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Guedry SE, Langley BO, Schaefer K, Hanes DA. Integrative medicine for hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS): a feasibility study. Disabil Rehabil 2024:1-14. [PMID: 38353245 DOI: 10.1080/09638288.2024.2314713] [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: 04/16/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are multisystem conditions marked by dysfunctional connective tissue. This feasibility study evaluated a 9-week integrative medicine program in this population. METHODS Using a single-arm study design, adults with HSD or EDS were given recommendations for an anti-inflammatory Mediterranean diet and self-management with additional behavioral and psychosocial support. Preliminary data on feasibility based on recruitment and retention, adherence to the diet, mobile app tracking, changes to perceived well-being via health outcomes, and satisfaction with care were obtained. RESULTS Thirteen participants were enrolled within a 4-month timeframe. Eight participants completed the study. Three participants met dietary tracking requirement in at least 4 of 8 intervention weeks and met the macronutrient requirements in at least half of the weeks tracked. No decreases in VAS pain scores after 5 and 9 weeks were noted; however, 62.5% (n = 5) of participants had decreased pain at 9 weeks, compared to baseline. There were significant improvements (p<.05) in six of twelve measurements of satisfaction with care at the end of the intervention. CONCLUSION This study provides a foundation for future research on patient experience and introduces a novel treatment paradigm focused on nutrition and self-management. Trial Registration: National Institutes of Health clinicaltrials.gov; identifier: NCT04734041. IMPLICATIONS FOR REHABILITATION Lifestyle and dietary interventions are relatively safe and well tolerated in the hypermobility spectrum disorder (HSD) and Ehlers-Danlos disorder (EDS) population.Participants in our 9-week integrative medicine program actively engaged in self-management of their condition and showed promising adherence to dietary and tracking requirements.Effective treatment of the intricacies and dynamics of these highly variable and clinically heterogeneous disorders may require a network of healthcare providers, integrative healthcare, as well as behavioral and psychosocial support.Dietary tracking through mobile apps might help promote self-efficacy and adherence to dietary changes.Symptom tracking might be an effective way for patients to track changes to their health and could provide valuable information for health professionals engaged in managing the disorders.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- School of Nursing, University of WA, Seattle, WA, USA
| | - Kerry Schaefer
- Co-investigator, Healthy Living Community Clinic, Portland, OR, USA
| | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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2
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Guedry SE, Langley BO, Schaefer K, Hanes DA. Patient experience of chronic illness care and complementary integrative health use: a cross-sectional study of patients with hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS). Disabil Rehabil 2023; 45:3549-3559. [PMID: 36222285 DOI: 10.1080/09638288.2022.2131003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are frequently underdiagnosed, contributing to patient dissatisfaction in the healthcare system. This study evaluated the health service utilization, care, and subjective experiences of living with chronic illness among adults with HSD and EDS in the United States and Canada. METHODS This was an anonymous, web-based, cross-sectional healthcare survey. The survey obtained basic demographic information, the Patient Assessment of Chronic Illness Care (PACIC+), as well as responses to questions on the use of healthcare and integrative medicine. RESULTS A total of 353 surveys were received. The most common complementary therapies used were physical therapy (82%), massage (68%), yoga (58%), chiropractic (48%), and meditation (43%). Mean (SD) summary PACIC and PACIC 5 As scores were 2.16 (0.77) and 2.25 (0.83), respectively. Across all PACIC domains, mean scores of individuals whose typical doctor visit was 30 min or at least an hour were significantly higher than those of individuals who indicated typical visits of 15 min (all p < 0.0001 by one-way ANOVA). There was widespread agreement on the importance of patient-provider relationship and trust, physicians' understanding of the individual's complete medical history, and prioritization of physical and emotional safety (>95% agree or strongly agree to each). CONCLUSION Individuals with HSD or EDS report low satisfaction with chronic illness care and commonly seek out complementary and self-administered therapies, likely in an attempt to manage symptoms. Respondents reported a desire for greater time and attention from physicians. Results from this study could educate the healthcare community to improve support mechanisms for HSD and EDS populations.IMPLICATIONS FOR REHABILITATIONPatients with hypermobility spectrum disorders (HSD) or Ehlers-Danlos syndromes (EDS) express a desire for patient-centered care and peer support from other individuals with HSD or EDS.Individuals with HSD or EDS have typically seen multiple doctors for their condition and their satisfaction with chronic care, as measured by the Patient Assessment of Chronic Illness Care (PACIC+), is low.The use of various complementary and integrative health treatments, as well as specialized diets, is common in this population, and might be beneficial for symptom management.Healthcare delivery for HSD and EDS may require a multidisciplinary healthcare team, as complementary and self-care modalities are typically used in addition to physical therapy, pain medication, and other conventional care.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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3
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Efentakis P, Molitor M, Kossmann S, Bochenek M, Wild J, Lagrange J, Finger S, Jung R, Karbach S, Schaefer K, Schulz A, Wild P, Muenzel T, Wenzel P. Tubulin-folding cofactor E deficiency is associated with vascular dysfunction and endoplasmatic reticulum stress of vascular smooth muscle cells. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3360] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Endothelial function assessed via flow mediated dilatation (FMD) has shown to predict risk in individuals with established cardiovascular diseases, whereas its predictive value is uncertain in the setting primary prevention.
Purpose
The aim of the current work was to discover and evaluate novel mediators of vascular dysfunction in the general population and in conditional knock-out transgenic animal models.
