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Adams D, Wolfe AJ, Warren J, Laberge A, Richards AC, Herzer K, Fleisher LA. Initial Findings From an Acute Hospital Care at Home Waiver Initiative. JAMA Health Forum 2023; 4:e233667. [PMID: 37921747 PMCID: PMC10625041 DOI: 10.1001/jamahealthforum.2023.3667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
This cohort study assesses outcomes of patients treated during the initial 16 months of the Centers for Medicare & Medicaid Services Acute Hospital Care at Home initiative.
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Affiliation(s)
- Danielle Adams
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Dallas, Texas
| | - Ashby J. Wolfe
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Seattle, Washington
| | - Jessica Warren
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Alexandre Laberge
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Adam C. Richards
- Clinical Standards Group, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Kurt Herzer
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Lee A. Fleisher
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland
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2
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Pereira-Lima K, Plegue MA, Case B, Swenor BK, Herzer K, Betchkal R, Meeks LM. Prevalence of Disability and Use of Accommodation Among US Allopathic Medical School Students Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2318310. [PMID: 37314809 DOI: 10.1001/jamanetworkopen.2023.18310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
| | - Melissa A Plegue
- Susan B. Meister Child Health Evaluation and Research Center, Department of General Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Ben Case
- Meeks Research Lab, University of Michigan Medical School, Ann Arbor
| | | | - Kurt Herzer
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rylee Betchkal
- Meeks Research Lab, University of Michigan Medical School, Ann Arbor
| | - Lisa M Meeks
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Center for Disability Health and Wellness, University of Michigan Medical School, Ann Arbor
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Sonnenfeld N, Li J, Lichtenfeld J, Shang K, Herzer K, Flemming R, Yu P, Monteiro A, McGann P, Fleisher L. Centers for Medicare and Medicaid's
Qin‐Qio
Targeted Response Intervention Associated with Reductions in
COVID
‐19 Incidence in Nursing Homes. Health Serv Res 2021. [PMCID: PMC8441493 DOI: 10.1111/1475-6773.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Research Objective In 2020 COVID‐19 became the leading cause of death in the United States,[1] with nursing home (NH) residents accounting for approximately 40% of all COVID‐19 deaths.[2] To help NHs combat COVID‐19, the Centers for Medicare and Medicaid Services (CMS) directed targeted response (TR) interventions through its twelve Quality Improvement Network – Quality Improvement Organization (QIN‐QIOs) contractors. TR involves focused onsite and/or virtual one‐on‐one technical assistance to nursing homes. For COVID‐19 TR, the most common QIN‐QIO‐reported activities include: assistance with developing and implementing policies and improved processes for hand hygiene, ensuring availability and proper use of personal protective equipment, and general infection control. CMS’ criteria to refer NHs for QIN‐QIO assistance varied over the entire study period as the program evolved. At various times, these criteria included: infection control‐related health inspection deficiencies, NHs located in counties designated as geographic hot spots, having 30 or more new COVID‐19 cases in the past week. NH participation in TR is voluntary and free‐of‐charge. The objective of this study was to assess TR impact on COVID‐19 incidence in NHs. Study Design We used a quasi‐experimental observational design. NHs may have started receiving TR any time between April 24, and October 28, 2020. COVID‐19 incidence data were obtained for May 31 through November 29, 2020 from the National Healthcare Safety Network. Each program NH was matched at the time of first QIN‐QIO interaction with a similar non‐TR NH. Matching characteristics were: overall NH star rating, health inspections star rating, bed size, state, area deprivation index, and county‐level COVID incidence in the month of and the month prior to first receipt of TR. We used longitudinal regression models in the period following first QIN‐QIO interaction to compare COVID‐19 incidence between NHs that received TR to matched controls that did not. Generalized estimating equations with a Poisson distribution and log‐link were used to model COVID‐19 incidence, TR status and a full set of covariates. Population Studied CMS‐certified NHs providing short‐stay, long‐stay, or both types of care. Principal Findings Among the 2474 NHs that received TR in the study period, 2013 were matched to 2013 similar NHs that did not. Depending on the month, COVID‐19 incidence after matching was similar or higher in the TR group at baseline, but all other covariates were balanced. In this preliminary analysis, NHs receiving TR had 27.7% (p‐value <0.0001, 95% CI: 17.2%–36.9%) lowered COVID‐19 incidence compared to similar NHs that did not receive TR. Effect estimates withstood early sensitivity analyses. Conclusions The TR intervention was associated with a decline in COVID‐19 incidence in TR NHs relative to non‐TR NHs. Future analyses will explore which aspects of TR and QIN‐QIOs may have been most effective and the attributes of nursing homes that demonstrated improvement. Implications for Policy or Practice Deploying TR for quality improvement in NHs in real‐time demonstrated a relative improvement in infection control. CMS should consider expanding TR to a broader range of outcomes. In addition, we must continue to conduct real‐time evaluation of the QIN‐QIO program as the tools and technologies evolve to prevent infections and other negative outcomes in facilities. Primary Funding Source Centers for Medicare and Medicaid Services.
