change in Hypothyroid Symptoms and Tiredness scores on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire. RESULTS Among 660 participants (54% women) ≥65 years, 188 (28.5%) had positive anti-TPO. LT4 versus placebo on Hypothyroid Symptoms lead to an adjusted between-group difference of -2.07 (95% confidence interval: -6.04 to 1.90) for positive antibodies versus 0.89 (-1.76 to 3.54) for negative antibodies (p for interaction = 0.31). Similarly, there was no treatment effect modification by baseline antibody status for Tiredness scores-adjusted between-group difference 1.75 (-3.60 to 7.09) for positive antibodies versus 1.14 (-1.90 to 4.19) for negative antibodies (p for interaction = 0.98). Positive anti-TPO were not associated with better quality of life, improvement in handgrip strength, or fewer cardiovascular outcomes with levothyroxine treatment. CONCLUSIONS Among older adults with SHypo, positive antithyroid antibodies are not associated with more benefits on clinical outcomes with LT4.
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Affiliation(s)
- Christina Lyko
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Manuel R Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nazanin Abolhassani
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Mirah J Stuber
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jolanda Oberle
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katharina T Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Wendy P J den Elzen
- Atalmedial Diagnostics Centre, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Clinical Chemistry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center UMC, Leiden, The Netherlands
| | - Robert S Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center UMC, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology and Metabolic Disorders, Leiden University Medical Center, Leiden, The Netherlands
| | - Stella Trompet
- Department of Internal Medicine-Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Terry Quinn
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences University of Glasgow, Glasgow, UK
| | - Rudi Westendorp
- Department of Public Health and, Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center UMC, Leiden, The Netherlands
| | - Diana Van Heemst
- Department of Internal Medicine-Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine-Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Douglas C Bauer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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4
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Aebersold H, Serra-Burriel M, Foster-Wittassek F, Moschovitis G, Aeschbacher S, Auricchio A, Beer JH, Blozik E, Bonati LH, Conen D, Felder S, Huber CA, Kuehne M, Mueller A, Oberle J, Paladini RE, Reichlin T, Rodondi N, Springer A, Stauber A, Sticherling C, Szucs TD, Osswald S, Schwenkglenks M. Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort. Heart 2022; 109:763-770. [PMID: 36332981 DOI: 10.1136/heartjnl-2022-321520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.MethodsSwiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.ResultsA subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.ConclusionOur results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.
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Affiliation(s)
- Helena Aebersold
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Angelo Auricchio
- Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Jürg Hans Beer
- Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| | - Carola A Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Michael Kuehne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Jolanda Oberle
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Rebecca E Paladini
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Anne Springer
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Annina Stauber
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Christian Sticherling
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas D Szucs
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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5
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Aubert CE, Rodondi N, Terman SW, Feller M, Schneider C, Oberle J, Dalleur O, Knol W, O'Mahony D, Aujesky D, Donzé J. HOSPITAL Score and LACE Index to Predict Mortality in Multimorbid Older Patients. Drugs Aging 2022; 39:223-234. [PMID: 35260994 PMCID: PMC8934762 DOI: 10.1007/s40266-022-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
Abstract
