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Mausbach S, van Spankeren T, Hudel H, Schirotzik I, Viard M, Struffert T, Kaps M. TCCD Fusion Imaging to Estimate Intracranial Pressure and Tissue Displacement with Large Hemispheric Infarction. Neurocrit Care 2024; 40:562-567. [PMID: 37415022 DOI: 10.1007/s12028-023-01784-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Despite breakthroughs in stroke treatment, some patients still experience large infarctions of the cerebral hemispheres resulting in mass effect and tissue displacement. The evolution of mass effect is currently monitored using serial computed tomography (CT) imaging. However, there are patients who are ineligible for transport, and there are limited options for bedside monitoring of unilateral tissue shift. METHODS We used fusion imaging for overlaying transcranial color duplex with CT angiography. This method allows overlay of live ultrasound on top of CT or magnetic resonance imaging scans. Patients with large hemispheric infarctions were eligible to participate. Position data from the source files were used and matched with live imaging and correlation to magnetic probes on the patient's forehead and ultrasound probe. Shift of cerebral parenchyma, displacement of the anterior cerebral arteries, basilary artery and third ventricle were analyzed, as well as pressure on the midbrain, and the displacement of the basilar artery on the head were analyzed. Patients received multiple examinations in addition to standard care of treatment with CT imaging. RESULTS The sensitivity for diagnosing a shift of 3 mm with fusion imaging was 100%, with a specificity of 95%. No side effects or interactions with critical care equipment were recorded. CONCLUSIONS Fusion imaging is an easy method to access and acquire measurements for critical care patients and follow-up of tissue and vascular displacement after stroke. Fusion imaging may be a decisive support for indicating hemicraniectomy.
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Affiliation(s)
- Stefan Mausbach
- Department of Neurology and Neurocritical Care Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
- , Shmuel Bait Street, 9103102, Jerusalem, Israel.
| | - Teresa van Spankeren
- Department of Neurology, Justus-Liebig University Hospital Giessen, Giessen, Germany
| | - Helge Hudel
- Institute for Medical Informatics, Justus-Liebig University Hospital Giessen, Giessen, Germany
| | - Ingo Schirotzik
- Department of Neurology, Justus-Liebig University Hospital Giessen, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, Justus-Liebig University Hospital Giessen, Giessen, Germany
| | - Tobias Struffert
- Department for Neuroradiology, Justus-Liebig University Hospital Giessen, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig University Hospital Giessen, Giessen, Germany
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Castro P, Ferreira J, Malojcic B, Bazadona D, Baracchini C, Pieroni A, Skoloudik D, Azevedo E, Kaps M. Detection of microemboli in patients with acute ischaemic stroke and atrial fibrillation suggests poor functional outcome. Eur Stroke J 2023:23969873231220508. [PMID: 38149620 DOI: 10.1177/23969873231220508] [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] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. PATIENTS AND METHODS This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. RESULTS Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04. CONCLUSIONS Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).
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Affiliation(s)
- Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculty of Medicine of University of Porto, Porto, Portugal
| | - J Ferreira
- UnIC@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Branko Malojcic
- Department of Neurology, Hospital Centre Zagreb, Zagreb, Croatia
| | - Danira Bazadona
- Department of Neurology, Hospital Centre Zagreb, Zagreb, Croatia
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, University of Padua School of Medicine, Padova. Italy
| | - Alessio Pieroni
- Stroke Unit and Neurosonology Laboratory, University of Padua School of Medicine, Padova. Italy
| | - David Skoloudik
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Portugal
| | - Manfred Kaps
- Justus-Liebig-University Giessen, Giessen, Germany
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Okada C, Kaps M, Walter I, Gautier C, Aurich J, Aurich C. 84 Low plasma progestogen concentration during the early luteal phase delays endometrial development and the beginning of placentation in mares. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab84] [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: 12/11/2022] Open
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Long-term outcomes of stroke unit care in older stroke patients: a retrospective cohort study. Age Ageing 2022; 51:6691374. [PMID: 36057988 DOI: 10.1093/ageing/afac197] [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: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older patients are less frequently treated in stroke units (SUs). Clinicians do not seem convinced that older patients benefit from specialised treatment in SU similarly to younger patients. OBJECTIVE our study aimed to compare older patients' long-term outcomes with and without SU treatment. METHODS this study used routinely collected health data of 232,447 patients admitted to hospitals in Germany between 2007 and 2017 who were diagnosed with ischaemic stroke (ICD 10 I63). The sample included 29,885 patients aged ≥90 years. The outcomes analysed were 10-, 30- and 90-day, and 1-, 3- and 5-year mortality and the combinations of death or recurrence, inpatient treatment and increase in long-term care needs. Bivariate chi-square tests and multivariable logistic regression analyses were used, adjusting for the covariates age, sex, co-morbidity, long-term care needs before stroke and socioeconomic status of the patients' region of origin. RESULTS between 2007 and 2017, 57.1% of patients aged <90 years and 49.6% of those aged ≥90 years were treated in a SU. The 1-year mortality rate of ≥90-year-olds was 56.9 and 61.9% with and without SU treatment, respectively. The multivariable-adjusted risk of death in ≥90-year-olds with SU treatment was odds ratio (OR) = 0.67 (95% confidence interval [CI] = 0.62-0.73) 10 days after the initial event and OR = 0.76 (95% CI = 0.71-0.82) 3 years after stroke. CONCLUSIONS even very old patients with stroke benefit from SU treatment in the short and long term. Therefore, SU treatment should be the norm even in older patients.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westphalian-Wilhelms-University of Muenster, 48149 Münster, Germany
| | | | - Christian Günster
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Patrik Dröge
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
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Valaikiene J, Schlachetzki F, Azevedo E, Kaps M, Lochner P, Katsanos AH, Walter U, Baracchini C, Bartels E, Školoudík D. Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group. Ultraschall Med 2022; 43:354-366. [PMID: 35512836 DOI: 10.1055/a-1816-8548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the last decade, ultrasound examination in neurology has been undergoing a significant expansion of its modalities. In parallel, there is an increasing demand for rapid and high-quality diagnostics in various acute diseases in the prehospital setting, the emergency room, intensive care unit, and during surgical or interventional procedures. Due to the growing need for rapid answers to clinical questions, there is particular demand for diagnostic ultrasound imaging. The Neuro-POCUS working group, a joint project by the European Academy of Neurology Scientific Panel Neurosonology, the European Society of Neurosonology and Cerebral Hemodynamics, and the European Reference Centers in Neurosonology (EAN SPN/ESNCH/ERcNsono Neuro-POCUS working group), was given the task of creating a concept for point-of-care ultrasound in neurology called "Neuro-POCUS". We introduce here a new ultrasound examination concept called point-of-care ultrasound in neurology (Neuro-POCUS) designed to streamline conclusive imaging outside of the ultrasound center, directly at the bedside. The aim of this study is to encourage neurologists to add quick and disease-oriented Neuro-POCUS to accompany the patient in the critical phase as an adjunct not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive neurosonology examination. Another goal is to avoid unwanted complications during imaging-free periods, ultimately resulting in advantages for the patient.
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Affiliation(s)
- Jurgita Valaikiene
- Center of Neurology, Clinic of Neurology and Neurosurgery, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, medbo Bezirksklinikum Regensburg, University of Regensburg, Germany
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manfred Kaps
- Neurology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padova, Italy
| | - Eva Bartels
- Neurology, Center for Neurological Vascular Diagnostics, Munich, Germany
| | - David Školoudík
- Center for Health Research, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
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Kaps M, Lutzer A, Gautier C, Nagel C, Aurich J, Aurich C. Altrenogest treatment reduces the stress response of three-year-old warmblood mares during their initial equestrian training. Domest Anim Endocrinol 2022; 80:106728. [PMID: 35421809 DOI: 10.1016/j.domaniend.2022.106728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
Horse mares are frequently treated with the progestin altrenogest with the aim to suppress estrous behavior and its negative impact on equestrian performance. Progestogens, however, also have sedative effects in males, and females of different species. The aim of our study was therefore to investigate altrenogest-induced changes in the stress response of female horses during initial equestrian training. Three-yr-old Warmblood mares were randomly assigned to treatment with altrenogest (ALT; 0.044 mg/kg once daily; n = 6) or sunflower oil (CON; n = 5) for 12 wk during training. At predefined steps of the training program (free movement, lunging without and with side reins, lunging with saddle, mounting of a rider, free riding, riding by an unfamiliar rider) salivary cortisol concentration, and heart rate were determined from 60 min before to 120 min after training. The same procedures were performed during repeated gynecologic examinations and 2 novel object tests. Bodyweight and body condition scores (BCS) were assessed at 4-wk intervals. During all training units, salivary cortisol concentration and heart rate increased (P < 0.001), but the increase was smaller in group ALT mares (time x treatment P < 0.001). Gynecologic examinations and novel object tests induced a much smaller increase in cortisol and heart rate (P < 0.001) than equestrian training with no difference between groups ALT and CON. Initially, bodyweight, and BCS decreased during training. The subsequent increase was larger in group ALT vs CON (time x treatment P < 0.05). In conclusion, altrenogest reduced the stress response of 3-yr-old mares to equestrian training. The use of altrenogest during equestrian competitions should therefore be reconsidered.
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Affiliation(s)
- M Kaps
- Department for Small Animals and Horses, Artificial Insemination and Embryo Transfer, Vetmeduni Vienna, Veterinärplatz 1, 1210, Vienna, Austria
| | - Anne Lutzer
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Hauptgestüt 10, 16845, Neustadt (Dosse), Germany
| | - C Gautier
- Department for Small Animals and Horses, Artificial Insemination and Embryo Transfer, Vetmeduni Vienna, Veterinärplatz 1, 1210, Vienna, Austria
| | - C Nagel
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Hauptgestüt 10, 16845, Neustadt (Dosse), Germany
| | - J Aurich
- Department for Small Animals and Horses, Gynecology, Obstetrics and Andrology, Vetmeduni Vienna, Veterinärplatz 1, 1210, Vienna, Austria
| | - C Aurich
- Department for Small Animals and Horses, Artificial Insemination and Embryo Transfer, Vetmeduni Vienna, Veterinärplatz 1, 1210, Vienna, Austria; Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Hauptgestüt 10, 16845, Neustadt (Dosse), Germany.
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Kaps M, Okada CTC, Gautier CM, Aurich J, Aurich C. Increased AMH plasma concentration and small antral follicles - Deslorelin slow release implants as a promising tool for preparation of mares for OPU? J Equine Vet Sci 2022. [DOI: 10.1016/j.jevs.2022.103972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ebbeler D, Schneider M, Busse O, Berger K, Dröge P, Günster C, Kaps M, Misselwitz B, Timmesfeld N, Geraedts M. Spezialisierung der Schlaganfallversorgung in Deutschland:
Strukturveränderungen im Zeitraum von 2006–2017. Gesundheitswesen 2021; 85:242-249. [PMID: 34942663 DOI: 10.1055/a-1690-6786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zusammenfassung
Hintergrund Um die Schlaganfallversorgung zu optimieren, wurden in
Deutschland in den letzten Jahren verschiedene
qualitätsfördernde Maßnahmen (qfM) in regional
unterschiedlichem Maß eingeführt. Ob sich diese
Maßnahmen über die Jahre flächendeckend etabliert
haben, ist unklar.
Methode Für die strukturbezogenen Analysen der Schlaganfallversorgung
in Deutschland wurden alle relevanten dokumentierten Schlaganfälle
(ICD-10) aus den Qualitätsberichten (QB) deutscher
Krankenhäuser und eine repräsentative Stichprobe von
Krankenversicherungsdaten (AOK) im Zeitraum von 2006 (QB)/2007 (AOK)
bis 2017 verwendet. Diese Informationen wurden u. a. durch Angaben
zu zertifizierten Stroke Units der Deutschen Schlaganfall-Gesellschaft (DSG)
und Daten zur Führung von regionalen Schlaganfall-Registern der
Arbeitsgemeinschaft Deutschsprachiger Schlaganfall-Register (ADSR)
ergänzt. Zur Verfolgung der Veränderungen des
Versor-gungsgeschehens im deutschen Bundesgebiet wurden die Daten mit
geografischen Daten (Bundesamt für Kartographie und
Geodäsie) verknüpft. Es erfolgten univariate Analysen der
Daten und eine Trend-Analyse der verschiedenen qfM im Jahresverlauf
(Konkordanzkoeffizient nach Kendall).
Ergebnisse Die QB Analysen zeigten einen Anstieg kodierter
Schlaganfälle in Krankenhäusern mit qfM um
14–20%. In 2006 wurden 80% der Schlaganfälle
(QB) in einem Krankenhaus mit min. einer qfM kodiert, in 2017 95%.
Diese Entwicklungen spiegelten sich auch in den AOK-Routinedaten wider,
wobei in 2007 89% und in 2017 97% der Patient:innen unter
mindestens einer qfM behandelt wurden. Dabei waren in 2007 bei 55%
der behandelnden Krankenhäuser qfM vorhanden, in 2017 bei
72%.