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Affiliation(s)
- Nancy Sonnenfeld
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
| | - Jiaqi Li
- Booz Allen Hamilton Washington District of Columbia USA
| | | | - Kevin Shang
- Booz Allen Hamilton Washington District of Columbia USA
| | - Kurt Herzer
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
| | - Robert Flemming
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
| | - Ping Yu
- Booz Allen Hamilton Washington District of Columbia USA
| | - Anita Monteiro
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
| | - Paul McGann
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
| | - Lee Fleisher
- Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services Baltimore Maryland USA
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Abstract
This survey study assesses the prevalence of students with disabilities and types of accomodation provided at US allopathic medical schools in 2019, and compares the numbers with those of a 2016 survey to characterize 3-year changes.
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Affiliation(s)
- Lisa M. Meeks
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Ben Case
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Kurt Herzer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
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5
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Affiliation(s)
- Lisa M Meeks
- Assistant professor, University of Michigan Medical School, Ann Arbor, Michigan; . Doctoral candidate, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand. Director, Health, Oscar Health, New York, New York
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Abstract
UNLABELLED Nearly one-fifth of the U.S. population has a disability, and many of these Americans experience disparities in the health care they receive. In part, these health care disparities result from a lack of understanding about disability by health care providers. The education of physicians is grounded in a biomedical model that emphasizes pathology, impairment, or dysfunction, rather than a social model of disability that focuses on removing barriers for individuals with disabilities and improving their capabilities. According to a recent report, only 2.7% of medical students disclosed having disabilities-far fewer than the proportion of people with disabilities in the U.S. POPULATION Including students and other trainees with disabilities-those with lived experiences of disability who can empathize with patients and serve as an example for their peers-in medical education is one mechanism to address the health care disparities faced by individuals with disabilities. At present, medical students and residents with disabilities face structural barriers related to policies and procedures, clinical accommodations, disability and wellness support services, and the physical environment. Additionally, many face cultural barriers related to the overarching attitudes, beliefs, and values prevalent at their medical school. In this Commentary, the authors review the state of disability in medical education and training, summarize key findings from an Association of American Medical Colleges special report on disability, and discuss considerations for medical educators to improve inclusion, including emerging technologies that can enhance access for students with disabilities.
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Affiliation(s)
- Lisa M Meeks
- L.M. Meeks is co-principal investigator, Lived Experience Project, faculty member, Department of Family Medicine, and clinician scholar, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3647-3657. K. Herzer is physician-scientist, Oscar Health, New York, New York. N.R. Jain is co-principal investigator, Lived Experience Project, and doctoral candidate, University of Auckland, Faculty of Education and Social Work, School of Curriculum and Pedagogy, Auckland, New Zealand; ORCID: https://orcid.org/0000-0002-2931-2740
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Mark L, Lester L, Cover R, Herzer K. A Decade of Difficult Airway Response Team: Lessons Learned from a Hospital-Wide Difficult Airway Response Team Program. Crit Care Clin 2018; 34:239-251. [PMID: 29482903 DOI: 10.1016/j.ccc.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A decade ago the Difficult Airway Response Team (DART) program was created at The Johns Hopkins Hospital as a multidisciplinary effort to address airway-related adverse events in the nonoperative setting. Root cause analysis of prior events indicated that a major factor in adverse patient outcomes was lack of a systematic approach for responding to difficult airway patients in an emergency. The DART program encompasses operational, safety, and educational initiatives and has responded to approximately 1000 events since its initiation, with no resultant adult airway-related adverse events or morbidity. This article provides lessons learned and recommendations for initiating a DART program.