Background Estimating life expectancy of older adults informs whether to pursue future investigation and therapy. Several models to predict mortality have been developed but often require data not immediately available during routine clinical care. The HOSPITAL score and the LACE index were previously validated to predict 30-day readmissions but may also help to assess mortality risk. We assessed their performance to predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy. Methods We calculated the HOSPITAL score and LACE index in patients from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial (patients aged ≥ 70 years with multimorbidity and polypharmacy, admitted to hospital across four European countries in 2016–2018). Our primary and secondary outcomes were 1-year and 30-day mortality. We assessed the overall accuracy (scaled Brier score, the lower the better), calibration (predicted/observed proportions), and discrimination (C-statistic) of the models. Results Within 1 year, 375/1879 (20.0%) patients had died, including 94 deaths within 30 days. The overall accuracy was good and similar for both models (scaled Brier score 0.01–0.08). The C-statistics were identical for both models (0.69 for 1-year mortality, p = 0.81; 0.66 for 30-day mortality, p = 0.94). Calibration showed well-matching predicted/observed proportions. Conclusion The HOSPITAL score and LACE index showed similar performance to predict 1-year and 30-day mortality in older multimorbid patients with polypharmacy. Their overall accuracy was good, their discrimination low to moderate, and the calibration good. These simple tools may help predict older multimorbid patients’ mortality after hospitalization, which may inform post-hospitalization intensity of care.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Samuel W Terman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jolanda Oberle
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium.,Pharmacy Department, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork, Munster, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Munster, Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland.,Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Ruhl N, Crumrine P, Oberle J, Richmond C, Thomas S, Wright S. Harnessing the Four‐Dimensional Ecology Education Framework to redesign an introductory ecology course in a changing higher education landscape. Ecosphere 2022. [DOI: 10.1002/ecs2.3857] [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: 11/10/2022] Open
Affiliation(s)
- N. Ruhl
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
| | - P. Crumrine
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
- Department of Environmental Science Rowan University Glassboro New Jersey 08028 USA
| | - J. Oberle
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
- Department of Biology Rutgers University Camden New Jersey 08102 USA
| | - C. Richmond
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
| | - S. Thomas
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
| | - S. Wright
- Department of Biological Sciences Rowan University Glassboro New Jersey 08028 USA
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7
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Gramatzki D, Roth P, Rushing E, Weller J, Andratschke N, Hofer S, Korol D, Regli L, Pangalu A, Pless M, Oberle J, Bernays R, Moch H, Rohrmann S, Weller M. Bevacizumab may improve quality of life, but not overall survival in glioblastoma: an epidemiological study. Ann Oncol 2018; 29:1431-1436. [DOI: 10.1093/annonc/mdy106] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Gramatzki D, Roth P, Rushing EJ, Weller J, Andratschke N, Hofer S, Regli L, Oberle J, Rohrmann S, Weller M. OS01.6 Glioblastoma in the era of bevacizumab: an epidemiological study in the Canton of Zurich, Switzerland. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.005] [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: 11/14/2022] Open
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9
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Koechlin NO, Bothmann M, Kast E, Oberle J, Hasler S, Sartoretti S, Binkert CA. [Unusual course of a planned lumbar microdiscectomy]. Praxis (Bern 1994) 2012; 101:865-867. [PMID: 22715079 DOI: 10.1024/1661-8157/a000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report the case of a 30-year-old female patient who underwent unilateral transverse sinus stenosis stenting due to a newly diagnosed idiopathic intracranial hypertension (Pseudotumor cerebri) with symptoms of papilledema, decreased visual acuity and headache. Resolution of the symptoms and improvement of magnetic resonance and ophthalmiologic findings could be documented.
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Affiliation(s)
- N O Koechlin
- Klinik für Neurochirurgie, Kantonsspital Winterthur
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10
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Oexle K, Oberle J, Finckh B, Kohlschütter A, Nagy M, Seibel P, Seissler J, Hübner C. Islet cell antibodies in diabetes mellitus associated with a mitochondrial tRNA(Leu(UUR)) gene mutation. Exp Clin Endocrinol Diabetes 2009; 104:212-7. [PMID: 8817238 DOI: 10.1055/s-0029-1211445] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An A3243G point mutation of the mitochondrial tRNA(Leu(UUR)) gene was detected in a Caucasian family with maternal diabetes mellitus and signs of mitochondrial dysfunction such as muscular hypotonia, encephalopathy, lactic acidosis, stroke-like episodes (MELAS), neurosensory hearing loss, cardial pre-excitation, and short stature. Low levels (10 JDF) of islet cell antibodies (ICA) in insulin-treated diabetes of the mother and impaired glucose tolerance with high levels of ICA (80 JDF) in her older son indicated that mitochondrial diabetes mellitus may involve beta cell damage. Furthermore, exocrine pancreas cell damage may also occur since the stroke-like episodes of this son were combined with pancreatitis. In all family members HLA types and plasma antioxidants were determined. Normal concentrations of hydro- and lipophilic antioxidants (including ubiquinol-10) were found.