Schlussfolgerung Patient:innen werden inzwischen signifikant häufiger
in Krankenhäusern mit Spezialisierung auf die Schlaganfallversorgung
behandelt. Auch die verschiedenen qfM haben sich im Laufe der Jahre im
gesamten Bundesgebet verbreitet, jedoch existieren noch
Versorgungslücken, die geschlossen werden sollten, damit in Zukunft
alle Patient:innen qualitativ hochwertig behandelt werden
können.
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Affiliation(s)
- Dijana Ebbeler
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Michael Schneider
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Otto Busse
- Deutsche Schlaganfall-Gesellschaft e.V., Berlin,
Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin,
Westfälische Wilhelms- Universität Münster, Medizinische
Fakultät, Münster, Deutschland
| | - Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Manfred Kaps
- Neurologische Klinik, Universitätsklinikum
Gießen/Marburg, Justus-Liebig-Universität
Gießen, Gießen, Deutschland
| | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH),
Hessische Krankenhausgesellschaft e. V. Eschborn,
Deutschland
| | - Nina Timmesfeld
- Abteilung für Medizinische Informatik, Biometrie und
Epidemiologie, Ruhr-Universität Bochum, Medizinische Fakultät,
Bochum, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Quality Assurance Measures and Mortality After Stroke. Dtsch Arztebl Int 2021; 118:857-863. [PMID: 34730084 PMCID: PMC8948340 DOI: 10.3238/arztebl.m2021.0339] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality assurance for acute in-hospital care in Germany is based on compulsory comparisons between institutions, so-called external quality assurance (EQA). The effectiveness of EQA has not yet been adequately studied. The purpose of the QUASCH project, which is supported by the Innovation Fund of the Federal Joint Committee, is to investigate the association between EQA and health care outcomes, specifically with respect to stroke. METHODS The analyses were based on data from 379 825 patients insured by the AOK health insurance fund who were acutely admitted to a hospital because of stroke over the period 2007-2017. Data on 47 659 patients were derived from EQA documentation in the state of Hesse, in which stroke EQA had already been introduced in 2003; data on the remaining 332 166 patients were from other federal states, where 117 734 of these patients had been treated under EQA conditions. The association of EQA with mortality over the period of observation was analyzed by multivariate Cox regression, with the following covariates: age, sex, comorbidities, time period of occurrence, nursing care level, type of stroke, socio-economic deprivation in the region of origin, and treatment in a stroke unit. RESULTS Compared to treatment without EQA, mortality risk under EQA in the state of Hesse was significantly lower (hazard ratio [HR]: 0.93; 95% confidence interval: [0.92; 0.95]). The reduction in mortality risk with EQA was somewhat lower in the other federal states (HR: 0.96 [0.95; 0.97]). Treatment in a stroke unit was associated with a mortality risk that was lower still (HR: 0.86 [0.85; 0.87]). Mortality risk rose with age, comorbidities, and need for nursing care; it was lower in women and in persons whose stroke occurred in a later period. CONCLUSION Quality assurance measures are associated with lower mortality risk after stroke. The concentration of care in specially qualified institutions is associated with stronger effects than EQA alone.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr University Bochum
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus Liebig University of Giessen
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Medical Faculty, Westphalian Wilhelms University of Münster
| | | | - Christian Günster
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Patrik Dröge
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
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Bulinski C, Viard M, Vlazak A, Habig K, Juenemann M, Best C, Schirotzek I, Kaps M, Krämer HH. Neuromuscular sonography detects changes in muscle echotexture and nerve diameter in ICU patients within 24 h. J Ultrasound 2021; 25:535-545. [PMID: 34870825 PMCID: PMC9402876 DOI: 10.1007/s40477-021-00621-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/25/2021] [Indexed: 11/03/2022] Open
Abstract
Purpose During an ICU stay, changes in muscles and nerves occur that is accessible via neuromuscular sonography. Methods 17 patients recruited from the neurological and neurosurgical ICU (six women; 66 ± 3 years) and 7 healthy controls (three women, 75 ± 3 years) were included. Muscle sonography (rectus abdominis, biceps, rectus femoris and tibialis anterior muscles) using gray-scale values (GSVs), and nerve ultrasound (peroneal, tibial and sural nerves) analyzing the cross-sectional area (CSA) were performed on days 1 (t1), 3 (t2), 5 (t3), 8 (t4), and 16 (t5) after admission. Results Time course analysis revealed that GSVs were significantly higher within the patient group for all of the investigated muscles (rectus abdominis: F = 7.536; p = 0.011; biceps: F = 14.761; p = 0.001; rectus femoris: F = 9.455; p = 0.005; tibialis anterior: F = 7.282; p = 0.012). The higher GSVs were already visible at t1 or, at the latest, at t2 (tibialis anterior muscles). CSA was enlarged in all of the investigated nerves in the patient group (peroneal nerve: F = 7.129; p = 0.014; tibial nerve: F = 28.976, p < 0.001; sural nerve: F = 13.051; p = 0.001). The changes were visible very early (tibial nerve: t1; peroneal nerve: t2). The CSA of the motor nerves showed an association with the ventilation time and days within the ICU (t1 through t4; p < 0.05). Discussion We detected very early changes in the muscles and nerves of ICU-patients. Nerve CSA might be a useful parameter to identify patients who are at risk for difficult weaning. Therefore our observations might be severity signs of neuromuscular suffering for the most severe patients.
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Affiliation(s)
- Catherine Bulinski
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Alexander Vlazak
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Kathrin Habig
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Christoph Best
- Department of Neurology, Phillipps University, Baldingerstrasse 1, Marburg, Germany
| | - Ingo Schirotzek
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Heidrun H Krämer
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
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Braun T, Sünner L, Hachenberger M, Müller C, Wietelmann A, Juenemann M, Pons-Kühnemann J, Kaps M, Gerriets T, Tschernatsch M, Roth J, Yenigün M. Microbubble-mediated sonothrombolysis with BR38 of a venous full blood thrombus in a rat embolic stroke model. Ann Transl Med 2021; 9:1061. [PMID: 34422973 PMCID: PMC8339866 DOI: 10.21037/atm-21-75] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
Background Early recanalization of an occluded vessel is associated with a better clinical outcome in acute ischemic stroke. Intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is only available in a minority of patients and often fails to reopen the occluded vessel. Mechanical recanalization is more effective in this matter but only available for selected patients when a thrombectomy centre can be reached. Therefore, sonothrombolysis might represent an alternative or complementary approach. Here, we tested microbubble-mediated sonothrombolysis (mmSTL) in a thromboembolic stroke model for middle cerebral artery occlusion (MCAO) in rats. Methods Sixty-seven male Wistar rats underwent MCAO using an autologous full blood thrombus and were randomly assigned to four groups receiving rt-PA, mmSTL, a combination of both, or a placebo. Diagnostic workup included neurological examination, assessment of infarct size, and presence of intracerebral haemorrhage by magnetic resonance imaging (MRI) and presence of microbleedings in histological staining. Results Neurological examination revealed no differences between the treatment groups. In all treatment groups, there was a reduction in infarct size 24 hours after MCAO as compared to the placebo (P≤0.05), but there were no differences between the active treatment groups (P>0.05) (placebo 0.75±0.10 cm3; mmSTL 0.43±0.07 cm3; rt-PA 0.4±0.07 cm3; mmSTL + rt-PA 0.27±0.08 cm3). Histological staining displayed intracerebral microbleedings in all animals. The frequency of gross bleeding detected by MRI did not differ between the groups (placebo 3; mmSTL 4; rt-PA 2; mmSTL + rt-PA 2; P>0.05) and was not associated with worse performance in clinical testing (P>0.05). There were no statistical differences in the mortality between the groups (P>0.05). Conclusions Our study showed the efficacy and safety of mmSTL with or without rt-PA in an embolic rat stroke model using a continuous full blood thrombus. Sonothrombolysis might be useful for patients who need to be transported to a thrombectomy centre or for those with distal vessel occlusion.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Laura Sünner
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Maaike Hachenberger
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Clemens Müller
- Department of Radiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Astrid Wietelmann
- Scientific Service Group Magnetic Resonance Imaging, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Martin Juenemann
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Jörn Pons-Kühnemann
- Institute of Medical Informatics, Department of Medical Statistics, Justus-Liebig-University, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany
| | - Tibo Gerriets
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
| | - Joachim Roth
- Department of Veterinarian Physiology and Biochemistry, Justus-Liebig-University, Giessen, Germany
| | - Mesut Yenigün
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
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12
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Boss EG, Bohmann FO, Misselwitz B, Kaps M, Neumann-Haefelin T, Pfeilschifter W, Kurka N. Quality assurance data for regional drip-and-ship strategies- gearing up the transfer process. Neurol Res Pract 2021; 3:38. [PMID: 34334134 PMCID: PMC8327429 DOI: 10.1186/s42466-021-00136-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke patients with large vessel occlusion (LVO) require endovascular therapy (EVT) provided by comprehensive stroke centers (CSC). One strategy to achieve fast stroke symptom 'onset to treatment' times (OTT) is the preclinical selection of patients with severe stroke for direct transport to CSC. Another is the optimization of interhospital transfer workflow. Our aim was to investigate the dynamics of the OTT of 'drip-and-ship' patients as well as the current 'door-in-door-out' time (DIDO) and its determinants at representative regional German stroke units. METHODS We determined the numbers of all EVT treatments, 'drip-and-ship' and 'direct-to-center' patients and their median OTT from the mandatory quality assurance registry of the federal state of Hesse, Germany (2012-2019). Additionally, we captured process time stamps from primary stroke centers (PSC) in a consecutive registry of patients referred for EVT in our regional stroke network over a 3 months period. RESULTS Along with an increase of the EVT rate, the proportion of drip-and-ship patients grew steadily from 19.4% in 2012 to 31.3% in 2019. The time discrepancy for the median OTT between 'drip-and-ship' and 'direct-to-center' patients continuously declined from 173 to 74 min. The largest share of the DIDO (median 92, IQR 69-110) is spent with the organization of EVT and consecutive patient transfer. CONCLUSIONS 'Drip-and-ship' patients are an important and growing proportion of stroke patients undergoing EVT. The discrepancy in OTT for EVT between 'drip-and-ship' and 'direct-to-center' patients has been reduced considerably. Further optimization of the DIDO primarily aiming at the processes after the detection of LVO is urgently needed to improve stroke patient care.
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Affiliation(s)
- Erendira G Boss
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.
| | | | | | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
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Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. Methods This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). Results 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21–3.30; OROFF 3.18, 95% CI 3.04–3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9–47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6–79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
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Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany. .,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
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14
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Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Mausbach S, Doerr JM, Schirotzek I, Prosiegel M, Schramm P, Kaps M, Tanislav C. Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients' oral diet. Int J Speech Lang Pathol 2021; 23:83-91. [PMID: 32245331 DOI: 10.1080/17549507.2020.1744727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation. METHOD FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy. RESULT This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake. CONCLUSION As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients' oral diet. This knowledge might contribute to lower mortality and morbidity.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Marco Meyer
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Siegen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Stefan Mausbach
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Johanna M Doerr
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Ingo Schirotzek
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mario Prosiegel
- Faculty of Languages and Literatures, Department I, Ludwig-Maximilians-University (LMU), Munich, Germany, and
| | - Patrick Schramm
- Department of Anaesthesiology, University Hospital Mainz, Mainz, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Siegen, Germany
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15
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Kaps M, Okada CTC, Gautier C, Aurich J, Scarlet D, Kuhl J, Aurich C. Transient suppression of ovulatory ovarian function in pony mares after treatment with slow-release deslorelin implants. Domest Anim Endocrinol 2021; 74:106505. [PMID: 32846375 DOI: 10.1016/j.domaniend.2020.106505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Behavior during the estrous cycle of mares can affect their performance and therefore inhibition of cyclical ovarian activity is indicated. We hypothesized that implants containing the GnRH analog deslorelin downregulate GnRH receptors and inhibit ovulation in mares. The estrous cycles of Shetland mares were synchronized with 2 injections of a PGF2α analog. One day after the second injection (day 0), mares received 9.4 (group D1, n = 6) and 4.7 mg deslorelin (D2, n = 5) as slow-release implants or 1.25 mg short-acting deslorelin as a control (C, n = 5). Ultrasonography of the reproductive tract and ovaries and observation of estrous behavior and collection of blood samples for analysis of progesterone and LH concentrations were performed every second day until day 10 and thereafter at 5-d intervals. Stimulation tests with the GnRH-agonist buserelin were performed on days 10 and 45. Until day 50, there were less spontaneous ovulations in group D1 (P < 0.01) and estrous behavior was reduced in groups D1 and D2 compared with group C (P < 0.05). The time until first ovulation (D1 62.0 ± 8.6, D2 44.2 ± 14.1, C 22.2 ± 3.1 d, P < 0.05) and the number of days with estrous behavior (P < 0.05) differed among groups. On day 10 after treatment, a GnRH stimulation test revealed interactions between group and time (P < 0.001) in plasma LH concentration that were no longer detectable on day 45 after treatment. In conclusion, long-acting deslorelin implants result in a transient downregulation of pituitary GnRH receptors that is associated with inhibition of ovulation and estrous behavior in Shetland mares.