Methods
In order to identify novel targets that were negatively correlated with FMD and investigate their contribution in vascular function, a Genome Wide Association Study (GWAS) of 5,000 participants was performed and subsequently immune cell-, endothelial- and vascular smooth muscle cell (VSMCs)-targeted conditional knockout mouse models were generated and characterized.
Results
GWAS analysis revealed that single nucleotide polymorphisms (SNPs) in the tubulin folding cofactor E (TBCE) gene were negatively correlated with FMD and TBCE expression in the peripheral blood mononuclear cells (PBMCs). Myelomonocytic cell-targeted TBCE deficiency did not lead to any vascular dysfunction in vivo in the LysM+Cre+/−TBCEfl/fl mice. Endothelial-targeted TBCE deficiency led to an NLR family pyrin domain containing 3 (NLRP3)-dependent activation of the inflammasome in the endothelial cells of Tie2-ERT2Cre+/−TBCEfl/fl mice. Importantly, VSMC-targeted TBCE deficiency was associated with endothelial dysfunction, increased aortic wall thickness and endoplasmatic reticulum (ER) stress-mediated VSMC hyperproliferation in vivo (SMMHC-ERT2Cre+/−TBCEfl/fl), paralleled by calnexin upregulation. Administration of the blood pressure hormone angiotensin II exacerbated the vascular dysfunction and phenotype. Administration of the ER stress modulator tauroursodeoxycholic acid to the SMMHC-ERT2Cre+/−TBCEfl/fl mice reversed vascular dysfunction, paralleled by induction of Raptor/Beclin-1-dependent autophagy both in vitro and in vivo.
Conclusion
TBCE and tubulin homeostasis in the vascular musculature seem to be novel markers of vascular function and represent a new druggable target for the treatment of ER-stress-mediated vascular dysfunction.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by grants of the German Federal Ministry for Education and Research (BMBF01EO1003 and BMBF01EO1503), the DFG Major Research Instrumentation Programme (DFG INST 371/47-1 FUGG) as well as the Boehringer Ingelheim Foundation. PW received funds from the German Research Foundation in support of his work (DFG WE4361-4-1 and WE 4361/7-1). KS, TM and PW are PIs of the DZHK.
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Affiliation(s)
- P Efentakis
- National & Kapodistrian University of Athens, Pharmacy, Athens, Greece
| | - M Molitor
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - S Kossmann
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - M Bochenek
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - J Wild
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - J Lagrange
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - S Finger
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - R Jung
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - S Karbach
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - K Schaefer
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - A Schulz
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - P Wild
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - T Muenzel
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
| | - P Wenzel
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology, Mainz, Germany
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Schmeisser A, Rauwolf T, Groscheck T, Fischbach K, Luani B, Kropf S, Tanev I, Hansen M, Meissler S, Schaefer K, Steendijk P, Braun-Dullaeus R. Predictors and prognosis of RV function in pulmonary hypertension due to heart failure with reduced ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0754] [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 and aims
Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV-pulmonary artery (PA) coupling, is defined by the ratio of RV end-systolic to PA elastances (Ees/Ea). Using pressure volume loop (PV-L) technique we aimed to identify an Ees/Ea cutoff predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to Heart Failure with Reduced Ejection Fraction (HFREF).
Methods
This post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography, and a baseline PV-L and RV catheter measurement. A subgroup of patients (n=50) without a pre-implanted cardiac device underwent MRI at baseline.
Results
The analysis revealed that 0.68 is an optimal Ees/Ea cutoff (area under the curve: 0.697, p<0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥0.68 vs. <0.68, log-rank 8.9, p=0.003. In patients with PH (n=76, 68%) Multivariate Cox-regression demonstrated the independent prognostic value of RV-Ees/Ea in PH patients (HR 0.2, p<0.038). Patients without PH (n=36, 32%) and those with PH but RV-Ees/Ea ≥0.68 showed comparable RV-Ees/Ea ratios (0.88 vs. 0.9, p=0.39), RV size/function, and survival. In contrast, secondary PH with RV-PA coupling ratio Ees/Ea <0.68 corresponded extremely close to cut-off values that define RV dilatation/remodeling (RVEDV >160ml, RV-mass/volume-ratio <0.37 g/ml) and dysfunction (RVEF <38%, TAPSE <16mm, FAC <42%, and stroke-volume/end-systolic volume ratio <0.59) and is associated with a dramatically increased short and medium-term all-cause mortality. Independent predictors of prognostically unfavorable RV-PA coupling (Ees/Ea <0.68) in secondary PH were a preexistent dilated RV (end-diastolic volume >171ml, odds ratio, OR 0.96, p=0.021), high pulsatile load (PA compliance <2.3 ml/mmHg, OR 8.6, p=0.003), and advanced systolic left heart failure (left ventricular (LV) ejection fraction <30%, OR 1.23, p=0.028).