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Affiliation(s)
- Lynette Mark
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Difficult Airway Response Team (DART) Program, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine Multidisciplinary Airway Programs, Difficult Airway Response Team (DART) Program, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Laeben Lester
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Emergency Medicine, Johns Hopkins Medicine Multidisciplinary Airway Programs, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Renee Cover
- Johns Hopkins Health System Legal Department, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Kurt Herzer
- Oscar Health, 219 Withers Street, Brooklyn, NY 11211, USA
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Imdad A, Mayo‐Wilson E, Herzer K, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev 2017; 3:CD008524. [PMID: 28282701 PMCID: PMC6464706 DOI: 10.1002/14651858.cd008524.pub3] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence. OBJECTIVES To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. SEARCH METHODS In March 2016 we searched CENTRAL, Ovid MEDLINE, Embase, six other databases, and two trials registers. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS For this update, two reviewers independently assessed studies for inclusion and abstracted data, resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We identified 47 studies (4 of which are new to this review), involving approximately 1,223,856 children. Studies took place in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most of the studies included equal numbers of girls and boys and lasted about a year. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for vitamin A compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-quality evidence). This result was sensitive to choice of model, and a random-effects meta-analysis showed a different summary estimate (24% reduction: RR 0.76, 95% CI 0.66 to 0.88); however, the confidence intervals overlapped with that of the fixed-effect model. Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 participants; high-quality evidence). There was no significant effect for VAS on mortality due to measles, respiratory disease, and meningitis. VAS reduced incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies; 77,946 participants; low-quality evidence) and measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies; 19,566 participants; moderate-quality evidence). However, there was no significant effect on incidence of respiratory disease or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies; 10,541 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS Vitamin A supplementation is associated with a clinically meaningful reduction in morbidity and mortality in children. Therefore, we suggest maintaining the policy of universal supplementation for children under five years of age in populations at risk of VAD. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented vitamin A deficiency, it would be unethical to conduct placebo-controlled trials.
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Affiliation(s)
- Aamer Imdad
- Vanderbilt University School of MedicineDepartment of Pediatrics, D. Brent Polk Division of Gastroenterology, Hepatology and NutritionNashvilleTNUSA37212
| | - Evan Mayo‐Wilson
- Johns Hopkins University Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe StreetBaltimoreMarylandUSA21205
| | - Kurt Herzer
- Johns Hopkins School of MedicineTower 711600 North Wolfe St.BaltimoreMDUSA21287
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCentre for Global Child HealthTorontoONCanadaM5G A04
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Piras-Straub K, Bachmann H, Bedreli S, Khairzada K, Müller J, Paul A, Gerken G, Herzer K. Der SNP3099 im mTOR Gen ist prädiktiv für die Verträglichkeit und Wirkung von Everolimus nach Lebertransplantation. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597468] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Piras-Straub
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - H Bachmann
- Universitätsklinikum Essen, Institut für Pharmakogenetik, Essen, Deutschland
| | - S Bedreli
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - K Khairzada
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - J Müller
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - A Paul
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Essen, Deutschland
| | - G Gerken
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - K Herzer
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Essen, Deutschland
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10