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Affiliation(s)
- M Kaps
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - C T C Okada
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - C Gautier
- Gynecology, Obstetrics and Andrology, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - J Aurich
- Gynecology, Obstetrics and Andrology, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - D Scarlet
- Gynecology, Obstetrics and Andrology, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - J Kuhl
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria
| | - C Aurich
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Veterinärplatz 1, 1210 Vienna, Austria.
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16
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Braun T, Juenemann M, Dornes K, El-Shazly J, Schramm P, Bick-Ackerschott S, Kaps M, Gerriets T, Blaes F, Tschernatsch M. BAFF serum and CSF levels in patients with multiple sclerosis and infectious nervous system diseases. Int J Neurosci 2020; 131:1231-1236. [PMID: 32602764 DOI: 10.1080/00207454.2020.1784167] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Multiple sclerosis (MS) is the most common immune-mediated CNS disease, characterised by demyelination and progressive neurological disability. The B-cell activating factor BAFF has been described as one important factor in the pathophysiology of different autoimmune diseases.Methods: We measured BAFF levels in the serum and cerebrospinal fluid (CSF) in 50 consecutive patients with MS and 35 patients with infectious CNS disease (ID). 52 patients with other, non-inflammatory disorders (OND), served as controls.Results: BAFF-serum levels in ID patients were higher than in patients diagnosed with MS (ID 0.55 ± 0.24 ng/ml, MS 0.43 ± 0.14 ng/ml, OND 0.45 ± 0.24 ng/ml; p = 0.09). Interestingly, MS patients had lower BAFF CSF levels compared to the controls and ID patients, and the CSF levels in the latter were elevated compared to those of the controls (MS 0.17 ± 0.11 ng/ml, OND 0.25 ± 0.14 ng/ml, ID 0.97 ± 0.78 ng/ml; p < 0.001).Conclusions: The ID patients' having higher absolute BAFF levels in the CSF than in the serum indicates that the increased BAFF CSF levels were caused by intrathecal synthesis rather than passive transfer via a disturbed blood-brain-barrier. The significantly decreased BAFF CSF levels in MS patients were a surprising result of our study. Although it has been reported that astrocytes in active MS lesions can express BAFF, the soluble form was not increased in the CSF of MS patients. It remains unclear whether the inflammatory features of active MS plaques are truly represented by the CSF compartment.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Martin Juenemann
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Kathrin Dornes
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany
| | - Jasmin El-Shazly
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Patrick Schramm
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | | | - Manfred Kaps
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany
| | - Tibo Gerriets
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
| | - Franz Blaes
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Department of Neurology, Klinikum Oberberg, Gummersbach, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
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Hasseli R, Fürst MM, Singh P, Müller-Ladner U, Kaps M, Blaes F, Gerriets T, Tschernatsch M. AB0157 IGG FROM PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND SYSTEMIC SCLEROSIS HAVE AN INFLUENCE ON COAGULATION FACTORS IN HUMAN CEREBRAL MICROVASCULAR ENDOTHELIAL CELLS IN-VITRO. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Endothelial cells from the microvasculature (hBMEC) of the brain show significant morphological and functional differences compared to EC from other anatomical areas. They are characterized by tight junctions, are not fenestrated and show less active transport mechanisms. On the other hand, the mitochondrial density is relatively high in hBMEC due to the high cerebral glucose metabolism.It could be already observed that interferon-α from SLE-sera induces the expression of MHC class I molecules on human dermal microendothelial cell line, but it is not known whether this also occurs on hBMEC. hBMECs can synthesize pro-inflammatory cytokines and chemokines such as IL-1β, but in lower concentrations than human umbilical vein endothelial cells.Patients suffering from systemic lupus erythematosus (SLE) or systemic sclerosis (SSc) show a wide spectrum of central nervous symptoms. Both, SLE and SSc, are characterised by different autoantibodies and endothelial vascular damage, especially in microvessels. 10-40% of patients with SLE suffer from lupus vasculopathy. Vascular dysfunction is one of the earliest pathological changes in SSc. Anti-endothelial autoantibodies (AECA) appear in SLE as well as in SSc and other connective tissue diseases. Research within the last years revealed that AECA play a critical role within the vascular pathogenesis of SLE and SSc. So far there is no evidence that AECA bind to hBMEC and it is not clear whether they have an effect on this special endothelial class.Objectives:In this project, we investigated if autoantibodies against hBMEC are detectable in SLE and SSc patients and if they have an influence on the activation of the endothelium by inducing adhesion molecules and on haemostasis by inducing factors of the clotting cascade.Methods:HiTrap Protein G HP antibody purification columns were used to purify IgG antibodies. Flow cytometry was used for analysis of autoantibodies against human cerebral microvascular endothelial cell line (hCMEC/D3). 26 sera of patients with SLE and 29 sera of patients with SSc were tested for presence of autoantibodies against hCMEC/D3. To analyse in vitro effects on hCMEC/D3, we measured changes in the expression of the following surface proteins: ICAM-1, VCAM-1, MHC class I and II, tissue factor, von-Willebrand-Factor, E-Selectin, P-Selectin, Thrombomodulin, CD73 and t-PA, each before and after three- and 24-hours incubation with IgG-fractions. IgG fractions of 12 SLE patients, 13 SSc patients and 13 healthy control persons (HC) were tested.Results:Autoantibodies against hCMEC/D3 were found in 21 of 26 patients with SLE (81%) and in 19 of 29 patients with SSc (66%) (p > 0.05) but not in healthy donors. After three hours incubation of hCMEC/D3 IgG-fractions, an upregulation of tissue factor by SSc-IgG (6.7% ± 5.2%) compared to HC-IgG (1.1% ± 2.8%, p < 0.01) and to SLE-IgG (1.6% ± 3.9%, p < 0.05), was detectable.There was no significant correlation between changes in surface protein expression and detection of ANA or of anti-hCMEC/D3 antibodies (p > 0.05).No change in expression of ICAM-1, VCAM-1, MHC class I and II, von-Willebrand-Factor, E-Selectin, P-Selectin, Thrombomodulin, CD73 and t-PA could be detected after incubation with IgG-fractions.Conclusion:Both, patients with SLE and patients with SSc showed autoantibodies against hBMEC. IgG fractions of patients with SSc, but not with SLE, induced an upregulation of tissue factor on the cell surface of hCMEC/D3. This could be an indicator for a direct pathogenic effect of AECA on hBMEC and might have an influence on haemostasis by activating the clotting cascade. Inhibition of these antibodies could reduce cerebral involvement of SSc.References:[1]Weksler BB, Subileau EA, Perriere N, et al. Blood-brain barrier-specific properties of a human adult brain endothelial cell line. Faseb J 2005;19:1872-1874.Disclosure of Interests:Rebecca Hasseli: None declared, Magdalena Maria Fürst: None declared, Pratibha Singh: None declared, Ulf Müller-Ladner Speakers bureau: Biogen, Manfred Kaps: None declared, Franz Blaes: None declared, Tibo Gerriets: None declared, Marlene Tschernatsch: None declared
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Juenemann M, Braun T, Schleicher N, Yeniguen M, Schramm P, Gerriets T, Ritschel N, Bachmann G, Obert M, Schoenburg M, Kaps M, Tschernatsch M. Neuroprotective mechanisms of erythropoietin in a rat stroke model. Transl Neurosci 2020; 11:48-59. [PMID: 33312715 PMCID: PMC7702138 DOI: 10.1515/tnsci-2020-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study was designed to investigate the indirect neuroprotective properties of recombinant human erythropoietin (rhEPO) pretreatment in a rat model of transient middle cerebral artery occlusion (MCAO). Methods One hundred and ten male Wistar rats were randomly assigned to four groups receiving either 5,000 IU/kg rhEPO intravenously or saline 15 minutes prior to MCAO and bilateral craniectomy or sham craniectomy. Bilateral craniectomy aimed at elimination of the space-consuming effect of postischemic edema. Diagnostic workup included neurological examination, assessment of infarct size and cerebral edema by magnetic resonance imaging, wet–dry technique, and quantification of hemispheric and local cerebral blood flow (CBF) by flat-panel volumetric computed tomography. Results In the absence of craniectomy, EPO pretreatment led to a significant reduction in infarct volume (34.83 ± 9.84% vs. 25.28 ± 7.03%; p = 0.022) and midline shift (0.114 ± 0.023 cm vs. 0.083 ± 0.027 cm; p = 0.013). We observed a significant increase in regional CBF in cortical areas of the ischemic infarct (72.29 ± 24.00% vs. 105.53 ± 33.10%; p = 0.043) but not the whole hemispheres. Infarct size-independent parameters could not demonstrate a statistically significant reduction in cerebral edema with EPO treatment. Conclusions Single-dose pretreatment with rhEPO 5,000 IU/kg significantly reduces ischemic lesion volume and increases local CBF in penumbral areas of ischemia 24 h after transient MCAO in rats. Data suggest indirect neuroprotection from edema and the resultant pressure-reducing and blood flow-increasing effects mediated by EPO.
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Affiliation(s)
- Martin Juenemann
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Tobias Braun
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Nadine Schleicher
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Mesut Yeniguen
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Patrick Schramm
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Tibo Gerriets
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
| | - Nouha Ritschel
- Max-Planck-Institute for Heart and Lung Research, Ludwigstraße 43, 61231, Bad Nauheim, Germany
| | - Georg Bachmann
- Department of Radiology, Kerckhoff Clinic, 61231, Bad Nauheim, Germany
| | - Martin Obert
- Department of Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Markus Schoenburg
- Department of Cardiac Surgery, Kerckhoff Clinic, 61231, Bad Nauheim, Germany
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
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19
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Zöllner JP, Konczalla J, Stein M, Roth C, Krakow K, Kaps M, Steinmetz H, Rosenow F, Misselwitz B, Strzelczyk A. Acute symptomatic seizures in intracerebral and subarachnoid hemorrhage: A population study of 19,331 patients. Epilepsy Res 2020; 161:106286. [PMID: 32065924 DOI: 10.1016/j.eplepsyres.2020.106286] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Received: 10/13/2019] [Revised: 01/07/2020] [Accepted: 02/04/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Risk factors for acute symptomatic seizures after stroke demonstrated in retrospective analyses should be confirmed in large population studies. While seizures following ischemic stroke have been studied intensively, less is known about seizure predictors in hemorrhagic stroke. This study sought to identify risk factors of acute symptomatic seizures and to elucidate associated short-term (in-hospital) morbidity and mortality rates in primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS We determined the frequency of all acute symptomatic seizures perceived by clinical staff after hemorrhagic stroke in a large population-based registry in a central European region between 2004 and 2016. Further, we analyzed risk factors for seizure occurrence, morbidity, and mortality in univariate and multivariate analyses. RESULTS Of 297,120 stroke patients, 19,331 experienced a hemorrhagic stroke. Frequency of acute seizures (without semiological differentiation) in this subpopulation was 4% (4.0% in ICH and 3.6% in SAH). The risk for acute symptomatic seizures was significantly increased in both stroke types in the presence of an acute non-neurological infection (odds ratio: 2.0 for ICH and 4.2 for SAH). A lower premorbid functional level also significantly increased the seizure risk (odds ratio: 2.0 for ICH and 3.1 for SAH). The odds of in-hospital mortality in the presence of acute seizures were significantly reduced in ICH patients (odds ratio: 0.7) but not in SAH patients. CONCLUSION Acute symptomatic seizures are equally common in ICH and SAH patients in this registry. Seizure risk is invariably increased in the presence of acute non-neurological infection. Mortality is reduced in ICH patients with seizures, but the exact reason for this relationship is not clear and might represent a biased finding.