Conclusions
The RV-PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodeling and LV dysfunction. Prognostically favorable coupling (RV-Ees/Ea ≥0.68) in PH was associated with preserved RV size/function and mid-term survival, comparable to HFREF without PH.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
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Affiliation(s)
- A Schmeisser
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - T.H Rauwolf
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - T Groscheck
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - K Fischbach
- Otto-von-Guericke University of Magdeburg, Radiology, Magdeburg, Germany
| | - B Luani
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - S Kropf
- University of Magdeburg, Biostatistics, Magdeburg, Germany
| | - I Tanev
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - M Hansen
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - S Meissler
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - K Schaefer
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
| | - P Steendijk
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - R Braun-Dullaeus
- Otto-von-Guericke University of Magdeburg, Cardiology, Magdeburg, Germany
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Merz A, Gutiérrez-Sacristán A, Bartz D, Williams N, Ojo A, Schaefer K, Huang M, Li C, Sandoval R, Ye S, Cathcart A, Starosta A, Avillach P. O5 Large-scale trends in contraceptive attitudes over time as expressed on Twitter. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.013] [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: 10/23/2022]
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Abstract
The effect of different blood temperatures on the vascular stability during hemofiltration was evaluated in 10 patients being in the regular chronic hemofiltration program. In contrast to recent data, no differences could be observed with regard to the heart rate, systolic blood pressure or mean arterial pressure, when the blood returned to the patient either with a temperature of 34.68°C or 36.22°C. According to these data it is therefore presently not justified to consider differences in the blood temperature as a critical determinant for the vascular stability during HF.
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Affiliation(s)
- K. Schaefer
- Med. Abt. II, St. Joseph-Krankenhaus, 1000 Berlin 42 Germany
| | - D. Von Herrath
- Med. Abt. II, St. Joseph-Krankenhaus, 1000 Berlin 42 Germany
| | - M. Hüfler
- Med. Abt. II, St. Joseph-Krankenhaus, 1000 Berlin 42 Germany
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7
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Stein G, Schauer ST, Süss J, Müller A, Hüller M, Schaefer K, Falkenhagen D, Linβ W. Influence of Membranes on Generation of β2 M and Release of Leukocyte Lysosomal Enzymes. Int J Artif Organs 2018. [DOI: 10.1177/039139889001300606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Normal leukocyte functional capacity was investigated by evaluation of phagocytosis of opsonised yeast cells in a radiometric test system. After incubation with dialysis membranes (different cellulosic membranes, polysulfon membrane (PS), polymethylmetacrylate membrane (PMMN), the phagocytosis index, expressed as percent decrease with respect to initial values without membrane, decreased by 10%–25%. The most pronounced effect was observed with PS, cuprophane, modified cellulose and PMMA. The results are not related to differences in the viability of PMN during the test procedure; dead PMN amounted to about 4–6.5%. A significant increase in β-NAG and β-Gluc activities was released in the supernatants of the phagocytosis suspensions. This increase activity can be explained by the phagocytosis of PMN but it was not influenced by membrane contact. There was no influence of membrane contact or phagocytosis activity of PMN on the β2M concentration in the supernatant demonstrating that no in vitro generation during incubation with either membrane exists.
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Affiliation(s)
- G. Stein
- Departments of Internal Medicine and Friedrich-Schiller University of Jena - G.D.R
| | - ST. Schauer
- Departments of Internal Medicine and Friedrich-Schiller University of Jena - G.D.R
| | - J. Süss
- Institutes of Medical Microbiology and Friedrich-Schiller University of Jena - G.D.R
| | | | - M. Hüller
- Departments of Radiology, Friedrich-Schiller University of Jena - G.D.R
| | - K. Schaefer
- Departments of St. Joseph-Hospital Berlin (West) - D.D.R
| | - D. Falkenhagen
- Department of Internal Medicine, University of Rostock - G.D.R
| | - W. Linβ
- Departments of Anatomy, Friedrich-Schiller University of Jena - G.D.R
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8
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Jafarov EE, Parsekian AD, Schaefer K, Liu L, Chen AC, Panda SK, Zhang T. Estimating active layer thickness and volumetric water content from ground penetrating radar measurements in Barrow, Alaska. Geosci Data J 2017; 4:72-79. [PMID: 29610660 PMCID: PMC5873252 DOI: 10.1002/gdj3.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 09/07/2017] [Accepted: 11/21/2017] [Indexed: 06/08/2023]
Abstract
Ground penetrating radar (GPR) has emerged as an effective tool for estimating active layer thickness (ALT) and volumetric water content (VWC) within the active layer. In August 2013, we conducted a series of GPR and probing surveys using a 500 MHz antenna and metallic probe around Barrow, Alaska. We collected about 15 km of GPR data and 1.5 km of probing data. Here, we describe the GPR data processing workflow from raw GPR data to the estimated ALT and VWC. We include the corresponding uncertainties for each measured and estimated parameter. The estimated average GPR-derived ALT was 41 cm, with a standard deviation of 9 cm. The average probed ALT was 40 cm, with a standard deviation of 12 cm. The average GPR-derived VWC was 0.65, with a standard deviation of 0.14.