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Bedreli S, Rashidi J, Willuweit K, Piras-Straub K, Khairzada K, Gerken G, Paul A, Herzer K. 3 Jahre Real-Life Essener Erfahrungen einer Everolimus-basierten Immunsuppression nach Lebertransplantation. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597382] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Bedreli
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - J Rashidi
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirugie, Essen, Deutschland
| | - K Willuweit
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - K Piras-Straub
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - K Khairzada
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - G Gerken
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Deutschland
| | - A Paul
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirugie, Essen, Deutschland
| | - K Herzer
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirugie, Essen, Deutschland
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Rashidi-Alavijeh J, Heinold A, Willuweit K, Baba HA, Horn PA, Paul A, Witzke O, Gerken G, Herzer K. Diagnostics and treatment of a severe humoral rejection after liver transplantation: donor-specific antibodies as a still underestimated cause of graft failure. Z Gastroenterol 2016; 54:647-52. [PMID: 27429102 DOI: 10.1055/s-0042-108212] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Donor-specific antibodies (DSAs) are increasingly being considered a cause of complications after liver transplant (LT). However, neither monitoring of DSAs nor the appropriate therapeutic procedures for humoral graft damage are yet standardized. Here we report a case of DSA-positive humoral rejection after LT that was successfully treated with plasmapheresis and immunoglobulins. METHODS Human leukocyte antigen (HLA)-specific DSAs were detected by Luminex bead assay. Patient characteristics, laboratory values, and data about the patient's general condition were documented from April 2013 to June 2015. CASE REPORT Eighteen months after LT, a 54-year-old man experienced severe hepatopathy with rapidly increasing transaminase activity and total bilirubin levels. Histologic findings were inconclusive, demonstrating chronic cholestasis and minimal positive staining for C4 d. However, an analysis for anti-HLA antibodies detected DSAs against HLA class II molecules with high mean fluorescence intensity. The patient underwent 8 courses of plasmapheresis, resulting in sustained amelioration of his condition and decreases in bilirubin levels and transaminase activity. CONCLUSION De novo DSAs can be responsible for graft failure after LT. Thus, procedures aimed at detecting DSAs are recommended, and regular monitoring of DSAs after LT is important for individualized risk management. Plasmapheresis is an efficient therapeutic procedure for DSA-associated graft failure.
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Affiliation(s)
- J Rashidi-Alavijeh
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - A Heinold
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Germany
| | - K Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - H A Baba
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - P A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Germany
| | - O Witzke
- Department of Infectious Diseases and Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - G Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - K Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany
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Zimmermann T, Beckebaum S, Berg C, Berg T, Braun F, Eurich D, Herzer K, Neumann U, Rupp C, Sterneck M, Strassburg C, Welker MW, Zachoval R, Gotthardt DN, Weigand K, Schmidt H, Wedemeyer H, Galle PR, Zeuzem S, Sarrazin C. [Expert recommendations: Hepatitis C and transplantation]. Z Gastroenterol 2016; 54:665-84. [PMID: 27429106 DOI: 10.1055/s-0042-107360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the approval of new direct acting antiviral agents (DAA), therapeutic options for patients with chronic hepatitis C virus (HCV) infection are now generally available before and after liver transplantation (LT). Interferon-free DAA regimens are highly effective therapies and provide a good safety profile. However, the body of clinical evidence in this patient population is limited and the best treatment strategies for patients on the waiting list with (de)compensated cirrhosis and after LT are not well defined. The following recommendations for antiviral therapy in the context of LT are based on the currently available literature and clinical experience of experts in the field, and have been discussed in an expert meeting. The aim of this article is to guide clinicians in the decision making when treating patients before and after LT with DAAs.