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Affiliation(s)
- Johann Philipp Zöllner
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany
| | - Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany
| | - Karsten Krakow
- Asklepios Neurologische Klinik Falkenstein, Königstein-Falkenstein, Germany
| | - Manfred Kaps
- Department of Neurology, Justus Liebig University Giessen, Giessen, Germany
| | - Helmuth Steinmetz
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany
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Kaps M, Gautier C, Cardoso Okada C, Kuhl J, Aurich J, Aurich C. 157 Effect of a slow-release gonadotrophin-releasing hormone analogue on ovarian activity and oestrous behaviour in mares. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oestrus behaviour in mares can contribute to problems in their handleability and reduced performance in equestrian sports. Therefore, methods of transient suppression of oestrous cyclicity in mares are of interest. The aim of our study was to determine whether treatment of mares with slow-release implants containing the gonadotrophin-releasing hormone (GnRH) analogue deslorelin downregulates pituitary GnRH receptors and reduces ovarian function and oestrous behaviour. Shetland mares (age=11.0±1.4 years; bodyweight=185.5±7kg) were oestrous synchronised with two injections of the prostaglandin F2α analogue luprostiol (3.725mg) at an interval of 12 days. One day after the second injection (Day 0), mares were randomly assigned to three groups: slow-release implant with 9.4mg of deslorelin (Suprelorin, Virbac; group D1; n=6), implant with 4.7mg of deslorelin (group D2; n=5), and intramuscular injection of 1.25mg of short-acting deslorelin (control, group C; n=5). Collection of blood samples for analysis of progesterone, LH, and anti-Müllerian hormone (AMH) using established and validated enzyme immunoassays (Scarlet et al. 2018 Theriogenology 117, 72-77), testing for oestrus-like behaviour with a Shetland stallion, and ultrasonography of the genital tract were performed at 2-day intervals until Day 10 after treatment and at 5-day intervals from there. On Days 10 and 45 after treatment, LH stimulation tests with the GnRH agonist buserelin (4µg IV) were performed. Data were normally distributed; differences among groups were analysed using analysis of variance and subsequent Tukey test. Values are means±s.e.m. In all mares without a corpus luteum on Day 0 (progesterone <1ngmL−1; one mare in group D1 and two in group C), ovulation was detected within 9 days after deslorelin treatment. These ovulations were classified as deslorelin induced, whereas ovulations after Day 10 were classified as spontaneous ovulations. The mean interval from deslorelin until the first spontaneous ovulation was 62.0±8.6, 44.2±14.1, and 22.2±3.1 days in groups D1, D2, and C (P<0.05), respectively. Subsequent oestrous cycles were regular. Oestrus-like behaviour until day 50 was reduced in groups D1 (2.0±0.9 days) and D2 (2.4±1.3 days) compared with group C (6.4±1.2 days; P<0.05). Concentration of plasma LH and AMH decreased in group D1 (P<0.05) but not in groups D2 and C. The GnRH stimulation test on Day 10 resulted in an increase (P<0.001) in plasma LH concentration in group C but not in groups D1 and D2 (treatment×time P<0.05). On Day 45, LH concentration increased in all mares in response to buserelin (NS among groups). Within 100 days of treatment, LH concentrations but not AMH concentrations in mares of group D1 returned to baseline. In conclusion, deslorelin slow-release implants transiently suppress ovarian function and oestrus behaviour in mares. Spontaneous ovulation is delayed in a dose-dependent manner. A decrease in AMH concentration suggests inhibitory effects of deslorelin on small antral follicles. Long-term effects on follicular dynamics and fertility in larger horses also need to be assessed.
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Okada C, Kaps M, Handschuh S, Scarlet D, Aurich C. 61 Low plasma progestin concentration during the early luteal phase impairs equine conceptus development until placentation. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab61] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
During the early luteal phase, low progesterone concentrations delay downregulation of endometrial progesterone receptors. This contributes to impaired histotroph production at Day 14 of pregnancy (Beyer et al. 2019 Theriogenology 125, 236-241). Until the beginning of placentation (i.e. Day 37 of pregnancy), nutritional supply of the equine conceptus depends on histotrophy alone. The aim of the present study was to analyse development of the equine conceptus under reduced plasma progesterone concentrations until shortly before placentation. Fertile Haflinger mares (n=11; 4-11 years old) were examined daily by transrectal ultrasonography, and when in oestrus, they were inseminated every 48h until spontaneous ovulation. Mares were randomly assigned to either the treatment group and received the prostaglandin F2α agonist cloprostenol (PGF2α; 125μg) once daily for 3 days after ovulation (Beyer et al. 2019) or the control group and left untreated. After conceptus collection on Day 34, mares were allowed one oestrous cycle for recovery and subsequently assigned to the opposite treatment, thus serving as their own controls. From Day 10 after ovulation, conceptus development including size, uterine fixation, and heartbeat detection was evaluated daily by transrectal ultrasonography. On Day 34, conceptus and fetal membranes were recovered transcervically. The recovered material was weighed, measured, and stored for further analysis. Conceptuses underwent microcomputed tomography that was evaluated by Amira (Thermo Fisher Scientific). Statistical comparison for differences between control and treatment pregnancies was performed by nonparametric Wilcoxon test or chi-square analysis. The day of first visualisation of the conceptus and of the embryo proper and heartbeat did not differ between treatments. Uterine fixation occurred on Day 19.3±0.5 in conceptuses from PGF2α-treated pregnancies but on Day 16.7±0.4 in controls (P<0.05). At 34 days of gestation, the conceptuses from PGF2α-treated mares were smaller (P<0.05) than control conceptuses when measured with ultrasound callipers in utero (maximal length: PGF2α 17.4±0.3mm, control 19.0±0.4mm). Conceptus weight determined after recovery was less in treated pregnancies (PGF2α 2.5±0.2 g; control 3.5±0.3 g; P<0.05). Microcomputed tomography analysis of selected inner organs showed some differences in development. Seven complete pairs of undestroyed conceptuses were available. Mean numbers of 33.4±3.2 and 18.8±7.5 bronchi were detected in control and PGF2α conceptuses, respectively (P<0.05). Heart volume did not differ, but communication between ventricles was detected in only 1/7 control but 5/7 PGF2α conceptuses (P<0.05). The footpad was present in 6/7 control and 0/7 PGF2α conceptuses (P<0.001). In conclusion, subphysiological progesterone concentration during the early luteal phase delays development of the equine conceptus before placentation. The condition may contribute to early conceptus loss in horses, which occurs in up to 20% of pregnancies.
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Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Prosiegel M, Kaps M, Tanislav C. Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study. BMC Neurol 2019; 19:282. [PMID: 31718562 PMCID: PMC6852733 DOI: 10.1186/s12883-019-1499-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/15/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. METHODS The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry. RESULTS We investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6-17] vs. 7 [4-12], p = .013; median mRS 5 [IQR 4-5] vs. 4 [IQR 3-5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities. A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011). CONCLUSION Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392 Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Marco Meyer
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Wichernstraße 40, 57074 Siegen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Mario Prosiegel
- Lecturer at Faculty of Languages and Literatures, Department I, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Wichernstraße 40, 57074 Siegen, Germany
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23
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Bornstein NM, Saver JL, Diener HC, Gorelick PB, Shuaib A, Solberg Y, Devlin T, Leung T, Molina CA, Skoloudik D, Fiksa J, Krieger D, Andersen G, Berrouschot J, Hobohm C, Schneider D, Griewing B, Endres M, Hausler KG, Kimmig H, Ringleb P, Weimar C, Schilling M, Kohrmann M, Hetzel A, Kaps M, Cheung R, Sobolewski P, Nyke W, Czlonkowska A, Stepien A, Waldemar B, Słowik A, Zbigniewem S, Lubiński I, Portela P, Segure T, Marti-Fabregas J, Alonso M, Nunez A, Miguel MB, Campello A, Arenillas J, Marshall N, Chiu D, Shownkeen H, Rymer M, Sen S, Roubec M, Kuliha M, Lakomý C, Tyl D, Kemlink D, Doležal O, Rekova P, Krejčí V, Christensen A, Belhage B, Maschmann C, Kruse Larsen C, Pott F, Christensen H, Marstrand J, Nielsen JK, Meden P, Prytz S, Rosenbaum S, Hedemann Sorensen JC, Stenhoj Meier K, Schmift Ettrup K, Dupont Hougaard K, Von Wietzel P, Stoll A, Schwetlick H, Pradel H, Hemprich A, Schulz A, Frerich B, Hobohm C, Weise C, Michalski D, Schaller F, Schiefke F, Helmrich J, Pelz J, Schnieder M, Schneider M, Matzen P, Langos R, Müller-Duerwald S, Lukhaup S, Bauer U, Kloppig W, Hiermann E, Mucha G, Soda H, Weinhardt R, Mucha T, Ziegler V, Abbushi A, Hotter B, Winter B, Anthofer B, Noack C, Laubisch D, Heldge Schneider G, Jan Jungehulsing G, Mueller H, Dreier J, Fiebach J, Flechsenhar J, Villringer K, Ebinger M, Rozanski M, Vajkoczy P, Klingebiel R, Steinicke R, Pittl S, Hoffmann S, Maul S, Krause T, Liman T, Plath T, Nowe T, Schmidt W, Fritzsch C, Haas C, Will HG, Haußmann-Betz K, Bayat M, Pordzik T, Hug A, Staff CJ, Lichy C, Eggers G, Kloss M, Bendszus M, Herrmann O, Seeberger R, Schwarting S, Rhode S, Rizos T, Hacke W, Frank B, Bozkurt B, Holle D, Mueller D, Koch D, Shanib H, Sudendey J, Brenck J, Busch K, Gartzen K, Gasser T, Hagenacker T, Buerke B, Prigge G, Minnerup J, Albers J, Wermker K, Schwindt W, Kallmünzer RB, Hauer E, Breuer L, Schellinger P, Kollmar R, Sauer R, Schwab S, Struffert T, Funfack A, Stechmann A, Schlaeger A, Laeppchen C, Schuchardt F, Klingler JH, Reis J, Lambeck J, Friedrich M, Laible M, Wellermeyer P, Beck S, Rutsch S, Niesen WD, Tanislav C, Schaaf H, Kerkmann H, Schirotzek I, Allendörfer J, Wolff S, Yuk-Lun Lau A, Yin Yan Chan A, Siu D, Wong EHC, Chu Wong GK, Leung H, Wong LK, Zhu XL, Yan Soo YO, Ting Tse AC, Kit Leung GK, Leung KM, Ngai Hung K, Wai Mei Kwan M, Man Yu Tse M, Tse P, Hon Chan P, Lee R, Shek Kwan Chang R, Yin Yu Pang S, Fong Kwong Hon S, Cheng TS, Lui WM, Wo Mak WW, Sobota A, Wiater B, Loch B, Wolak G, Łabudzka I, Dabal J, Grzesik M, Sledzinska M, Hatalska-Żerebiec R, Szczuchniak W, Gójska A, Nałęcz D, Gasecki D, Kozera G, Dylewicz Ł, Niekra M, Kwarciany M, Chomik P, Skowron P, Kobayashi A, Chabik G, Makowicz G, Bembenek J, Jędrzejewska J, Karlinski M, Czepiel W, Brodacki B, Staszewski J, Kosek J, Jadczak M, Durka-Kęsy M, Kaluzny K, Ziomek M, Fudala M, Sosnowski Z, Ferens A, Szczygieł E, Banaszkiewicz K, Ziomek M, Wnuk M, Szczepańska-Szerej A, Jach E, Maslanko GE, Wojczal J, Luchowski P, Kowalczyk A, Jakubiak J, Kopcewicz J, Gajda M, Wichlinska-Lubinska M, Rodriguez D, Santamarin E, Pagola J, Lorente Guerrero J, Ribo M, Rubiera M, Maisterra O, Pinero S, Catalina Iglesias V, Plans G, Quesada H, Aparicio Caballero MA, Portela PC, De Diego AB, Garay DS, García Rodriguez MR, Martin OA, Braña SC, Garcia J, Hernandez FM, Catala I, Marti-Vilalta JL, Delgado Mederos R, de Quintana SC, Martinez-Ramirez S, Valcarcel Gonzalez J, Masjuan Vallejo J, Diamantopoulus J, Del Alamo M, Poveda PD, Pastor AG, Carballal CF, Diaz F, Garcia Leal R, Juretschke R, Echabe EA, Sanchez JC, Yanez MR, Garcia RS, Muino RL, Rivas SA, Lopez Gonzalez DM, Cuadrado E, Giralt E, Villalba G, Roquer J, Angel O, Jimenez M, Cedeño RR, Salinas R, Lejarreta S, Silva Y, Fraile A, Calleja A, Cepeda Landínez GA, Tellez N, Garcia Bermejo P, Santos PJ, Herranz RF, Hunt P, Browning D, Violette M, Hoddeson R, Rose J, Zhang J, Mazumdar A, Echiverri H, Chow J, Lovick D, Coleman M, Akhtar N, Sugg R, Zanation A, Germanwala A, Senior B, Huang D, Aucutt-Walter N, Kasner S, LeRoux P, von Kummer R, Palesch Y. Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow. Stroke 2019; 50:2108-2117. [DOI: 10.1161/strokeaha.118.024582] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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
Background and Purpose—
Many patients with acute ischemic stroke are not eligible for thrombolysis or mechanical reperfusion therapies due to contraindications, inaccessible vascular occlusions, late presentation, or large infarct core. Sphenopalatine ganglion (SPG) stimulation to enhance collateral flow and stabilize the blood-brain barrier offers an alternative, potentially more widely deliverable, therapy.
Methods—
In a randomized, sham-controlled, double-masked trial at 41 centers in 7 countries, patients with anterior circulation ischemic stroke not treated with reperfusion therapies within 24 hours of onset were randomly allocated to active SPG stimulation or sham control. The primary efficacy outcome was improvement beyond expectations on the modified Rankin Scale of global disability at 90 days (sliding dichotomy), assessed in the modified intention-to-treat population. The initial planned sample size was 660 patients, but the trial was stopped early when technical improvements in device placement occurred, so that analysis of accumulated experience could be conducted to inform a successor trial.