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Affiliation(s)
- E. E. Jafarov
- Computational Earth SciencesLos Alamos National LaboratoryLos AlamosNMUSA
- Institute of Arctic and Alpine ResearchUniversity of Colorado at BoulderBoulderCOUSA
| | - A. D. Parsekian
- Geology and Geophysics DepartmentUniversity of WyomingLaramieWYUSA
- Department of Civil & Architectural EngineeringUniversity of WyomingLaramieWYUSA
| | - K. Schaefer
- National Snow and Ice Data CenterCooperative Institute for Research in Environmental SciencesUniversity of Colorado at BoulderBoulderCOUSA
| | - L. Liu
- Earth System Science ProgrammeFaculty of ScienceThe Chinese University of Hong KongHong KongChina
| | - A. C. Chen
- Department of GeophysicsStanford UniversityStanfordCAUSA
| | - S. K. Panda
- Geophysical InstituteUniversity of AlaskaFairbanksAKUSA
| | - T. Zhang
- College of Earth and Environmental SciencesLanzhou UniversityLanzhouChina
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9
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Bochenek M, Saar K, Marini F, Gerhold-Ay A, Huebner N, Muenzel T, Mayer E, Konstantinides S, Schaefer K. P3490Phenotypic specification of endothelial cells in chronic thromboembolic pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Bochenek M, Leidinger C, Rosinus N, Lankeit M, Mayer E, Muenzel T, Konstantinides S, Bosmann M, Schaefer K. P2586Role of endothelial transforming growth factor-beta signalling for chronic fibrotic remodelling in murine and human venous thrombosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Hobohm L, Reiss Y, Koelmel S, Munzel T, Konstantinides S, Plate K, Wenzel P, Schaefer K, Lankeit M. P176Endothelial cell-specific expression of Angiopoietin-2 leads to reduced thrombus resolution. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Huntzinger DN, Michalak AM, Schwalm C, Ciais P, King AW, Fang Y, Schaefer K, Wei Y, Cook RB, Fisher JB, Hayes D, Huang M, Ito A, Jain AK, Lei H, Lu C, Maignan F, Mao J, Parazoo N, Peng S, Poulter B, Ricciuto D, Shi X, Tian H, Wang W, Zeng N, Zhao F. Uncertainty in the response of terrestrial carbon sink to environmental drivers undermines carbon-climate feedback predictions. Sci Rep 2017; 7:4765. [PMID: 28684755 PMCID: PMC5500546 DOI: 10.1038/s41598-017-03818-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [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] [Received: 10/11/2016] [Accepted: 05/05/2017] [Indexed: 11/17/2022] Open
Abstract
Terrestrial ecosystems play a vital role in regulating the accumulation of carbon (C) in the atmosphere. Understanding the factors controlling land C uptake is critical for reducing uncertainties in projections of future climate. The relative importance of changing climate, rising atmospheric CO2, and other factors, however, remains unclear despite decades of research. Here, we use an ensemble of land models to show that models disagree on the primary driver of cumulative C uptake for 85% of vegetated land area. Disagreement is largest in model sensitivity to rising atmospheric CO2 which shows almost twice the variability in cumulative land uptake since 1901 (1 s.d. of 212.8 PgC vs. 138.5 PgC, respectively). We find that variability in CO2 and temperature sensitivity is attributable, in part, to their compensatory effects on C uptake, whereby comparable estimates of C uptake can arise by invoking different sensitivities to key environmental conditions. Conversely, divergent estimates of C uptake can occur despite being based on the same environmental sensitivities. Together, these findings imply an important limitation to the predictability of C cycling and climate under unprecedented environmental conditions. We suggest that the carbon modeling community prioritize a probabilistic multi-model approach to generate more robust C cycle projections.
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Affiliation(s)
- D N Huntzinger
- School of Earth Sciences and Environmental Sustainability, Northern Arizona University, P.O. Box 5694, Flagstaff, Arizona, 86011-5694, USA.
| | - A M Michalak
- Department of Global Ecology, Carnegie Institution for Science, Stanford, California, USA
| | - C Schwalm
- School of Earth Sciences and Environmental Sustainability, Northern Arizona University, P.O. Box 5694, Flagstaff, Arizona, 86011-5694, USA
- Woods Hole Research Center, Falmouth, MA, 02540, USA
| | - P Ciais
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL-LSCE CEA CNRS UVSQ, 91191, Gif sur, Yvette, France
| | - A W King
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - Y Fang
- Department of Global Ecology, Carnegie Institution for Science, Stanford, California, USA
| | - K Schaefer
- National Snow and Ice Data Center, Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado, USA
| | - Y Wei
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - R B Cook
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - J B Fisher
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - D Hayes
- School of Forest Resources, University of Maine, Orno, ME, USA
| | - M Huang
- Atmospheric and Global Change Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - A Ito
- National Institute for Environmental Studies, Tsukuba, Japan
| | - A K Jain
- Department of Atmospheric Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - H Lei
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, Washington, USA
- State Key Laboratory of Hydroscience and Engineering, Department of Hydraulic Engineering, Tsinghua University, Beijing, China
| | - C Lu
- Department of Ecology, Evolution and Organismal Biology, Iowa State University, Ames, IA, USA
| | - F Maignan
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL-LSCE CEA CNRS UVSQ, 91191, Gif sur, Yvette, France
| | - J Mao
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - N Parazoo
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - S Peng
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL-LSCE CEA CNRS UVSQ, 91191, Gif sur, Yvette, France
| | - B Poulter
- Department of Ecology, Montana State University, Bozeman, MT, USA
| | - D Ricciuto
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - X Shi
- Environmental Sciences Division and Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - H Tian
- International Center for Climate and Global Change Research and School of Forestry and Wildlife Sciences, Auburn University, Auburn, Alabama, USA
| | - W Wang
- Ames Research Center, National Aeronautics and Space Administration, Moffett Field, California, USA
| | - N Zeng
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, Maryland, USA
| | - F Zhao
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, Maryland, USA
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Windhager S, Bookstein FL, Millesi E, Wallner B, Schaefer K. Patterns of correlation of facial shape with physiological measurements are more integrated than patterns of correlation with ratings. Sci Rep 2017; 7:45340. [PMID: 28349947 PMCID: PMC5368612 DOI: 10.1038/srep45340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 11/22/2016] [Accepted: 02/27/2017] [Indexed: 11/30/2022] Open
Abstract
This article exploits a method recently incorporated in the geometric morphometric toolkit that complements previous approaches to quantifying the facial features associated with specific body characteristics and trait attribution during social perception. The new method differentiates more globally encoded from more locally encoded information by a summary scaling dimension that is estimated by fitting a line to the plot of log bending energy against log variance explained, partial warp by partial warp, for some sample of varying shapes. In the present context these variances come from the regressions of shape on some exogenous cause or effect of form. We work an example involving data from male faces. Here the regression slopes are steepest, and the sums of explained variances over the uniform component, partial warp 1 and partial warp 2 are greatest, for the conventional body mass index, followed by cortisol and, lastly, perceived health. This suggests that physiological characteristics may be represented at larger scale (global patterns), whereas cues in perception are of smaller scale (local patterns). Such a polarity within psychomorphospace, the global versus the focal, now has a metric by which patterns of morphology can be modeled in both biological and psychological studies.