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Affiliation(s)
- T Zimmermann
- I. Med. Klinik und Poliklinik, Universitätsmedizin Mainz
| | - S Beckebaum
- Klinik für Transplantationsmedizin, Universitätsklinikum Münster
| | - C Berg
- Abteilung Innere Medizin I, Universitätsklinikum Tübingen
| | - T Berg
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig
| | - F Braun
- Transplantationszentrum, Universitätsklinikum Schleswig-Holstein, Kiel
| | - D Eurich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin
| | - K Herzer
- Klinik für Gastroenterologie und Hepatologie/Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen
| | - U Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Fakultät, RWTH Aachen
| | - C Rupp
- Abteilung Innere Medizin IV, Universitätsklinikum Heidelberg
| | - M Sterneck
- Klinik und Poliklinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - C Strassburg
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn
| | - M-W Welker
- Med. Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - R Zachoval
- Transplantationszentrum München der LMU, München
| | - D N Gotthardt
- Abteilung Innere Medizin IV, Universitätsklinikum Heidelberg
| | - K Weigand
- Innere Medizin I, Universitätsklinikum Regensburg
| | - H Schmidt
- Klinik für Transplantationsmedizin, Universitätsklinikum Münster
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover
| | - P R Galle
- I. Med. Klinik und Poliklinik, Universitätsmedizin Mainz
| | - S Zeuzem
- Med. Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - C Sarrazin
- Med. Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main
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Martinez EA, Shore A, Colantuoni E, Herzer K, Thompson DA, Gurses AP, Marsteller JA, Bauer L, Goeschel CA, Cleary K, Pronovost PJ, Pham JC. Cardiac surgery errors: results from the UK National Reporting and Learning System. Int J Qual Health Care 2014. [DOI: 10.1093/intqhc/mzr023] [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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Herzer K, Papadopoulos-Köhn A, Timm J, Paul A, Jochum C, Gerken G. [HCV reinfection after liver transplantation - management and first experiences with telaprevir-based triple therapy]. Dtsch Med Wochenschr 2013; 138:1759-64. [PMID: 24002874 DOI: 10.1055/s-0033-1349494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The management of hepatitis C virus (HCV) recurrence after liver transplantation (LTx) is a major challenge in patient care. For patients with HCV GT1, treatment standard with pegylated interferon (PEG-IFN) and ribavirin (RBV) has been augmented in 2011 by first generation protease inhibitors (PI), telaprevir (TVR) and boceprevir (BOC). We report our first experiences with TVR-based triple therapy in patients with GT1-reinfection of the graft. PATIENTS AND METHOD 13 patients with histologically proven HCV GT1-reinfection of the graft received 12 weeks of PEG-IFN/RBV/TVR followed by 12 weeks of PEG-IFN/ RBV only. During the triple therapy phase immune suppression was tightly monitored, and the patients were also closely monitored for side effects. RESULTS The dosage of immunosuppressants had to be reduced significantly (TAC: 30-fold; CSA 3,5-fold). Stable levels were achieved by daily or over-daily dosing of a special size application of 0,1 mg tacrolimus (Tac) bid or a minimal dose of 10 mg cyclosporine (CSA) bid or qd, respectively. In all patients hematological side effects were observed, 65 % of which required RBV dose reduction, administration of erythropoietin or blood transfusions. Increase of kidney retention values requiring infusions occurred in 50 %. All side effects were reversible. There were no early discontinuations of therapy. An early viral response (EVR) with viral decline below limit of detection was noted at week 12 in 9/13 patients and at week 12 in further 3 patients. CONCLUSION Our preliminary results show high EVR response rates of TVR-based triple therapy in LTx patients with HCV-GT1 re-infection.
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Affiliation(s)
- K Herzer
- Klinik für Gastroenterologie und Hepatologie, Medizinisches Zentrum, Universitätsklinikum Essen.
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Hintemann C, Straub K, Biesterfeld S, Galle PR, Erthle J, Gerken G, Canbay A, Herzer K. Nuclear proteins in primary biliary cirrhosis as guardians against HCC development. Z Gastroenterol 2013. [DOI: 10.1055/s-0032-1332068] [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: 10/27/2022]
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Herzer K, Müller S, Antoch G, Hilgard P. Locoregional therapy for hepatocellular carcinoma: radioembolization with yttrium-90 microspheres. MINERVA GASTROENTERO 2011; 57:287-298. [PMID: 21769078] [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: 05/31/2023]
Abstract
Compared with other malignant tumours, hepatocellular carcinoma (HCC) exhibits particular characteristics regarding its supplying vessels and tumour biology. If a potentially curative surgical approach, such as resection or liver transplantation, is due to technical or prognostical reasons no option, these characteristics are a fundamental prerequisite for the possibility to effectively treat this tumour by local ablation methods. Microsphere and particle technology with selective transport of tumoricidal substances or radiation represents a new generation of therapeutics in interventional oncology. With the intrahepatic application of radioactive microspheres via the hepatic artery (radioembolization) local ablation can be performed even of diffuse and multifocal liver tumours, which hitherto, could only be approached with systemic therapy. The present standard for radioembolization, is the use of yttrium-90 glass or resin microspheres. The indications, technique and current results of radioembolization with yttrium-90 microspheres for the treatment of HCC are discussed in this review.