Results—
Among 303 enrolled patients, 253 received at least one active SPG or sham stimulation, constituting the modified intention-to-treat population (153 SPG stimulation and 100 sham control). Age was median 73 years (interquartile range, 64–79), 52.6% were female, deficit severity on the National Institutes of Health Stroke Scale was median 11 (interquartile range, 9–15), and time from last known well median 18.6 hours (interquartile range, 14.5–22.5). For the primary outcome, improved 3-month disability beyond expectations, rates in the SPG versus sham treatment groups were 49.7% versus 40.0%; odds ratio, 1.48 (95% CI, 0.89–2.47);
P
=0.13. A significant treatment interaction with stroke location (cortical versus noncortical) was noted,
P
=0.04. In the 87 patients with confirmed cortical involvement, rates of improvement beyond expectations were 50.0% versus 27.0%; odds ratio, 2.70 (95% CI, 1.08–6.73);
P
=0.03. Similar response patterns were observed for all prespecified secondary efficacy outcomes. No differences in mortality or serious adverse event safety end points were observed.
Conclusions—
SPG stimulation within 24 hours of onset is safe in acute ischemic stroke. SPG stimulation was not shown to statistically significantly improve 3-month disability above expectations, though favorable outcomes were nominally higher with SPG stimulation. Beneficial effects may distinctively be conferred in patients with confirmed cortical involvement. The results of this study need to be confirmed in a larger pivotal study.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03767192.
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Affiliation(s)
- Natan M. Bornstein
- From the Brain Division, Shaarei Zedek Medical Center, Jerusalem and Tel Aviv Sourasky Medical School, Tel Aviv University (N.M.B.)
| | - Jeffrey L. Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles CA (J.L.S.)
| | | | - Philip B. Gorelick
- Davee Department of Neurology, Northwestern University, Chicago, IL (P.B.G.)
| | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.)
| | | | - Thomas Devlin
- Department of Neurology, University of Tennessee College of Medicine, Chattanooga (T.D.)
| | - Thomas Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong (T.L.)
| | - Carlos A. Molina
- and Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Barcelona (C.A.M.)
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Walter U, Brandt S, Förderreuther S, Hansen HC, Hinrichs H, Kaps M, Müllges W, Weise D. Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung zur Diagnostik des irreversiblen Hirnfunktionsausfalls. KLIN NEUROPHYSIOL 2019. [DOI: 10.1055/a-0792-0986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungGemeinsam mit der Vierten Fortschreibung der Richtlinie der Bundesärztekammer zur Feststellung des irreversiblen Hirnfunktionsausfalls („Hirntod“) im Jahr 2015 erfolgte eine Revision der Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung (DGKN) zu den ergänzenden elektrophysiologischen (Elektroenzephalografie, frühe akustisch evozierte Potenziale, somatosensorisch evozierte Potenziale) und neurovaskulären (Dopplersonografie, Duplexsonografie) Untersuchungen.Die Empfehlungen der DGKN wurden 2018 in einigen Punkten aktualisiert. Neben redaktionellen Änderungen (u. a. Ersetzen des Begriffs „Eichsignal“ durch „Kalibriersignal“, präzisere Formulierung der zu setzenden Elektroden für die Elektroenzephalografie) wurden Vorgaben zur Bildanzeige bei digitaler Elektroenzephalografie und altersbezogene Mindestgrößen des arteriellen Mitteldruckes bei Kindern für die Doppler- und Duplexsonografie neu aufgenommen. Diese hier präsentierten Empfehlungen stellen die Indikationen, Limitationen, Voraussetzungen und die Durchführung dieser Zusatzverfahren in der Diagnostik des irreversiblen Hirnfunktionsausfalls bei Kindern und Erwachsenen dar.
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Affiliation(s)
- Uwe Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - Stephan Brandt
- Klinik für Neurologie, Campus Mitte, Charité-Universitätsmedizin Berlin
| | | | | | - Hermann Hinrichs
- Universitätsklinik für Neurologie, Universitätsklinikum Magdeburg A. ö. R
| | - Manfred Kaps
- Klinik für Neurologie am Standort Gießen, Universitätsklinikum Gießen und Marburg
| | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
| | - David Weise
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig
- Klinik für Neurologie, Schmerztherapie und Schlafmedizin, Asklepios Fachklinikum Stadtroda
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Grimm A, Allendörfer J, Bischoff C, Buchner H, Décard B, Kaps M, Schelle T, Schulte-Mattler W, Walter U, Witte O, Nedelmann M, Köhrmann M, Schminke U. Positionspapier der Deutschen Gesellschaft für klinische Neurophysiologie DGKN und der Deutschen Gesellschaft für Ultraschall in der Medizin DEGUM, Sektion Neurologie zur „Wertigkeit des Nerven- und Muskelultraschalls in der Diagnostik neuromuskulärer Erkrankungen“. KLIN NEUROPHYSIOL 2018. [DOI: 10.1055/a-0635-9584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alexander Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Tübingen
| | | | | | | | - Bernhard Décard
- Departement für Neurologie, Universitätsspital Basel, Schweiz
| | - Manfred Kaps
- Klinik und Poliklinik für Neurologie Universitätsklinikum Gießen
| | | | | | - Uwe Walter
- Klinik und Poliklinik für Neurologie Universitätsklinikum Rostock
| | - Otto Witte
- Hans-Berger Klinik für Neurologie, Universitätsklinikum Jena
| | | | - Martin Köhrmann
- Klinik und Poliklinik für Neurologie Universitätsklinikum Essen
| | - Ulf Schminke
- Klinik und Poliklinik für Neurologie Universitätsmedizin Greifswald
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Braun T, Juenemann M, Viard M, Meyer M, Fuest S, Reuter I, Kaps M, Prosiegel M, Tanislav C. What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study. BMJ Open 2018; 8:e019016. [PMID: 29511010 PMCID: PMC5855308 DOI: 10.1136/bmjopen-2017-019016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Fibre-endoscopic evaluation of swallowing (FEES) to detect dysphagia is gaining more and more importance as a diagnostic tool. Therefore, we have investigated the impact of FEES in neurological patients in a clinical setting. DESIGN Cross-sectional hospital-based registry. SETTING Primary acute care in a neurological department of a German university hospital. PARTICIPANTS 241patients with various neurological diseases who underwent FEES procedure. PRIMARY AND SECONDARY OUTCOME MEASURES Dysphagia and related comorbidities. RESULTS 267 FEES were performed in 241 patients with various neurological diagnoses. Dysphagia was diagnosed in 68.9% of the patients. In only 33.1% of the patients, appropriate oral diet was chosen prior to FEES. A relevant dysphagia occurred more often in patients with structural brain lesions (83.1% vs 65.3%, P=0.001), patients with dysphagia had a longer hospitalisation (median 18 (IQR 12-30) vs 15 days (IQR 9.75-22.75), P=0.005) and had a higher mortality (8.4% vs 1.3%, P=0.041). When the oral diet was changed, we observed a lower pneumonia rate (36% vs 50%, P=0.051) and a lower mortality (3.7% vs 11.3%, P=0.043) in comparison to no change of oral diet. A restriction of oral diet was identified more often in older patients (median 75 years (IQR 66.3-82 years) vs median 72 years (IQR 60-79 years), P=0.01) and in patients with structural brain lesions (86.8% vs 73.1%, P=0.05). CONCLUSION On clinical investigation, dysphagia was misjudged for the majority of the patients. FEES might help to compensate this drawback, revising the diet regime in nearly 70% of the patients.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Marco Meyer
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Sven Fuest
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mario Prosiegel
- Institute of German Linguistics, Ludwig-Maximilians-University, Giessen, Germany
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
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Würzer B, Laza C, Pons-Kühnemann J, Kaps M, Junge B, Roessler FC. Speckle Tracking in Transcranial Ultrasound Allows Noninvasive Analysis of Pulsation Patterns of the Third Ventricle. Ultrason Imaging 2018; 40:127-138. [PMID: 29207924 DOI: 10.1177/0161734617745670] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cerebrospinal fluid (CSF) flow is sensitive to many cerebral disorders. We aimed to develop a noninvasive bedside method to detect physiological and pathological CSF phenomena by measuring pulsation patterns of the third ventricle. By transcranial B-mode ultrasound, electrocardiography (ECG)-gated video loops of the third ventricle were acquired. "Speckle tracking" software was used to quantify the relative change of its width. We conducted measurements of nine cardiac cycles in 11 healthy subjects in sitting and in supine position during Valsalva maneuver to investigate the influence of an increased intracranial pressure on the relative deformation of the third ventricle. In one patient with occlusive hydrocephalus, 19 cardiac cycles were measured in sitting position before and after removal of a tumorous obstruction of the aqueduct of Sylvius. Healthy subjects expressed a pulse-related increased width of the third ventricle ([Formula: see text]: +5.69, 95% confidence interval [CI] = [4.38, 7.00]). No significant difference was found between the sitting and the supine position in healthy adults. In the preoperative state of occlusive hydrocephalus, we found a negative, pulse-related deformation ([Formula: see text]: -1.86, 95% CI = [-2.15, -1.58]) with delayed onset. After surgery, the deformation pattern resembled that of our healthy controls. The difference between pre- and postoperative condition was significant (p < 0.001). Transcranial B-mode sonography can be used to record small movements of the sidewalls of the third ventricle. This noninvasive bedside method is suitable to assess CSF pulsatility within the third ventricle and might be able to distinguish between physiological and pathological flows.
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Affiliation(s)
- Benjamin Würzer
- 1 Department of Neurology, Justus-Liebig University Giessen, Giessen, Germany
| | - Cristina Laza
- 2 Clinic of Neurology, County Clinical Emergency Hospital "Sfântul Apostol Andrei," Constanța, Romania
| | - Jörn Pons-Kühnemann
- 3 Medical Statistics, Institute of Medical Informatics, Justus-Liebig University Giessen, Giessen, Germany
| | - Manfred Kaps
- 1 Department of Neurology, Justus-Liebig University Giessen, Giessen, Germany
| | - Bernd Junge
- 1 Department of Neurology, Justus-Liebig University Giessen, Giessen, Germany
| | - Florian C Roessler
- 1 Department of Neurology, Justus-Liebig University Giessen, Giessen, Germany
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Haverkamp C, Ganslandt T, Horki P, Boeker M, Dörfler A, Schwab S, Berkefeld J, Pfeilschifter W, Niesen WD, Egger K, Kaps M, Brockmann MA, Neumaier-Probst E, Szabo K, Skalej M, Bien S, Best C, Prokosch HU, Urbach H. Regional Differences in Thrombectomy Rates : Secondary use of Billing Codes in the MIRACUM (Medical Informatics for Research and Care in University Medicine) Consortium. Clin Neuroradiol 2018; 28:225-234. [PMID: 29313057 DOI: 10.1007/s00062-017-0656-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/14/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines. A locally executed uniform SQL (structured query language) query delivered aggregated site data for all inpatients with a discharge diagnosis of ischemic stroke (ICD-10 I63) containing counts for type of acute treatment, type of admission and age groups, which were centrally analyzed with R. RESULTS From 2014 to 2016, the thrombectomy rate almost doubled from a mean of 4.7% to 9.6%, although significant differences between centers exist (range in 2016: 5.8-17%). The number of drip-and-ship procedures increased in 3 out of 8 centers. There was no evidence for a decrease in thrombectomy rates during weekends/holiday or among patients older than 80 years, but this age group is more likely to receive i.v. recombinant tissue plasminogen activator (rtPA). CONCLUSION The observed increase of thrombectomy rates and drip-and-ship procedures without a significant difference between weekdays and weekends or patients of different ages is substantiating a rapid implementation of stroke guidelines within the analyzed neurovascular centers. The prototype of the MIRACUM Data Integration Center already contributes to health services research in Germany.