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Affiliation(s)
- S Windhager
- Department of Anthropology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria.,Department of Theoretical Biology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria
| | - F L Bookstein
- Department of Anthropology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria.,Department of Statistics, University of Washington, Box 354322, Seattle, WA 98195-4322, USA
| | - E Millesi
- Department of Behavioural Biology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria
| | - B Wallner
- Department of Behavioural Biology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria
| | - K Schaefer
- Department of Anthropology, University of Vienna, Althanstrasse 14, 1090 Wien, Austria
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Schaefer K, Buck W, Rao M, Sharapova T, Geil R, Bodié K, Hempel K, Blomme E, Germann P. Small RNA profiling to identify potential serum biomarkers for testicular toxicity in dogs. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kappeler C, Reichardt P, Kang YK, Blay JY, Joensuu H, Schaefer K, Chung J, Wagner A, Casali P, Demetri G. O-016 Exploratory analysis of tumor growth rate in patients with advanced gastrointestinal stromal tumors (GIST) treated with regorafenib in the GRID phase 3 trial. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Saupe J, Hirschberg R, von Herrath D, Schaefer K. Long-Term Application of 1,25-Dihydroxyvitamin D3. Metabolic Disturbances in the Predialytic Phase of Chronic Renal Failure 2015. [DOI: 10.1159/000415756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Norman AW, Coburn JW, Schaefer K. Recent advances in the endocrinology of vitamin D and implications for renal failure. Contrib Nephrol 2015; 14:190-207. [PMID: 214273 DOI: 10.1159/000402360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Schaefer K, Ryzlewicz T, Sandri M, von Bernewitz S, von Herrath D. Effect of hemofiltration on acid-base status and ventilation. Contrib Nephrol 2015; 32:69-76. [PMID: 6813023 DOI: 10.1159/000406907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mazzone E, De Sanctis R, Fanelli L, Bianco F, Main M, van den Hauwe M, Ash M, de Vries R, Fagoaga Mata J, Schaefer K, D'Amico A, Colia G, Palermo C, Scoto M, Mayhew A, Eagle M, Servais L, Vigo M, Febrer A, Korinthenberg R, Jeukens M, de Viesser M, Totoescu A, Voit T, Bushby K, Muntoni F, Goemans N, Bertini E, Pane M, Mercuri E. Hammersmith Functional Motor Scale and Motor Function Measure-20 in non ambulant SMA patients. Neuromuscul Disord 2014; 24:347-52. [PMID: 24491485 DOI: 10.1016/j.nmd.2014.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 10/26/2013] [Revised: 12/12/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
The aim of this prospective longitudinal multi centric study was to evaluate the correlation between the Hammersmith Functional Motor Scale and the 20 item version of the Motor Function Measure in non ambulant SMA children and adults at baseline and over a 12 month period. Seventy-four non-ambulant patients performed both measures at baseline and 49 also had an assessment 12 month later. At baseline the scores ranged between 0 and 40 on the Hammersmith Motor function Scale and between 3 and 45 on the Motor Function Measure 20. The correlation between the two scales was 0.733. The 12 month changes ranged between -11 and 4 for the Hammersmith and between -11 and 7 for the Motor Function Measure 20. The correlation between changes was 0.48. Our results suggest that both scales provide useful information although they appeared to work differently at the two extremes of the spectrum of abilities. The Hammersmith Motor Function Scale appeared to be more suitable in strong non ambulant patients, while the Motor Function Measures appeared to be more sensitive to capture activities and possible changes in the very weak patients, including more items capturing axial and upper limb activities. The choice of these measures in clinical trials should therefore depend on inclusion criteria and magnitude of expected changes.
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Affiliation(s)
- E Mazzone
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - R De Sanctis
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - L Fanelli
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - F Bianco
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - M Main
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College, London, UK
| | - M van den Hauwe
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - M Ash
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College, London, UK
| | - R de Vries
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Fagoaga Mata
- Service of Physical Medicine and Rehabilitation, University Hospital Sant Joan de Deu, Barcelona, Spain
| | - K Schaefer
- University Medical Centre, Freiburg, Germany
| | - A D'Amico
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, and Department of Laboratory Medicine, Unit of Molecular Medicine, Bambino Gesù Hospital, Rome, Italy
| | - G Colia
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, and Department of Laboratory Medicine, Unit of Molecular Medicine, Bambino Gesù Hospital, Rome, Italy
| | - C Palermo
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - M Scoto
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College, London, UK
| | - A Mayhew
- Institute of Genetic Medicine, Newcastle Upon Tyne, UK
| | - M Eagle
- Institute of Genetic Medicine, Newcastle Upon Tyne, UK
| | - L Servais
- Institute of Myology, Groupe hospitalier La Pitié Salpétrière, Paris, France
| | - M Vigo
- Service of Physical Medicine and Rehabilitation, University Hospital Sant Joan de Deu, Barcelona, Spain
| | - A Febrer
- Service of Physical Medicine and Rehabilitation, University Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - M Jeukens
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M de Viesser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Totoescu
- Institute of Myology, Groupe hospitalier La Pitié Salpétrière, Paris, France
| | - T Voit
- Institute of Myology, Groupe hospitalier La Pitié Salpétrière, Paris, France
| | - K Bushby
- Institute of Genetic Medicine, Newcastle Upon Tyne, UK
| | - F Muntoni
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College, London, UK
| | - N Goemans
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - E Bertini
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, and Department of Laboratory Medicine, Unit of Molecular Medicine, Bambino Gesù Hospital, Rome, Italy
| | - M Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - E Mercuri
- Department of Paediatric Neurology, Catholic University, Rome, Italy.