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Affiliation(s)
- K Herzer
- Department for Internal Medicine and Gastroenterology, Academic Teaching Hospital EVK, Germany
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Mayo-Wilson E, Imdad A, Herzer K, Yakoob MY, Bhutta ZA. Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. BMJ 2011; 343:d5094. [PMID: 21868478 PMCID: PMC3162042 DOI: 10.1136/bmj.d5094] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine if vitamin A supplementation is associated with reductions in mortality and morbidity in children aged 6 months to 5 years. DESIGN Systematic review and meta-analysis. Two reviewers independently assessed studies for inclusion. Data were double extracted; discrepancies were resolved by discussion. Meta-analyses were performed for mortality, illness, vision, and side effects. DATA SOURCES Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, Embase, Global Health, Latin American and Caribbean Health Sciences, metaRegister of Controlled Trials, and African Index Medicus. Databases were searched to April 2010 without restriction by language or publication status. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised trials of synthetic oral vitamin A supplements in children aged 6 months to 5 years. Studies of children with current illness (such as diarrhoea, measles, and HIV), studies of children in hospital, and studies of food fortification or β carotene were excluded. RESULTS 43 trials with about 215,633 children were included. Seventeen trials including 194,483 participants reported a 24% reduction in all cause mortality (rate ratio=0.76, 95% confidence interval 0.69 to 0.83). Seven trials reported a 28% reduction in mortality associated with diarrhoea (0.72, 0.57 to 0.91). Vitamin A supplementation was associated with a reduced incidence of diarrhoea (0.85, 0.82 to 0.87) and measles (0.50, 0.37 to 0.67) and a reduced prevalence of vision problems, including night blindness (0.32, 0.21 to 0.50) and xerophthalmia (0.31, 0.22 to 0.45). Three trials reported an increased risk of vomiting within the first 48 hours of supplementation (2.75, 1.81 to 4.19). CONCLUSIONS Vitamin A supplementation is associated with large reductions in mortality, morbidity, and vision problems in a range of settings, and these results cannot be explained by bias. Further placebo controlled trials of vitamin A supplementation in children between 6 and 59 months of age are not required. However, there is a need for further studies comparing different doses and delivery mechanisms (for example, fortification). Until other sources are available, vitamin A supplements should be given to all children at risk of deficiency, particularly in low and middle income countries.
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Affiliation(s)
- Evan Mayo-Wilson
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
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Martinez EA, Shore A, Colantuoni E, Herzer K, Thompson DA, Gurses AP, Marsteller JA, Bauer L, Goeschel CA, Cleary K, Pronovost PJ, Pham JC. Cardiac surgery errors: results from the UK National Reporting and Learning System. Int J Qual Health Care 2011; 23:151-8. [DOI: 10.1093/intqhc/mzq084] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev 2010:CD008524. [PMID: 21154399 DOI: 10.1002/14651858.cd008524.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [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: 01/31/2023]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low and middle income countries affecting 190 million children under 5. VAD can lead to many adverse health consequences, including death. OBJECTIVES To evaluate the effect of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged 6 months to 5 years. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010 Issue 2), MEDLINE (1950 to April Week 2 2010), EMBASE (1980 to 2010 Week 16), Global Health (1973 to March 2010), Latin American and Caribbean Health Sciences (LILACS), metaRegister of Controlled Trials and African Index Medicus (27 April 2010). SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster RCTs evaluating the effect of synthetic VAS in children aged 6 months to 5 years living in the community. We excluded studies concerned with children in hospital and children with disease or infection. We excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. Data were double abstracted and discrepancies were resolved by discussion. Meta-analyses were performed for outcomes including all-cause and cause-specific mortality, disease, vision, and side-effects. MAIN RESULTS 43 trials involving 215,633 children were included. A meta-analysis for all-cause mortality included 17 trials comprising 194,795 children with 3536 deaths in both groups. At follow-up, there was a 24% observed reduction in the risk of all-cause mortality for Vitamin A compared with Control (Relative risk (RR) = 0.76 [95% confidence interval (CI) 0.69, 0.83]). Seven trials reported diarrhoea mortality and a 28% overall reduction for VAS (RR = 0.72 [0.57, 0.91]). There was no significant effect of VAS on cause specific mortality of measles, respiratory disease and meningitis. VAS reduced incidence of diarrhoea (RR = 0.85 [0.82, 0.87]) and measles morbidity (RR = 0.50 [0.37, 0.67]); however, there was no significant effect on incidence of respiratory disease or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR = 2.75 [1.81, 4.19]). AUTHORS' CONCLUSIONS VAS is effective in reducing all-cause mortality by about 24% compared to no treatment. In our opinion, given the evidence that VAS causes considerable reduction in child mortality, further placebo-controlled trials of VAS in children between 6 months and 5 years of age are not required. There is a need for further studies comparing different doses and delivery mechanisms (for example, fortification).
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Affiliation(s)
- Aamer Imdad
- Division of Women and Child Health, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan, 74800
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Kneiseler G, Herzer K, Marggraf G, Gerken G, Canbay A. Die Interaktion zwischen Leber und Herz. Z Herz- Thorax- Gefäßchir 2010. [DOI: 10.1007/s00398-010-0803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Feller-Kopman DJ, Herzer K, Rodriguez-Paz J, Mark L. USING SIMULATION AND LEAN SIX SIGMA TO DECREASE RISK WHEN STARTING A PROGRAM IN INTERVENTIONAL PULMONOLOGY. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p15004] [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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Abstract
Viral hepatitis is a diffuse inflammatory reaction of the liver caused by hepatotropic viruses. Among the hepatitis viruses, only hepatitis B virus and hepatitis C virus are able to persist in the host and cause chronic hepatitis. In the course of persistent infection, inflammation forms the pathogenetic basis of chronic hepatitis that can lead to nodular fibrosis, which can progress to cirrhosis and, eventually, hepatocellular carcinoma (HCC). Of the different antiviral defense systems employed by the host, apoptosis significantly contributes to the prevention of viral replication, dissemination, and persistence. Pathomorphologic studies have shown acidophilic bodies and hepatocyte dropout, features that are compatible with apoptosis. The number of hepatocytes showing features of apoptosis in patients with chronic hepatitis B and C was found to be higher than in healthy subjects, indicating that apoptosis is involved in the pathogenesis of these diseases. There are various data suggesting that hepatitis B and C viral proteins may modulate apoptosis. Vice versa, mechanisms of apoptosis inhibition might represent central survival strategies employed by the virus which, in the end, may contribute to HCC development. While the expression and retention of viral proteins in hepatocytes may influence the severity and progression of liver disease, the mechanisms of liver injury in viral hepatitis are defined to be due not only to the direct cytopathic effects of viruses, but also to the host immune response to viral proteins expressed by infected hepatocytes. However, the exact role of these observations in relation to pathogenesis remains to be established. The mechanism and systems are complex. This report aims to provide an overview and intends to cite only a small number of pertinent references.
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Affiliation(s)
- K Herzer
- Deptartment I of Internal Medicine, Mainz University, Mainz, Germany.