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Affiliation(s)
- K Oexle
- Department of Pediatrics, Humboldt-University Medical Center (Charité), Berlin, Germany
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11
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Oberle J, Antoniadis G, Rath S, Richter HP. Intraoperativ evozierte Potentiale bei traumatischen Armplexusläsionen. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Oberle J, Richter HP. Die operative Behandlung des Thoracic Outlet Syndroms - Befunde, OP-Maßnahmen, Ergebnisse und Komplikationen bei 38 Patienten. Akt Neurol 2008. [DOI: 10.1055/s-2007-1017869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bordenave E, Abraham E, Jonusauskas G, Oberle J, Rulliere C. Longitudinal imaging in biological tissues with a single laser shot correlation system. Opt Express 2002; 10:35-40. [PMID: 19424327 DOI: 10.1364/oe.10.000035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We demonstrate the potential of a new optical imaging system to directly obtain a longitudinal slice of a biological sample. The system, based on a single-shot optical correlator, operates a time-to-space conversion and an optical time-gating by sum-frequency generation in a nonlinear crystal. Owing to the high speed acquisition of the technique, internal structures of in-vivo tissues can be imaged at video rate.With this apparatus, we recorded longitudinal images of ex vivo mouse ear and in vivo human skin with a depth resolution of approximately 15 microm.
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Abstract
A 27-year-old otherwise healthy male presented with an isolated but complete axillary nerve palsy after excessive squash playing. When repeated electromyographic investigations showed no signs of reinnervation in the deltoid muscle, surgery was performed in order to restore nerve function. Intraoperatively, the nerve showed a short segment of thinning about 2 cm distally the nerve's origin from the posterior fascicle. As intraoperative electrophysiological testing was also negative (no electrically evoked nerve action potentials across the lesion) the suspicious nerve segment was resected and nerve continuity restored by sural grafts. Histologically, no intact nerve structures could be found at the site of the thinning. Most likely the lesion was caused by traction forces. Follow-up studies showed reinnervation of deltoid function over time.
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Affiliation(s)
- J Oberle
- Neurochirurgischer Abteilung der Universität Ulm, Bezirkskrankenhaus Günzburg
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Oberle J, Antoniadis G, Rath SA, Seitz K, Schneider O, Braun V, Kahamba JF, Richter HP. Radiological investigations and intra-operative evoked potentials for the diagnosis of nerve root avulsion: evaluation of both modalities by intradural root inspection. Acta Neurochir (Wien) 1998; 140:527-31. [PMID: 9755318 DOI: 10.1007/s007010050136] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fourteen patients with traumatic brachial plexus injuries underwent intradural inspection of cervical nerve roots to evaluate radiological and intra-operative electrophysiological findings concerning cervical nerve root avulsion from the spinal cord. Four neurosurgeons of our department assessed independently from each other both myelography and CT-myelography concerning intradural nerve root lesions. Each neurosurgeon assessed a total of 26 cervical nerve roots. Two investigators assessed 6/26 and 2 investigators 7/26 nerve roots falsely concerning ventral or/and dorsal root lesions compared with the findings on intradural inspection (23% and 27% false findings). There was a considerable variance concerning the assessibility and findings among the 4 neurosurgeons. Reconstructive surgery was performed after a mean interval of 6.5 months following trauma and 2 weeks following intradural inspection. After exposure of the brachial plexus and the cervical nerve roots in question via a ventral approach, 13 cervical nerve roots were stimulated electrically close to the neuroforamen and cortical evoked potentials (root-SEPs) were recorded from the contralateral postcentral region. All 5 roots with SEPs were intact (no root lesion) and all 8 roots without SEPs showed interrupted (ventral or/and dorsal) rootlets on intradural inspection. Our results demonstrate that false radiological findings concerning root lesions are possible. Intra-operative root-SEPs seem to be a useful aid for evaluation of cervical nerve root lesions. However, more electrophysiological data are necessary to ascertain, if this modality is able to replace intradural inspection in unclear radiological cases in the future.
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Affiliation(s)
- J Oberle
- Neurosurgical Department, University of Ulm, Günzburg, Germany
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16
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Oberle J, Richter HP. [Painful paresthesia after removal of the sural nerve for autologous nerve transplantation]. Zentralbl Neurochir 1998; 59:1-3. [PMID: 9577925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The sural nerve is the most common nerve serving as a donor in an autologeous nerve grafting procedure. However, there is a certain risk for the development of painful paraesthesias at the donor site. Patients in whom a short segment of the sural nerve was resected are suspected to have a greater risk. In a retrospective study we investigated the incidence of painful paraesthesias following removal of a segment of the sural nerve for a grafting procedure. The study includes 41 patients, who were followed at least for one year after surgery (mean 30 months). 9 patients (22%) complained of persisting painful paraesthesias at the donor site suggesting a neuroma at the proximal stump of the sural nerve. The comparison of the length of the nerve segment harvested for grafting shows a tendency for patients with shorter segments having a greater risk to develop painful paraesthesias. However, the difference between the two groups was statistically not significant.