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Lankeit M, Kuhnert K, Hovarth V, Schaefer K, Hasenfuss G, Konstantinides S, Dellas C. Long-term follow-up after acute pulmonary embolism - impact of markers of acute prognosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1147] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Czepluch FS, Vogler M, Kuschicke H, Meier J, Gogiraju R, Katschinski D, Riggert J, Hasenfuss G, Schaefer K. The transcription factor Krueppel-like factor 4 is a positive regulator of angiogenic properties in endothelial cells. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Atkinson M, Shah A, Hari K, Schaefer K, Shah A. Injury Occurrence in the Epilepsy Monitoring Unit: Psychogenic Nonepileptic Versus Epileptic Seizures (P02.160). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.160] [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] Open
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Schaefer K. The Journal Blood Purification – Reasons for Its Birth. Blood Purif 2009. [DOI: 10.1159/000166437] [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: 11/19/2022]
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27
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Schaefer K, Ritz E. Drug Therapy in Renal Failure and Dialysis -A Critical Evaluation of the Necessities. Blood Purif 2009. [DOI: 10.1159/000169393] [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: 11/19/2022]
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Tashkin DP, Donohue JF, Mahler DA, Huang H, Goodwin E, Schaefer K, Hanrahan JP, Andrews WT. Effects of arformoterol twice daily, tiotropium once daily, and their combination in patients with COPD. Respir Med 2009; 103:516-24. [PMID: 19208459 DOI: 10.1016/j.rmed.2008.12.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/17/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE Current guidelines support using in combination more than one class of long-acting bronchodilator for COPD patients whose symptoms are not controlled by mono-therapy. This 2-week, multi-center (34 sites), randomized, modified-blind, parallel group study evaluated the efficacy and safety of concomitant treatment with nebulized arformoterol (the formoterol(R,R)-isomer) BID and tiotropium DPI QD. METHODS COPD patients (mean FEV(1) 1.37L, 45.4% predicted) were randomized to receive mono-therapy (either arformoterol 15microg BID [n=76] or tiotropium 18microg QD [n=80]), or combined therapy (sequential dosing of arformoterol 15microg BID and tiotropium 18microg QD [n=78]). Changes in pulmonary function, dyspnea, and rescue levalbuterol use were evaluated, as were safety outcomes. RESULTS Mean FEV(1)AUC(0-24) (the primary endpoint) improved similarly from baseline for arformoterol (0.10L) and tiotropium (0.08L) treatment groups and greater for the combined therapy group (0.22L; all p-values <0.005). Peak FEV(1), peak FVC, 24-h trough FEV(1), and inspiratory capacity also improved similarly for the mono-therapies and greatest for the combined therapy. Dyspnea (mean transition dyspnea index) improved similarly for arformoterol (+2.3) and tiotropium (+1.8) and greatest with combined therapy (+3.1; p-values <0.05). Levalbuterol use decreased for all treatment groups (range -1.8 to -2.5 actuations/day). All treatments had similar frequency of adverse events. CONCLUSION In this study, the combination of nebulized arformoterol 15microg BID plus tiotropium 18microg DPI QD was the most effective in improving pulmonary function and disease symptoms. Mono-therapy improvement with arformoterol or tiotropium was similar. All three treatments were well tolerated.
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Affiliation(s)
- D P Tashkin
- David Geffen School of Medicine UCLA, Los Angeles, CA 90095-1690, USA.