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Affiliation(s)
- Christian Haverkamp
- Staff Unit IT-Processes, Faculty of Medicine and Medical Center, University of Freiburg, Agnesenstr. 6-8, 79106, Freiburg, Germany.
| | - Thomas Ganslandt
- Center of Medical Information and Communication Technology, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Petar Horki
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Martin Boeker
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Johann Wolfgang Goethe-University, Schleusenweg 2-16, Haus 95, 60528, Frankfurt, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, Haus 95, 60528, Frankfurt, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstraße 33, 35385, Giessen, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55101, Mainz, Germany
| | - Eva Neumaier-Probst
- Department of Neuroradiology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Skalej
- Institute of Neuroradiology, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Siegfried Bien
- Department of Neuroradiology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany
| | - Christoph Best
- Department of Neurology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, 91058, Erlangen-Tennenlohe, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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Häusler K, Gröschel K, Köhrmann M, Schnabel R, Anker S, Brachmann J, Böhm M, Diener HC, Doehner W, Endres M, Gerloff C, Huttner H, Kaps M, Kirchhof P, Nabavi D, Nolte C, Pfeilschifter W, Pieske B, Poli S, Schäbitz W, Thomalla G, Veltkamp R, Steiner T, Laufs U, Röther J, Wachter R. Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall. Akt Neurol 2017. [DOI: 10.1055/s-0043-118476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas vorliegende Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall beinhaltet eine Stellungnahme der Arbeitsgemeinschaft „Herz und Hirn“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK) und der Deutschen Schlaganfallgesellschaft e. V. (DSG), die in Zusammenarbeit mit der Stroke Unit-Kommission der DSG und dem Kompetenznetz Vorhofflimmern (AFNET) e. V. erstellt wurde.Vorhofflimmern ist in den Leitlinien der Europäischen Gesellschaft für Kardiologie als eine mindestens 30 Sekunden anhaltende Episode einer Vorhofarrhythmie mit fehlenden P-Wellen definiert. Die 30-Sekundengrenze ist arbiträr gewählt und es ist unbekannt, ob das Schlaganfallrisiko bei Episoden von länger als 30 Sekunden höher ist als bei kürzeren Episoden. Bei Patienten, die einen Schlaganfall erlitten haben, sollte die Detektion von Vorhofflimmern üblicherweise zu einer Umstellung der medikamentösen Sekundärprävention führen, da eine orale Antikoagulation einer Thrombozytenaggregationshemmung überlegen ist. Die Detektion eines bis dato nicht diagnostizierten Vorhofflimmerns sollte daher bei Patienten mit ischämischem Schlaganfall verbessert werden, um die medikamentöse Sekundärprävention des Schlaganfalls zu optimieren. In diesem Positionspapier werden interdisziplinär erarbeitete Standards für eine „strukturierte Rhythmusvisite“ auf der Stroke Unit und ein diagnostisches „Stufenschema“ zur Detektion von Vorhofflimmern vorgeschlagen. Das Positionspapier fasst zudem den gegenwärtigen Kenntnisstand zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall zusammen. Das Positionspapier soll den in der Versorgung von Schlaganfallpatienten tätigen Ärzten eine Handhabe geben, auch wenn bisher nicht abschließend geklärt ist, wie lange und mit welcher EKG-Methode Schlaganfallpatienten ohne bisher bekannte Herzrhythmusstörung bestmöglich monitoriert werden sollten. Dem Charakter eines Positionspapiers angemessen, wurde auf die Kennzeichnung von Evidenzgraden verzichtet, da es sich überwiegend um die Meinung von Experten handelt, die auf berichteten Fallserien und klinischer Erfahrung beruht und somit nicht mit einer Leitlinie gleichzusetzen ist und so auch nicht verstanden werden will.
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Affiliation(s)
- Karl Häusler
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
- Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
- Kompetenznetz Vorhofflimmern e.V
| | - Klaus Gröschel
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Mainz
| | | | - Renate Schnabel
- Kompetenznetz Vorhofflimmern e.V
- Abteilung für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), Standort Hamburg/Kiel/Lübeck
| | - Stefan Anker
- Abteilung Kardiologie und Stoffwechsel – Herzinsuffizienz, Kachexie & Sarcopenie, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité – Universitätsmedizin Berlin
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen (UMG) & Deutsches Zentrum für Kardiovaskuläre Forschung (DZHK), Standort Berlin
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg
| | | | - Wolfram Doehner
- Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
- Klinik für Innere Medizin mit Schwerpunkt Kardiologie, Campus Virchow Klinikum, Berlin, Charité – Universitätsmedizin Berlin
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
- Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
- Berlin Institute of Health
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), Standort Berlin
- Deutsches Zentrum für Degenerative Erkrankungen (DZNE), Standort Berlin
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Eppendorf, Hamburg
- Stroke Unit Kommission der Deutschen Schlaganfall-Gesellschaft
| | - Hagen Huttner
- Neurologische Klinik, Universitätsklinikum Erlangen, Erlangen
| | - Manfred Kaps
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Gießen
| | - Paulus Kirchhof
- Kompetenznetz Vorhofflimmern e.V
- Institute of Cardiovascular Sciences, University of Birmingham, Sandwell and West Birmingham Hospitals NHS trust, University Hospitals Birmingham NHS Foundation NHS trust, Birmingham, Großbritannien
| | - Darius Nabavi
- Stroke Unit Kommission der Deutschen Schlaganfall-Gesellschaft
- Klinik für Neurologie, Vivantes Klinikum Neukölln, Berlin
| | - Christian Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin
- Centrum für Schlaganfallforschung Berlin, Charité – Universitätsmedizin Berlin
- Berlin Institute of Health
| | - Waltraud Pfeilschifter
- Zentrum der Neurologie und Neurochirurgie, Klinik für Neurologie, Universitätsklinikum Frankfurt
| | - Burkert Pieske
- Klinik für Innere Medizin mit Schwerpunkt Kardiologie, Campus Virchow Klinikum, Berlin, Charité – Universitätsmedizin Berlin
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), Standort Berlin
- Klinik für Innere Medizin und Kardiologie, Deutsches Herzzentrum Berlin
| | - Sven Poli
- Abteilung Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen und Hertie-Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen
| | - Wolf Schäbitz
- Klinik für Neurologie, Evangelisches Klinikum Bethel, Bielefeld
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Eppendorf, Hamburg
| | - Roland Veltkamp
- Department of Stroke Medicine, Imperial College London, Großbritannien
| | - Thorsten Steiner
- Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt
- Neurologische Klinik, Universitätsklinik Heidelberg, Heidelberg
| | - Ulrich Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig
| | - Joachim Röther
- Abteilung für Neurologie, Asklepios Klinik Altona, Hamburg
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen & Deutsches Zentrum Herz-Kreislauf-Forschung e.V., Standort Göttingen
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Tanislav C, Allendörfer J, Pfeilschifter W, Fuest S, Stein M, Meyer M, Reuter I, Kaps M, Misselwitz B. One decade of oral anticoagulation in stroke patients: Results from a large country-wide hospital-based registry. Int J Stroke 2017; 13:308-312. [PMID: 28952913 DOI: 10.1177/1747493017733928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background New evidence regarding stroke prevention in atrial fibrillation has been published. Implementing knowledge into clinical practice remains challenging. Aims To investigate oral anticoagulants in stroke patients documented in a nationwide registry. Methods The database is an obligatory federal-state-wide hospital-based registry that covers more than 95% of all ischemic strokes, transient ischemic attacks and intracerebral hemorrhages in a community of more than six million inhabitants (Hesse/Germany). We analyzed oral anticoagulants prescribed on discharge in patients with stroke or transient ischemic attack during 2006-2015. Results From 2006 to 2015, we annually selected median 20,895 patients. From 2006 to 2015, the proportion of patients treated with oral anticoagulants increased (9.8% to 24%). The annual proportion of patients with atrial fibrillation remained constant (median: 23%). In atrial fibrillation patients treated with oral anticoagulants, the age increased (median 2008/2009: 76.9 years vs. 2014/2015 79.4 years). The percentage of treated individuals in atrial fibrillation increased dramatically (2006: 30.1% to 2015: 74.5%); in 2015, 30.8% of these patients received vitamin K antagonists and 70.2% new oral anticoagulants. Independent factors associated with new oral anticoagulants therapy were a previous medication with new oral anticoagulants and a treatment on stroke unit. Between new oral anticoagulants- and vitamin K antagonists-treated patients (2015), no differences in age were noted (both mean: 79.4 years). Conclusions The new oral anticoagulants availability enhanced a general trend treating more target patients with oral anticoagulants.
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Affiliation(s)
| | | | | | - Sven Fuest
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Marco Stein
- 4 Neurosurgery, Justus Liebig University, Giessen, Germany
| | - Marco Meyer
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Iris Reuter
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Manfred Kaps
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Björn Misselwitz
- 5 Institute of quality assurance Hesse, Eschborn/Frankfurt, Germany
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Schlachetzki F, Nedelmann M, Poppert H, Saur D, Harloff A, Liman J, Reinhardt M, Stolz E, Kaps M. Neurosonologische Diagnostik in der Akutphase des Schlaganfalls ist Merkmal einer qualifizierten Versorgung. Akt Neurol 2017. [DOI: 10.1055/s-0043-109689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie Untersuchung der hirnversorgenden Arterien mittels Doppler- und Duplexsonografie war bislang fester Bestandteil des bewährten Stroke-Unit-Konzepts. Dies hat sich mit der Neufassung der Schlaganfall-OPS geändert: neurosonografische Untersuchungen während der Stroke-Unit-Behandlung sind im Falle der Durchführung einer CT- bzw. MR-Angiografie nicht mehr gefordert. Nach Eintritt eines ischämischen Schlaganfalls laufen im betroffenen Gefäßsegment und den dazugehörigen Kollateralwegen komplexe, individuell unterschiedliche, hämodynamische Umstellungsprozesse ab, die für das Schicksal des Patienten entscheidend sind. Verschlüsse können persistieren, partiell oder komplett rekanalisieren, kollateral kompensiert werden oder nach Rekanalisation wieder re-okkludieren. Diese Prozesse in den ersten Stunden können mittels Ultraschall wie mit keiner anderen Methode verfolgt werden. Je früher die Untersuchung erfolgt, desto aufschlussreicher sind die Befunde, desto besser ist das pathophysiologische Verständnis und desto größer ist der individuelle Nutzen für therapeutische Entscheidungen. Vielfach werden CTA, MRA und Ultraschall in der Schlaganfallversorgung als kompetitive Methoden begriffen. In Wahrheit handelt es sich aber um komplementäre Verfahren, mit denen auf der Basis von sehr unterschiedlichen physikalischen Prinzipien Bilder erzeugt und Blutgefäße, Hirnperfusion und Blutflüsse dargestellt werden. Mit Blick auf eine spezielle klinische Fragestellung ist jeweils das eine oder andere Verfahren indiziert. Es obliegt dem klinisch verantwortlichen Neurologen hier die richtige Auswahl zu treffen und spezifische neurosonologische Kompetenz einzubringen. Ziel dieser Übersichtsarbeit ist es, Neurologinnen und Neurologen dazu zu motivieren, Neurosonologie speziell in der Akutphase des Schlaganfalls einzusetzen um sich selbst ein Bild zu machen, anstatt sich „ein Bild machen zu lassen“.
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Affiliation(s)
- Felix Schlachetzki
- Klinik und Poliklinik für Neurologie der Universität Regensburg, Klinik für neurologische Rehabilitation, Bezirksklinikum Regensburg, Regensburg
| | - Max Nedelmann
- Klinik und Poliklinik für Neurologie am Universitätsklinikum Eppendorf, Klinik für Neurologie der Regio Kliniken GmbH, Pinneberg
| | - Holger Poppert
- Klinik und Poliklinik für Neurologie der Technischen Universität München, München
| | - Dorothee Saur
- Klinik und Poliklinik für Neurologie am Universitätsklinikum Leipzig, Leipzig
| | - Andreas Harloff
- Klinik und Poliklinik für Neurologie und Neurophysiologie am Universitätsklinikum Freiburg, Freiburg
| | - Jan Liman
- Klinik für Neurologie der Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - Matthias Reinhardt
- Klinik für Neurologie und klinische Neurophysiologie, Klinikum Esslingen GmbH, Esslingen
| | | | - Manfred Kaps
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Gießen, Gießen
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von Sarnowski B, Schminke U, Grittner U, Tanislav C, Böttcher T, Hennerici MG, Tatlisumak T, Putaala J, Kaps M, Fazekas F, Enzinger C, Rolfs A, Kessler C. Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1). Cerebrovasc Dis 2017; 43:152-160. [PMID: 28088807 DOI: 10.1159/000454840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. METHODS In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. RESULTS We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups. CONCLUSIONS Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.
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Affiliation(s)
- Bettina von Sarnowski
- Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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Walter U, Schreiber SJ, Kaps M. Doppler and Duplex Sonography for the Diagnosis of the Irreversible Cessation of Brain Function ("Brain Death"): Current Guidelines in Germany and Neighboring Countries. Ultraschall Med 2016; 37:558-578. [PMID: 27579796 DOI: 10.1055/s-0042-112222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Extra- and transcranial sonography of brain-supplying arteries is accepted worldwide in brain death protocols as a valid "ancillary" method of proving brain circulatory arrest. Color-coded duplex sonography and CT angiography have been newly incorporated in the fourth update of the German Medical Association's guidelines for the determination of the irreversible cessation of brain function ("brain death"), effective July 2015. The updated guidelines address in more detail the diagnostic procedures and the required qualifications of the examiners. The present article summarizes the guidelines and the recommendations regarding the application and documentation of ultrasound findings for the diagnosis of brain circulatory arrest in children and adults, as valid in Germany. The method, limitations, and procedure in the case of inconclusive findings are described. Age-related minimum values of mean arterial pressure for the diagnosis of cerebral circulatory arrest in children are presented. A concise overview of the respective regulations for the use of sonography for diagnosing brain death in other countries, especially in the countries neighboring Germany, is given.