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Affiliation(s)
- J Oberle
- Neurochirurgische Abteilung, Universität Ulm im Bezirkskrankenhaus Günzburg
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Braun V, Oberle J, Kretschmer T, Richter HP. [Cranial neuro-navigation with functional monitoring]. Rontgenpraxis 1998; 51:311-9. [PMID: 9810816] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- V Braun
- Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg.
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Abstract
16 patients with peripheral nerve neurinomas (benign schwannomas) were operated upon in our hospital between 1990-1995. The largest tumours were found on proximal segments of peripheral nerves (brachial plexus: 15 cm, sciatic nerve: 20 cm). The average duration of symptoms was 1 1/2 years (range: 3 months-15 years). Pain or painful paraesthesias were the main complaints (13/16). Postoperatively, 9 patients were painfree while 4 improved. Similarly, neurological deficits were favourably influenced by the operation: Out of 5 patients with motor deficits 4 had complete, 1 patient had partial recovery. One out of 4 patients with sensory deficits had complete recovery, 2 remained unchanged, while 1 worsened. Two patients developed new motor and 6 patients new sensory deficits, which (in the course of time) did not disappear completely. New deficits developed predominantly in patients with large tumours or longstanding symptoms. Tumour recurrences were not seen during the follow-up period of 23 months. Our findings revealed that in the majority of cases peripheral nerve neurinomas can be excised with good results. Patients should be treated by a neurosurgeon with special expertise in peripheral nerve surgery. The patient should be thoroughly informed pre-operatively about any eventual new neurological deficits following surgery.
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Affiliation(s)
- J Oberle
- Neurosurgical Department, University of Ulm, Federal Republic of Germany
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Antoniadis G, Rath SA, Mir-Ali L, Oberle J, Richter HP. [Experiences with endoscopic surgery in treatment of carpal tunnel syndrome. Preliminary results of a prospective study]. Nervenarzt 1997; 68:503-8. [PMID: 9312684 DOI: 10.1007/s001150050153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endoscopic carpal tunnel release is a new technique for treatment of carpal tunnel syndrome. The benefits of this procedure are a small skin wound with less local pain, the fact that the hand can quickly be used again, and earlier return to work or other activities. We present the preliminary results of the 3-month follow-up of 88 patients out of a prospective study of 100 patients. All patients were operated on using the one-port technique. Six additional decompressions had to be abandoned and open release was performed. Of the patients with pain, 73.6% (68/88) were completely pain-free and in 13.2% (9/68) pain improved in more than 50%. Subjective symptoms like paresthesia and numbness of the hand disappeared completely in 77.2% (64/83). Sensory deficits disappeared in 50% (33/66). Ten of 17 patients with preoperative paresis of the abductor pollicis brevis muscle and 11/14 with paresis of the opponens pollicis muscle had normal motor function 3 months after the operation. The complication rate concerning nerve lesions was 2.3%. The return to work time was 21 days (range 3-49 days). According to clinical symptoms, our preliminary results do not seem to have any benefits compared to the conventional open technique, and the costs for the endoscopic procedure are markedly higher. The complication rate after the learning curve period is approximately the same as open carpal tunnel release.