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Jonke E, Prossinger H, Bookstein FL, Schaefer K, Bernhard M, Freudenthaler JW. Secular trends in the European male facial skull from the Migration Period to the present: a cephalometric study. Eur J Orthod 2008; 30:614-20. [DOI: 10.1093/ejo/cjn065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Henderson LW, Schaefer K. A Note from the Editors. Blood Purif 2008. [DOI: 10.1159/000169408] [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: 11/19/2022]
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von Herrath D, Hüfler M, Pauls A, Hajdú P, Schaefer K. Effect of a Calcium Infusion on the Vascular Stability during Hemodialysis. Blood Purif 2008. [DOI: 10.1159/000169306] [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: 11/19/2022]
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Rafail S, Ritis K, Schaefer K, Kourtzelis I, Speletas M, Doumas M, Giaglis S, Kambas K, Konstantinides S, Kartalis G. Leptin induces the expression of functional tissue factor in human neutrophils and peripheral blood mononuclear cells through JAK2-dependent mechanisms and TNFalpha involvement. Thromb Res 2008; 122:366-75. [PMID: 18308368 DOI: 10.1016/j.thromres.2007.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 11/08/2007] [Accepted: 12/04/2007] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Leptin is an adipocyte-derived cytokine primarily involved in the regulation of body weight and energy balance. In vivo studies suggest that leptin promotes platelet aggregation and thrombosis. Neutrophils are involved in the crosstalk between inflammation and thrombosis in clinical disorders. Leptin is also involved in the regulation of inflammation. AIM We examined the in vitro effects of leptin on the expression of tissue factor (TF), the primary initiator of coagulation, in healthy neutrophils. MATERIALS AND METHODS/RESULTS The effects on TF expression were assayed functionally using a modified prothrombin time (mPT), as well as at mRNA and protein levels. The same experiments were performed in parallel with PBMC. Leptin induced functional TF and increased TF mRNA and protein expression in both cell types, as determined by mPT, real-time RT-PCR, western blot, flow cytometry, immunocytochemistry. Inhibition studies revealed that the effect of leptin on TF expression is mediated, at least in part, by JAK2 and PI3K. Our findings, after neutralising TNFalpha in supernatants of leptin-treated cells, also suggest the involvement of TNFalpha in the leptin-induced TF expression in leukocytes. CONCLUSIONS This study indicates a novel link between inflammation, obesity and thrombosis by showing that leptin is able to trigger the extrinsic coagulation cascade. This work suggests a possible mechanism of the thrombotic effects of hyperleptinemic-associated clinical disorders.
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Affiliation(s)
- S Rafail
- First Division of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Humpert PM, Papadopoulos G, Schaefer K, Djuric Z, Konrade I, Morcos M, Nawroth PP, Bierhaus A. sRAGE and esRAGE are not associated with peripheral or autonomic neuropathy in type 2 diabetes. Horm Metab Res 2007; 39:899-902. [PMID: 18046662 DOI: 10.1055/s-2007-993155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 10/22/2022]
Abstract
The receptor for glycation end-products RAGE was previously shown to play a central role in the development of diabetic neuropathy. The present study was aimed to investigate, whether plasma levels of the soluble forms of RAGE are associated with neuropathy in type 2 diabetes. One-hundred and eight patients were screened for peripheral and autonomic diabetic neuropathy using standardized screening tests. No differences in the levels of soluble RAGE or the more defined endogenous secretory RAGE were observed in patients categorized into having no, mild, moderate, or severe deficits in the neuropathy disability or symptom score. In bivariate analysis, neither soluble RAGE nor endogenous secretory RAGE correlated with the expiration to inspiration ratio of heart rate variability. In multivariate models, the neuropathy disability score was independently associated with age (beta=0.38, p<0.01), glomerular filtration rate (beta=0.28, p<0.01) and the presence of retinopathy (beta=0.27, p<0.01), while the neuropathy symptom score was associated with age (beta=0.31, p<0.01) and fasting glucose (beta=0.24, p<0.05). The expiration to inspiration ratio of heart rate variability was associated with age (beta=-0.42, p<0.01), the body-mass-index (beta=-0.28, p<0.01) and presence of retinopathy (beta=-0.19, p<0.05). In contrast to classical risk factors, plasma soluble RAGE and endogenous secretory RAGE are not associated with measures of diabetic neuropathy in type 2 diabetes patients.
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Affiliation(s)
- P M Humpert
- Universitätsklinikum Heidelberg Medizinische Klinik 1 und Klinische Chemie, Heidelberg, Germany.
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Pearlman D, Rees W, Huang H, Schaefer K, Andrews W. AN EVALUATION OF LEVALBUTEROL HFA IN THE PREVENTION OF EXERCISE-INDUCED BRONCHOSPASM. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.163s-d] [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: 11/01/2022] Open
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Lelièvre CP, Magnani G, Ramaroson R, Gouriou F, Talbaut M, Fréjafon E, Schuermann G, Schaefer K, Cornier I, Emeis S, Vannier F, Paux E, Copalle A, Perros P. Air quality and engine emission at Paris CDG airport during AIRPUR field campaigns. ACTA ACUST UNITED AC 2006. [DOI: 10.2495/air06027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- H. Ley
- Chemisches Institut der Universität Würzburg
| | - K. Schaefer
- Chemisches Institut der Universität Würzburg
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Foss S, Schmidt JR, Andersen T, Rasmussen JJ, Damsgaard J, Schaefer K, Munck LK. Congruence on medication between patients and physicians involved in patient course. Eur J Clin Pharmacol 2004; 59:841-7. [PMID: 14685801 DOI: 10.1007/s00228-003-0708-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Accepted: 11/13/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse congruence on medication throughout patient courses, including an acute admission to a medical department. DESIGN A prospective, observational study. Data were collected from patient records in primary health care, hospital departments, from the Health Insurance database and through patient interviews. SETTING Departments of internal medicine, general practice and patients' homes. MAIN OUTCOME MEASURES Number, type and character of discrepancies between paired sources of information on patient medication at predefined time points throughout the complete patient course. Assessment of likelihood and severity of potential untoward effects of discrepancies. RESULTS Data were obtained for 75 of 99 consecutive patients included. Patients stated use of four drugs (median, range 0-17) at admission, five (0-16) at discharge and four (0-15) 1 month after discharge. At admission, 11 patients used no drugs. A median of one (0-20) to three (0-16) discrepancies per patient were identified in seven paired source comparisons with no improvement along patient course. Full agreement throughout the course was found in six patients (8%; 95% confidence interval: 3-17%). No association was found among source discrepancies and number of drugs and age. Of discrepancies, 4-13% were considered serious and likely to cause untoward effects. Discrepancies due to synonymous and analogous drugs accounted for 2-7% of the discrepancies. CONCLUSION Congruence between sources of information on medication throughout patient courses cannot be obtained with separate medication charts. Discrepancies among patient, general practitioner and hospital give rise to a definitive risk of serious untoward effects.