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Affiliation(s)
- U Walter
- Department of Neurology, University of Rostock, Rostock, Germany
| | - S J Schreiber
- Department of Neurology, Asklepios Hospital Brandenburg, Brandenburg an der Havel, Germany
| | - M Kaps
- Department of Neurology, Justus-Liebig University, Giessen, Germany
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Schleicher N, Tomkins AJ, Kampschulte M, Hyvelin JM, Botteron C, Juenemann M, Yeniguen M, Krombach GA, Kaps M, Spratt NJ, Gerriets T, Nedelmann M. Sonothrombolysis with BR38 Microbubbles Improves Microvascular Patency in a Rat Model of Stroke. PLoS One 2016; 11:e0152898. [PMID: 27077372 PMCID: PMC4831751 DOI: 10.1371/journal.pone.0152898] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
Abstract
Background Early recanalization of large cerebral vessels in ischemic stroke is associated with improved clinical outcome, however persisting hypoperfusion leads to poor clinical recovery despite large vessel recanalization. Limited experimental sonothrombolysis studies have shown that addition of microbubbles during treatment can improve microvascular patency. We aimed to determine the effect of two different microbubble formulations on microvascular patency in a rat stroke model. Methods We tested BR38 and SonoVue® microbubble-enhanced sonothrombolysis in Wistar rats submitted to 90-minute filament occlusion of the middle cerebral artery. Rats were randomized to treatment (n = 6/group): control, rt-PA, or rt-PA+3-MHz ultrasound insonation with BR38 or SonoVue® at full or 1/3 dose. Treatment duration was 60 minutes, beginning after withdrawal of the filament, and sacrifice was immediately after treatment. Vascular volumes were evaluated with microcomputed tomography. Results Total vascular volume of the ipsilateral hemisphere was reduced in control and rt-PA groups (p<0.05), but was not significantly different from the contralateral hemisphere in all microbubble-treated groups (p>0.1). Conclusions Microbubble-enhanced sonothrombolysis improves microvascular patency. This effect is not dose- or microbubble formulation-dependent suggesting a class effect of microbubbles promoting microvascular reopening. This study demonstrates that microbubble-enhanced sonothrombolysis may be a therapeutic strategy for patients with persistent hypoperfusion of the ischemic territory.
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Affiliation(s)
- Nadine Schleicher
- Heart and Brain Research Group, Justus-Liebig-University, Giessen, Germany
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Amelia J. Tomkins
- Heart and Brain Research Group, Justus-Liebig-University, Giessen, Germany
- School of Biomedical Sciences & Pharmacy, University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Marian Kampschulte
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University, Giessen, Germany
| | | | | | - Martin Juenemann
- Heart and Brain Research Group, Justus-Liebig-University, Giessen, Germany
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Mesut Yeniguen
- Heart and Brain Research Group, Justus-Liebig-University, Giessen, Germany
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Gabriele A. Krombach
- Department of Diagnostic and Interventional Radiology, Justus-Liebig-University, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Neil J. Spratt
- School of Biomedical Sciences & Pharmacy, University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Tibo Gerriets
- Heart and Brain Research Group, Justus-Liebig-University, Giessen, Germany
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
- Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany
| | - Max Nedelmann
- Sana Regio Klinkum, Pinneberg, Germany
- Department of Neurology, University Hospital Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Walter U, Brandt S, Ferbert A, Förderreuther S, Hansen HC, Hinrichs H, Kaps M, Müllges W. Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung zur Diagnostik des irreversiblen Hirnfunktionsausfalls. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- U. Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - S. Brandt
- Klinik für Neurologie, Campus Mitte, Charité – Universitätsmedizin Berlin
| | - A. Ferbert
- Neurologische Klinik, Klinikum Kassel GmbH
| | - S. Förderreuther
- Neurologische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München
| | - H.-C. Hansen
- Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus Neumünster GmbH
| | - H. Hinrichs
- Universitätsklinik für Neurologie, Universitätsklinikum Magdeburg A. ö. R
| | - M. Kaps
- Klinik für Neurologie am Standort Gießen, Universitätsklinikum Gießen und Marburg
| | - W. Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
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Kaps M, Schreiber S, Walter U. Doppler- und Duplexsonografie in der Diagnostik des irreversiblen Hirnfunktionsausfalls. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M. Kaps
- Klinik für Neurologie am Standort Gießen, Universitätsklinikum Gießen und Marburg
| | - S. Schreiber
- Klinik für Neurologie, Campus Mitte, Charité – Universitätsmedizin Berlin
| | - U. Walter
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
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Schmid A, Hochberg A, Berghoff M, Schlegel J, Karrasch T, Kaps M, Schäffler A. Quantification and regulation of adipsin in human cerebrospinal fluid (CSF). Clin Endocrinol (Oxf) 2016; 84:194-202. [PMID: 26186410 DOI: 10.1111/cen.12856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/03/2015] [Accepted: 07/10/2015] [Indexed: 02/01/2023]
Abstract
CONTEXT Data on quantification and regulation of adipsin in human cerebrospinal fluid (CSF) are sparse, and the physiological role of adipsin as an adipokine crossing the blood-brain barrier (BBB) is uncertain. OBJECTIVES This study quantified adipsin concentrations in paired serum and CSF samples of patients undergoing neurological evaluation and spinal puncture. DESIGN A total of 270 consecutive patients with specified neurological diagnosis were included in this study without prior selection. MAIN OUTCOME MEASURES Adipsin serum and CSF concentrations were measured by ELISA. A variety of serum and CSF routine parameters were measured by standard procedures. Anthropometric data, medication and patient history were available. RESULTS Adipsin concentrations ranged between 467 and 5148 ng/ml in serum and between 4·2 and 133·5 ng/ml in CSF. Serum adipsin concentrations were correlated positively with respective CSF concentrations and were approximately 40-fold higher when compared to CSF. The mean CSF/serum ratio for adipsin was 27 ± 22 × 10-3 . Serum and CSF adipsin levels were independent of gender and significantly higher in overweight/obese individuals. Serum and CSF adipsin levels correlated significantly with age and were higher in patients suffering from diabetes mellitus or hypertension. CSF adipsin concentrations showed a significant correlation with markers of inflammation in CSF, but not with CSF total cell count or the presence of oligoclonal bands. Patients suffering from infectious diseases had higher CSF levels of adipsin than multiple sclerosis patients. CONCLUSIONS Adipsin is present in human CSF under pathophysiological conditions. The positive correlation between serum and CSF concentrations, the positive correlation between the CSF/serum ratios for adipsin and total protein and the lack of association with CSF cell count argue against an autochthonous production in the central nervous system. In contrast, the present data argue for a significant BBB permeability to adipsin.
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Affiliation(s)
- Andreas Schmid
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Alexandra Hochberg
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Martin Berghoff
- Department of Neurology, Giessen University Hospital, Giessen, Germany
| | - Jutta Schlegel
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Thomas Karrasch
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Giessen University Hospital, Giessen, Germany
| | - Andreas Schäffler
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
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Berghoff M, Hochberg A, Schmid A, Schlegel J, Karrasch T, Kaps M, Schäffler A. Quantification and regulation of the adipokines resistin and progranulin in human cerebrospinal fluid. Eur J Clin Invest 2016; 46:15-26. [PMID: 26509463 DOI: 10.1111/eci.12558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adipokines bearing the potential to cross the blood-brain barrier (BBB) are promising candidates for the endocrine regulation of central nervous processes and of a postulated fat-brain axis. Resistin and progranulin concentrations in paired serum and cerebrospinal fluid (CSF) samples of patients undergoing neurological evaluation and spinal puncture were investigated. MATERIALS AND METHODS Samples of n = 270 consecutive patients with various neurological diseases were collected without prior selection. Adipokine serum and CSF concentrations were measured by enzyme-linked immunosorbent assay and serum and CSF routine parameters by standard procedures. Anthropometric data, medication and patient history were available. RESULTS Serum levels of resistin and progranulin were positively correlated among each other, with respective CSF levels, low-density lipoprotein cholesterol levels and markers of systemic inflammation. CSF resistin concentrations were generally low. Progranulin CSF concentrations and CSF/serum progranulin ratio were significantly higher in patients with infectious diseases, with disturbed BBB function and with elevated CSF cell count and presence of oligoclonal bands. Both adipokines are able to cross the BBB depending on a differing patency that increases with increasing grade of barrier dysfunction. Whereas resistin represents a systemic marker of inflammation, CSF progranulin levels strongly depend on the underlying disease and dysfunction of blood-CSF barrier. CONCLUSIONS Resistin and progranulin represent novel and putative regulators of the fat-brain axis by their ability to cross the BBB under physiological and pathophysiological conditions. The presented data provide insight into the characteristics of BBB function regarding progranulin and resistin and the basis for future establishment of normal values for CSF concentrations and CSF/serum ratios.
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Affiliation(s)
- Martin Berghoff
- Department of Neurology, Giessen University Hospital, Giessen, Germany
| | - Alexandra Hochberg
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Andreas Schmid
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Jutta Schlegel
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Thomas Karrasch
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Giessen University Hospital, Giessen, Germany
| | - Andreas Schäffler
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
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Roessler FC, Wang Z, Schumacher S, Ohlrich M, Kaps M, Menciassi A, Eggers J. In Vitro Examination of the Thrombolytic Efficacy of Desmoteplase and Therapeutic Ultrasound Compared with rt-PA. Ultrasound Med Biol 2015; 41:3233-3240. [PMID: 26349583 DOI: 10.1016/j.ultrasmedbio.2015.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/26/2015] [Accepted: 07/08/2015] [Indexed: 06/05/2023]
Abstract
The aim of the study described here was to evaluate the thrombolytic efficacy of combined treatment with the fibrin-selective plasminogen activator desmoteplase (DSPA) and therapeutic ultrasound (sonothrombolysis [STL]) compared with conventional rt-PA (recombinant tissue plasminogen activator) treatment in vitro. Lysis rates were determined by the weight loss of platelet-rich plasma (PRP) clots treated with rt-PA (60 kU/mL) or DSPA (2 μg/mL) combined with pulsed wave ultrasound (2 MHz, 0.179 W/cm(2)). To reveal the individual effects of medication and ultrasound, lysis rates were also determined for DSPA monotherapy and for combined treatment with rt-PA and ultrasound. Clots solely placed in plasma served as the control group. Lysis increased significantly with rt-PA (26.5 ± 7.8%) and DSPA (30.5 ± 6%) compared with the control group (18.2 ± 5.9%) (each p < 0.001). DSPA lysis was more effective than rt-PA lysis (without STL: p = 0.015, with STL: p = 0.01). Combined treatment with DSPA and 2-MHz STL significantly exceeded rt-PA lysis (32.8% vs. 26.5%, p < 0.001).
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Affiliation(s)
| | - Zhihua Wang
- The BioRobotics Institute, Scuola Superiore Sant'Anna and Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Sabrina Schumacher
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Ohlrich
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen, Giessen, Germany
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna and Center for Micro-BioRobotics@SSSA, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Jürgen Eggers
- Department of Neurology, Sana Kliniken Lübeck GmbH, Lübeck, Germany
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Fühlhuber V, Bick S, Tschernatsch M, Dharmalingam B, Kaps M, Preissner KT, Blaes F. Autoantibody-mediated cytotoxicity in paediatric opsoclonus–myoclonus syndrome is dependent on ERK-1/2 phophorylation. J Neuroimmunol 2015; 289:182-6. [DOI: 10.1016/j.jneuroim.2015.10.022] [Citation(s) in RCA: 4] [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] [Received: 02/18/2014] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Lautenschläger G, Habig K, Best C, Kaps M, Elam M, Birklein F, Krämer HH. The impact of baroreflex function on endogenous pain control: a microneurography study. Eur J Neurosci 2015; 42:2996-3003. [DOI: 10.1111/ejn.13096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Gothje Lautenschläger
- Department of Neurology; Justus-Liebig-University; Klinikstraße 33 Giessen 35392 Germany
| | - Kathrin Habig
- Department of Neurology; Justus-Liebig-University; Klinikstraße 33 Giessen 35392 Germany
| | - Christoph Best
- Department of Neurology; Philipps University; Marburg Germany
| | - Manfred Kaps
- Department of Neurology; Justus-Liebig-University; Klinikstraße 33 Giessen 35392 Germany
| | - Mikael Elam
- Department of Clinical Neurophysiology; The Sahlgrenska Academy of Gothenburg University; Gothenburg Sweden
| | - Frank Birklein
- Department of Neurology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Heidrun H. Krämer
- Department of Neurology; Justus-Liebig-University; Klinikstraße 33 Giessen 35392 Germany
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Flügel A, Reuter I, Kaps M, Mehnert S. P119. Correlation of ventricular diameter and cognitive dysfunction in patients with IPD – Comparison of transcranial sonography and MRI. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.161] [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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Lautenschläger G, Thieme K, Malinowski R, Meller T, Kaps M, Krämer H. P28. Sympathetic activity in patients with fibromyalgia – A microneurographic study. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.166] [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: 11/27/2022]
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Nedelmann M, Graef M, Weinand F, Wassill KH, Kaps M, Lorenz B, Tanislav C. Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion. Stroke 2015; 46:2322-4. [PMID: 26111890 DOI: 10.1161/strokeaha.115.009839] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transorbital sonography may help establish diagnosis of central retinal artery occlusion (CRAO). Next to Doppler sonographic proof of CRAO, an intra-arterial spot sign can be detected in some cases. We hypothesized that it reflects calcified components. It may be associated with embolization from atherosclerotic plaques and may negatively influence thrombolysis. METHODS Prospective monocenter study of 46 patients with ophthalmologically confirmed CRAO. Systemic tissue-type plasminogen activator thrombolysis was performed when appropriate. All patients received etiologic workup. RESULTS CRAO was confirmed by Doppler in all patients. Fifty-nine percent of patients with arterio-arterial embolization were spot sign-positive compared with 20% from cardiac source (P<0.05) and none with vasculitis. Eleven patients underwent thrombolysis. Clinically relevant visual improvement was only found in absence of a spot sign (P<0.05). CONCLUSIONS Transbulbar ultrasound is valuable for initial diagnosis and diagnostic workup of CRAO. In the light of inconsistent results of previous thrombolysis trials, ultrasound may identify patients more likely to benefit from thrombolytic treatment.