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Zhang C, Kolb A, Mattern J, Gassler N, Wenger T, Herzer K, Debatin KM, Büchler M, Friess H, Rittgen W, Edler L, Herr I. Dexamethasone desensitizes hepatocellular and colorectal tumours toward cytotoxic therapy. Cancer Lett 2005; 242:104-11. [PMID: 16338063 DOI: 10.1016/j.canlet.2005.10.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 08/08/2005] [Revised: 10/25/2005] [Accepted: 10/26/2005] [Indexed: 01/05/2023]
Abstract
The glucocorticoid dexamethasone is frequently used as co-treatment in cytotoxic cancer therapy, e.g. to prevent nausea, to protect normal tissue or for other reasons. While the potent pro-apoptotic properties and the supportive effects of glucocorticoids to tumour therapy in lymphoid cells are well studied, the impact to cytotoxic treatment of colorectal and hepatocellular carcinoma is unknown. We tested apoptosis-induction, viability, tumour growth and protein expression using 8 established cell lines, 18 surgical specimen and a xenograft on nude mice. In the presence of dexamethasone we found strong inhibition of apoptosis in response to 5-FU, cisplatin, gemcitabine or gamma-irradiation, enhanced viability and tumour growth of colorectal and hepatocellular carcinomas. No correlation with age, gender, histology, TNM, the p53 status and induction of therapy resistance by dexamethasone co-treatment could be detected. These data show that glucocorticoid-induced resistance occurs not occasionally but is common in colorectal and hepatocellular carcinomas implicating that the use of glucocorticoids may be harmful for cancer patients.
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Affiliation(s)
- C Zhang
- Molecular Urooncology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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Blaukat A, Herzer K, Schroeder C, Bachmann M, Nash N, Müller-Esterl W. Overexpression and functional characterization of kinin receptors reveal subtype-specific phosphorylation. Biochemistry 1999; 38:1300-9. [PMID: 9930991 DOI: 10.1021/bi981727r] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
G protein-coupled receptors such as the receptors for bradykinin are present in low copy numbers in most natural cells. To overcome the problems associated with the analysis of these receptors at the protein level, we used highly efficient expression systems such as the baculovirus/insect cell system. However, the structural and functional statuses of recombinant receptors have often remained elusive. We have expressed the two types of human kinin receptors, B1 and B2, in Sf9 cells. Both receptors are found on the surface of infected cells where they display the same pharmacological profiles as their cognate receptors of native cells. The functional analysis of kinin receptors coupled to the intracellular signaling pathways of Sf9 cells revealed differential patterns of ligand-induced phosphorylation for the two kinin receptors. The B1 receptor failed to undergo ligand-induced phosphorylation. However the B2 receptor showed selective phosphorylation of a minor 38 kDa band and lack of phosphorylation of a dominant 33 kDa band, indicating that only a fraction of the receptor protein is functionally linked to the kinase pathway. A striking discrepancy between the number of binding sites and the amount of receptor protein per cell (molar ratio of 1:20 to 1:1000) indicated that a significant portion of kinin receptors is associated with the intracellular compartments of Sf9 cells. Pulse-chase and immunoprecipitation experiments demonstrated that the heterogeneity of recombinant receptors is not due to proteolytic processing but likely reflects incomplete or lacking N-glycosylation. We conclude that the baculovirus/Sf9 system is suitable for the recombinant expression and functional analysis of kinin receptors though limitations of the system have to be considered.
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Affiliation(s)
- A Blaukat
- Institute of Physiological Chemistry and Pathobiochemistry, University of Mainz, Duesbergweg 6, D-55099 Mainz, Germany
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Abstract
Clients' characteristics associated with outcome of group counseling were identified in a sample of physically disabled persons using standardized self-report inventories. 60 subjects were tested before and after an 8-wk. treatment interval for signs of emotional disorder, inactivity, and social problems related to being severely disabled. Treatment consisted of group conference phone calls using self-determined task assignments as a focus for discussion. Loneliness accounted for 68% of the variance in post-treatment life-satisfaction scores. Signs of depression and available social support were also significant predictors. Remarkably lonely persons showed significant decreases in signs of loneliness after treatment. Using regression analysis, persons with adjustment problems could be identified and prognosis for treatment predicted with acceptable reliability.
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Lück J, Schwepper D, Both A, Haerten K, Herzer K, Loogen F. [Complications after prosthetic heart valve replacement (author's transl)]. Z Kardiol 1977; 66:436-42. [PMID: 899146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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