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Oberle J, Antoniadis G, Rath SA, Richter HP. Intra-operative electrophysiological diagnosis of spinal root avulsion during surgical repair of brachial plexus stretch injuries. Acta Neurochir (Wien) 1997; 139:238-9. [PMID: 9143591 DOI: 10.1007/bf01844758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Fritz P, Schraube P, Oberle J, Wannenmacher M, Friedl P. [The percutaneous-endocavitary irradiation of esophageal carcinomas]. Strahlenther Onkol 1992; 168:154-61. [PMID: 1372768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
In a prospective, nonrandomized study 43 patients with inoperable oesophageal carcinoma were treated with a combined therapy of external and intracavitary irradiation according to the Heidelberg protocol adjusted to tumor stage, general condition and age. The proportion of external beam to afterloading doses was 2/3:1/3. The reference doses were between 50 and 75 Gy. Intracavitary radiotherapy was carried out with a HDR-afterloading device in single doses of 5 Gy. In a median follow-up of 23 months 46% had a complete remission and 42% had a partial remission. Within ten months 17 patients (39.5%) showed local tumor progression or recurrence. Presently the estimated median survival time of the whole collective is eleven months. The median survival was significantly influenced by achievement of complete remission (17.7 months in comparison to 8.7 months by missing complete remission). After completion of therapy 90% had sufficient oral nutrition. During long-term follow-up in 44% of the cases repeated measures had to be taken to eliminate initial or recurrent dysphagia. Almost all postradiogenic stenoses were caused by tumor progression. Radiogenic side-effects caused by HDR-afterloading boosts, exceeding the acceptance, were not found. The combined therapy reduces the period of hospitalisation and has the same palliative effects as an exclusively external radiotherapy.
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Affiliation(s)
- P Fritz
- Radiologische Klinik, Universität Heidelberg
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Pernow J, Schwieler J, Kahan T, Hjemdahl P, Oberle J, Wallin BG, Lundberg JM. Influence of sympathetic discharge pattern on norepinephrine and neuropeptide Y release. Am J Physiol 1989; 257:H866-72. [PMID: 2782443 DOI: 10.1152/ajpheart.1989.257.3.h866] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of sympathetic nerve stimulation on vasoconstrictor responses and overflow of norepinephrine (NE) and neuropeptide Y-like immunoreactivity (NPY-LI) were studied in the dog gracilis muscle and pig spleen in vivo. A continuous regular impulse activity was compared with irregular human sympathetic and regular bursting patterns. During control conditions, stimulation with the irregular activity induced larger peak vasoconstriction than the regular activity at 0.59 Hz, but not at higher frequencies in the muscle, at 0.59 and 2.0 Hz in the spleen. The nerve stimulation-evoked overflow of NE and NPY-LI from the muscle were not influenced by the pattern of stimulation. The overflow of NPY-LI, but not that of NE, from the spleen was enhanced by the irregular activity at 0.59 and 2.0 Hz, and both NPY-LI and NE overflows were enhanced by regular burst activity at 2.0 Hz. After blockade of alpha- and beta-adrenoceptors by phenoxybenzamine and propranolol, respectively, which enhanced nerve stimulation-evoked overflow of both NE and NPY-LI, the NE overflow from the muscle evoked by the irregular activity was slightly larger at 0.59 Hz but smaller at higher frequencies compared with that evoked by regular activity, whereas the detectable overflow of NPY-LI was not largely influenced by the stimulation pattern. In conclusion, both the vasoconstrictor response and the overflow of NPY-LI and NE seem to be influenced by the pattern and frequency of sympathetic nerve stimulation.
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Affiliation(s)
- J Pernow
- Department of Pharmacology, Karolinska Institute, Stockholm, Sweden
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Oberle J, Elam M, Karlsson T, Wallin BG. Temperature-dependent interaction between vasoconstrictor and vasodilator mechanisms in human skin. Acta Physiol Scand 1988; 132:459-69. [PMID: 3227886 DOI: 10.1111/j.1748-1716.1988.tb08353.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The putative influence of the thermoregulatory state on skin blood-flow responses to various stimuli was studied in 17 healthy subjects exposed to different ambient temperatures. Skin blood flow was monitored by laser Doppler flowmeters and photoelectrical pulse plethysmographs. Stimuli included painful intraneural electrical stimulation (INS) in the median nerve at the wrist, mental stress, arousal stimuli and deep breaths. Intraneural electrical stimulation and mental stress were accompanied by virtually identical changes in skin blood flow, warm subjects responding with cutaneous vasoconstriction whereas cold subjects responded with vasodilatation. Similar but less pronounced responses were obtained with arousal stimuli and single deep breaths. The data indicate that the thermoregulatory state profoundly influences the extent and direction of various cutaneous vasomotor reflex responses. Furthermore, there were differences between responses in hands and feet, suggesting a spatial organization of vasomotor control.
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Affiliation(s)
- J Oberle
- Department of Clinical Neurophysiology, Sahlgren's Hospital, Göteborg, Sweden
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