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Affiliation(s)
- Max Nedelmann
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
| | - Michael Graef
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
| | - Frank Weinand
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
| | - Klaus-Heiko Wassill
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
| | - Manfred Kaps
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
| | - Birgit Lorenz
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
| | - Christian Tanislav
- From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.)
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Tanislav C, Milde S, Schwartzkopff S, Misselwitz B, Sieweke N, Kaps M. Baseline characteristics in stroke patients with atrial fibrillation: clinical trials versus clinical practice. BMC Res Notes 2015; 8:262. [PMID: 26108787 PMCID: PMC4480890 DOI: 10.1186/s13104-015-1237-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/09/2014] [Accepted: 06/17/2015] [Indexed: 11/29/2022] Open
Abstract
Background When applying information gathered from medical research to the clinical setting, it is imperative that the sample of the investigated patients be representative of the clinical population. Because of this fact, it is necessary to closely examine the sample’s baseline characteristics in clinical trials. Methods We analysed baseline data of relevant trials investigating considerable proportions of patients with atrial fibrillation (AF) in the secondary stroke prevention: EAFT, SIFA, Active-W, BAFTA, RE-LY, AVERROES, ARISTOTLE and ROCKET AF. For comparing baseline data stroke patients with AF documented in a statutory stroke registry were considered. In a subgroup of patients (members of a large insurance) data on subsequent prescription for oral anticoagulants (oAK) were available. Results In the stroke registry (n = 15,886) the mean age was higher than in the selected clinical trials (mean 77.7 versus 70–72 years). Among insurance members (n = 1,828), those with a prescription for oAK (n = 827) were older than patients recruited in clinical trials (mean 75.1 versus 70–72 years). Results also showed that the male sex was overrepresented in clinical trials (59–63% versus 46%). The distribution of vascular risk factors in recent clinical trials was comparable to proportions in the registry (hypertension: 77–85% versus 80%; diabetes mellitus: 20–26% versus 27%). Conclusions The majority of stroke patients with AF in the clinical setting are considerably older than those included in clinical trials. While the distribution of vascular risk factors in clinical trials corresponds to proportions observed in clinical practice, an overrepresentation of the male sex in clinical trials is evident.
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Affiliation(s)
- Christian Tanislav
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Sonja Milde
- Dresden International University, Dresden, Germany.
| | | | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany.
| | - Nicole Sieweke
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Manfred Kaps
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
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Fazekas F, Enzinger C, Schmidt R, Grittner U, Giese AK, Hennerici MG, Huber R, Jungehulsing GJ, Kaps M, Kessler C, Martus P, Putaala J, Ropele S, Tanislav C, Tatlisumak T, Thijs V, von Sarnowski B, Norrving B, Rolfs A. Brain Magnetic Resonance Imaging Findings Fail to Suspect Fabry Disease in Young Patients With an Acute Cerebrovascular Event. Stroke 2015; 46:1548-53. [DOI: 10.1161/strokeaha.114.008548] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Fabry disease (FD) may cause stroke and is reportedly associated with typical brain findings on magnetic resonance imaging (MRI). In a large group of young patients with an acute cerebrovascular event, we wanted to test whether brain MRI findings can serve to suggest the presence of FD.
Methods—
The Stroke in Young Fabry Patients (SIFAP 1) study prospectively collected clinical, laboratory, and radiological data of 5023 patients (18–55 years) with an acute cerebrovascular event. Their MRI was interpreted centrally and blinded to all other information. Biochemical findings and genetic testing served to diagnose FD in 45 (0.9%) patients. We compared the imaging findings between FD and non-FD patients in patients with at least a T2-weighted MRI of good quality.
Results—
A total of 3203 (63.8%) patients had the required MRI data set. Among those were 34 patients with a diagnosis of FD (1.1%), which was definite in 21 and probable in 13 cases. The median age of patients with FD was slightly lower (45 versus 46 years) and women prevailed (70.6% versus 40.7%;
P
<0.001). Presence or extent of white matter hyperintensities, infarct localization, vertebrobasilar artery dilatation, T1-signal hyperintensity of the pulvinar thalami, or any other MRI finding did not distinguish patients with FD from non-FD cerebrovascular event patients. Pulvinar hyperintensity was not present in a single patient with FD but seen in 6 non-FD patients.
Conclusions—
Brain MRI findings cannot serve to suspect FD in young patients presenting with an acute cerebrovascular event. This deserves consideration in the search for possible causes of young patients with stroke.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00414583.
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Affiliation(s)
- Franz Fazekas
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Christian Enzinger
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Reinhold Schmidt
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Ulrike Grittner
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Anne-Katrin Giese
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Michael G. Hennerici
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Roman Huber
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Gerhard J. Jungehulsing
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Manfred Kaps
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Christof Kessler
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Peter Martus
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Jukka Putaala
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Stefan Ropele
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Christian Tanislav
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Turgut Tatlisumak
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Vincent Thijs
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Bettina von Sarnowski
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Bo Norrving
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
| | - Arndt Rolfs
- From the Department of Neurology (F.F., C.E., R.S., S.R.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Graz, Austria; Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany (U.G.); Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, Germany (A.-K.G., A.R.); Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany (M.G.H.); Department of
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Hochberg AM, Berghoff M, Schlegel J, Schmid A, Karrasch T, Kaps M, Schäffler A. Concentrations and regulation of adipokines resistin and progranulin in human cerebrospinal fluid. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tanislav C, Kropp P, Grittner U, Holzhausen M, Fazekas F, Jungehülsing GJ, Tatlisumak T, von Sarnowski B, Putaala J, Huber R, Thijs V, Schmidt R, Kaps M, Enzinger C, Dichgans M, Norrving B, Rolfs A. Clinically relevant depressive symptoms in young stroke patients - results of the sifap1 study. Neuroepidemiology 2015; 44:30-8. [PMID: 25659436 DOI: 10.1159/000371389] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. METHODS The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. RESULTS From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. CONCLUSION Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.
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Tomkins AJ, Schleicher N, Murtha L, Kaps M, Levi CR, Nedelmann M, Spratt NJ. Platelet rich clots are resistant to lysis by thrombolytic therapy in a rat model of embolic stroke. Exp Transl Stroke Med 2015; 7:2. [PMID: 25657829 PMCID: PMC4318170 DOI: 10.1186/s13231-014-0014-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/22/2014] [Indexed: 11/21/2022]
Abstract
Background Early recanalization of occluded vessels in stroke is closely associated with improved clinical outcome. Microbubble-enhanced sonothrombolysis is a promising therapy to improve recanalization rates and reduce the time to recanalization. Testing any thrombolytic therapy requires a model of thromboembolic stroke, but to date these models have been highly variable with regards to clot stability. Here, we developed a model of thromboembolic stroke in rats with site-specific delivery of platelet-rich clots (PRC) to the main stem of the middle cerebral artery (MCA). This model was used in a subsequent study to test microbubble-enhanced sonothrombolysis. Methods In Study 1 we investigated spontaneous recanalization rates of PRC in vivo over 4 hours and measured infarct volumes at 24 hours. In Study 2 we investigated tPA-mediated thrombolysis and microbubble-enhanced sonothrombolysis in this model. Results Study 1 demonstrated stable occlusion out to 4 hours in 5 of 7 rats. Two rats spontaneously recanalized at 40 and 70 minutes post-embolism. Infarct volumes were not significantly different in recanalized rats, 43.93 ± 15.44% of the ischemic hemisphere, compared to 48.93 ± 3.9% in non-recanalized animals (p = 0.7). In Study 2, recanalization was not observed in any of the groups post-treatment. Conclusions Site specific delivery of platelet rich clots to the MCA origin resulted in high rates of MCA occlusion, low rates of spontaneous clot lysis and large infarction. These platelet rich clots were highly resistant to tPA with or without microbubble-enhanced sonothrombolysis. This resistance of platelet rich clots to enhanced thrombolysis may explain recanalization failures clinically and should be an impetus to better clot-type identification and alternative recanalization methods. Electronic supplementary material The online version of this article (doi:10.1186/s13231-014-0014-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amelia J Tomkins
- School of Biomedical Sciences & Pharmacy, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Nadine Schleicher
- Heart and Brain Research Group, Justus-Liebig-University, Giessen and Kerckhoff Clinic, Bad Nauheim, Germany ; Department of Neurology, Justus-Liebig-University, Giessen, Germany ; Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Lucy Murtha
- School of Biomedical Sciences & Pharmacy, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Christopher R Levi
- Hunter New England Local Health District, Newcastle, Australia ; School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia
| | - Max Nedelmann
- Department of Neurology, Justus-Liebig-University, Giessen, Germany ; Sana Regio Klinkum, Pinneberg, Germany ; Department of Neurology, University Hospital Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neil J Spratt
- School of Biomedical Sciences & Pharmacy, University of Newcastle, and Hunter Medical Research Institute, Newcastle, Australia ; Hunter New England Local Health District, Newcastle, Australia
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von Sarnowski B, Schminke U, Grittner U, Fazekas F, Tanislav C, Kaps M, Tatlisumak T, Putaala J, Haeusler KG, Borges do Amaral E Silva AD, Kinsella JA, McCabe DJH, Tobin WO, Huber R, Willeit J, Furtner M, Bodechtel U, Rolfs A, Kessler C, Hennerici MG. Cervical artery dissection in young adults in the stroke in young Fabry patients (sifap1) study. Cerebrovasc Dis 2015; 39:110-21. [PMID: 25634656 DOI: 10.1159/000371338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with carotid artery dissection (CAD) have been reported to have different vascular risk factor profiles and clinical outcomes to those with vertebral artery dissection (VAD). However, there are limited data from recent, large international studies comparing risk factors and clinical features in patients with cervical artery dissection (CeAD) with other TIA or ischemic stroke (IS) patients of similar age and sex. METHODS We analysed demographic, clinical and risk factor profiles in TIA and IS patients ≤55 years of age with and without CeAD in the large European, multi-centre, Stroke In young FAbry Patients 1 (sifap1) study. Patients were further categorised according to age (younger: 18-44 years; middle-aged: 45-55 years), sex, and site of dissection. RESULTS Data on the presence of dissection were available in 4,208 TIA and IS patients of whom 439 (10.4%) had CeAD: 196 (50.1%) had CAD, 195 (49.9%) had VAD, and 48 had multiple artery dissections or no information regarding the dissected artery. The prevalence of CAD was higher in women than in men (5.9 vs. 3.8%, p < 0.01), whereas the prevalence of VAD was similar in women and men (4.6 vs. 4.7%, n.s.). Patients with VAD were younger than patients with CAD (median = 41 years (IQR = 35-47 years) versus median = 45 years (IQR = 39-49 years); p < 0.01). At stroke onset, about twice as many patients with either CAD (54.0 vs. 23.1%, p < 0.001) or VAD (63.4 vs. 36.6%, p < 0.001) had headache than patients without CeAD and stroke in the anterior or posterior circulation, respectively. Compared to patients without CeAD, hypertension, concomitant cardiovascular diseases and a patent foramen ovale were significantly less prevalent in both CAD and VAD patients, whereas tobacco smoking, physical inactivity, obesity and a family history of cerebrovascular diseases were found less frequently in CAD patients, but not in VAD patients. A history of migraine was observed at a similar frequency in patients with CAD (31%), VAD (27.8%) and in those without CeAD (25.8%). CONCLUSIONS We identified clinical features and risk factor profiles that are specific to young patients with CeAD, and to subgroups with either CAD or VAD compared to patients without CeAD. Therefore, our data support the concept that certain vascular risk factors differentially affect the risk of CAD and VAD.
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Affiliation(s)
- Bettina von Sarnowski
- Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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