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Affiliation(s)
- S Foss
- Hospital Pharmacy, Roskilde County Hospital, 4000 Roskilde, Denmark.
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Abstract
1. When the current available data in the literature is summarized it becomes evident that the majority of it supports the position that it is, at least for medical reasons, not advisable to exclude patients over the age of 80 years from chronic dialysis. 2. It is correct to say that the refusal of dialysis therapy for elderly dialysis patients would lead to a not insignificant cutting of costs, although elderly patients are not as 'expensive' as younger dialysis patients. 3. The decision to exclude patients over 80 from dialysis treatment is difficult, in our opinion, to support ethically. 4. The refusal of therapy by a dialysis patient--independent of his age--can only occur with his/her consent, as long as the patient is clearly conscious of the decision. 5. Should the patient no longer be in the condition to exercise his/her autonomy, and there is no AD, the Surrogate's Court must be consulted. 6. AD can be seen as helpful, since they not only make the decisions for physicians easier, but also because they can be seen as an act of care for family members. 7. Whenever dialysis therapy is discontinued the problematic nature of so-called essential care should be carefully considered, especially if no clear position has been taken in an AD.
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Affiliation(s)
- K Schaefer
- St. Joseph-Krankenhaus, Medizinische Abteilung II, Bäumerplan 24, 12101 Berlin, Germany
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Floro MS, Schaefer K. Restructuring of labor markets in the Philippines and Zambia: the gender dimension. J Dev Areas 2002; 33:73-98. [PMID: 12322204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Schaefer K, Asmus KD. Reaction of thiols and disulfides with phosphite radicals. A chain mechanism and RS.cntdot./PO32-.cntdot. equilibrium. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j150607a024] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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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Schaefer K, Asmus KD. Phosphite radicals and their reactions. Examples of redox, substitution, and addition reactions. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100454a010] [Citation(s) in RCA: 13] [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: 11/30/2022]
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Bonifacic M, Schaefer K, Moeckel H, Asmus KD. Primary steps in the reactions of organic disulfides with hydroxyl radicals in aqueous solution. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100582a003] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [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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Ponterotto JG, Rao V, Zweig J, Rieger BP, Schaefer K, Michelakou S, Armenia C, Goldstein H. The relationship of acculturation and gender to attitudes toward counseling in Italian and Greek American college students. Cultur Divers Ethnic Minor Psychol 2001; 7:362-75. [PMID: 11759272 DOI: 10.1037/1099-9809.7.4.362] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This exploratory study examined attitudes toward professional psychological services and help provider characteristics among 232 self-identified Italian and Greek American college students in 3 Northeast colleges. Regarding general attitudes toward psychological services in the Italian American sample, women had a greater recognition of personal need for help and higher confidence in the ability of mental health professionals to meet these needs than did men. With regard to preferred counselor demographic characteristics, regardless of gender, lower acculturated Italian American students had a stronger preference for seeing an ethnically similar counselor. With the Greek American sample, there was an interaction effect between acculturation level and gender on attitudes toward services. Among the higher acculturated Greek students, women were more open regarding their personal concerns than men; however, within the lower acculturated cohort, no gender differences were found. With regard to counselor characteristic variables, and similar to Italian Americans, regardless of gender, lower acculturated Greek Americans had a stronger preference for seeing an ethnically similar counselor to discuss a personal problem. Limitations and implications for further research are noted.
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Affiliation(s)
- J G Ponterotto
- Psychological and Educational Services, Fordham University-Lincoln Center, 113 West 60th Street, New York, New York 10023-7484, USA.
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Valliant JF, Riddoch RW, Dolovich M, Chirakal R, Hong Y, Bakale RP, Wald SA, Schaefer K. Two approaches for the syntheis of carbon-11 labeled (R) and (S)-albuterol. J Labelled Comp Radiopharm 2001. [DOI: 10.1002/jlcr.2580440147] [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: 11/05/2022]
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Damsgaard JJ, Schaefer K, Michelsen JW, Frimodt-Møller N, Munck AP, Vach K, Kragstrup J. [Antibiotic treatment of infections in general practice. Effect of audit assessed by prescriptions data from health insurance registry and physicians' own registration]. Ugeskr Laeger 2001; 163:165-8. [PMID: 11379242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The aim was to study whether an audit of treatment of infections in general practice resulted in changed prescribing habits. In 1995-1996 forty-six general practitioners (GP's) from the County of Roskilde participated in an audit regarding infectious diseases (incl. course participation and preparation of treatment guidelines). The effect evaluation was done on the basis of 1) two self-registrations of antibiotic prescriptions carried out with one year's interval, and 2) prescribing data from the National Insurance database collected over two periods, before the first and second self-registration respectively. The number of patients not receiving antibiotics increased significantly from 47.2% to 52.4% after intervention. The self-registration did not show any change in choice of antibiotics, while the registry data showed a shift from broad-spectrum to narrow-spectrum penicillin. This change was, however, also found among the GP's, who did not participate in the audit. The study demonstrated that audit can result in changes in prescribing patterns, but at the same time emphasizes the need for inclusion of external data sources and control groups in the evaluation of intervention effects.
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