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Rapp K, Roigk P, Becker C, Todd C, Rehm M, Rothenbacher D, Konnopka C, König HH, Friess T, Büchele G. Association of two geriatric treatment systems with anti-osteoporotic drug treatment and second hip fracture in patients with an index hip fracture: retrospective cohort study. BMC Geriatr 2024; 24:395. [PMID: 38702593 PMCID: PMC11069171 DOI: 10.1186/s12877-024-04989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND In Germany, geriatricians deliver acute geriatric care during acute hospital stay and post-acute rehabilitation after transfer to a rehabilitation clinic. The rate patients receive acute geriatric care (AGC) or are transferred to post-acute rehabilitation (TPR) differs between hospitals. This study analyses the association between the two geriatric treatment systems (AGC, TPR) and second hip fracture in patients following an index hip fracture. METHODS Nationwide health insurance data are used to identify the rate of AGC and TPR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes are a second hip fracture after surgery or after discharge within 180 or 360 days and new specific anti-osteoporotic drugs. Cox proportional hazard models and generalised linear models are applied. RESULTS Data from 29,096 hip fracture patients from 652 hospitals were analysed. AGC and TPR are not associated with second hip fracture when follow-up started after surgery. However, during the first months after discharge patients from hospitals with no AGC or low rates of TPR have higher rates of second hip fracture than patients from hospitals with high rates of AGC or high rates of TPR (Hazard Ratio (95% CI) 1.35 (1.01-1.80) or 1.35 (1.03-1.79), respectively). Lower rates of AGC are associated with lower probabilities of new prescriptions of specific anti-osteoporotic drugs. CONCLUSIONS Our study suggests beneficial relationships of geriatric treatment after hip fracture with a) the risk of second hip fractures during the first months after discharge and b) an improvement of anti-osteoporotic drug treatment.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Unit Digitale Geriatrie, Universtiätsklinikum Heidelberg, Heidelberg, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Center for Trauma Research, Ulm University, Ulm, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friess
- AUC - Akademie der Unfallchirurgie GmbH, Wilhelm-Hale-Straße 46B, Munich, 80639, Germany
| | - Gisela Büchele
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.
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2
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Rehm M, Jaensch A, Schöttker B, Mons U, Hahmann H, Koenig W, Brenner H, Rothenbacher D. Medical care and biomarker-based assessment of mortality in two cohorts of patients with chronic coronary syndrome 10 years apart. BMC Cardiovasc Disord 2023; 23:428. [PMID: 37644408 PMCID: PMC10466796 DOI: 10.1186/s12872-023-03469-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to describe the characteristics and mortality of two cohorts of patients with chronic coronary syndrome (CCS) recruited with identical study designs in the same rehabilitation clinics but approximately 10 years apart. METHODS The KAROLA cohorts included patients with CCS participating in an inpatient cardiac rehabilitation programme in Germany (KAROLA-I: years 1999/2000, KAROLA-II: 2009-2011). Blood samples and information on sociodemographic factors, lifestyle, and medical treatment were collected at baseline, at the end of rehabilitation, and after one year of follow-up. A biomarker-based risk model (ABC-CHD model) and Cox regression analysis were used to evaluate cardiovascular (CV) and non-CV mortality risk. RESULTS We included 1130 patients from KAROLA-I (mean age 58.7 years, 84.4% men) and 860 from KAROLA-II (mean age 60.4 years, 83.4% men). Patients in the KAROLA-I cohort had significantly higher concentrations of CV biomarkers and fewer patients were taking CV medications, except for statins. The biomarker-based ABC-CHD model provided a higher estimate of CV death risk for patients in the KAROLA-I cohort (median 3-year risk, 3.8%) than for patients in the KAROLA-II cohort (median 3-year risk, 2.7%, p-value for difference < 0.001). After 10 years of follow-up, 91 (8.1%) patients in KAROLA-I and 45 (5.2%) in KAROLA-II had died from a CV event. CONCLUSIONS Advances in disease management over the past 20 years may have led to modest improvements in pharmacological treatment during cardiac rehabilitation and long-term outpatient care for patients with CCS. However, modifiable risk factors such as obesity have increased in the more recent cohort and should be targeted to further improve the prognosis of these patients.
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Affiliation(s)
- Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Harry Hahmann
- Klinik Schwabenland, Isny-Neutrauchburg, Isny, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumour Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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3
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Rapp K, Becker C, Todd C, Rehm M, Rothenbacher D, Konnopka C, König HH, Friess T, Büchele G. Association of two geriatric treatment systems on care home admission and mortality in patients with hip fracture. BMC Geriatr 2022; 22:459. [PMID: 35624422 PMCID: PMC9145150 DOI: 10.1186/s12877-022-03037-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this study was to analyse the association between the two geriatric treatment systems and care home admission or mortality in patients following hip fracture. METHODS Health insurance claims data were used to identify the rate of AGC per hospital and the rate of TSR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes were cumulative admission to a care home and cumulative mortality within 6 months after hospital admission. RESULTS Data from 23,046 hip fracture patients from 561 hospitals were analysed. The rate of AGC was not associated with care home admission. However, compared to high rates of AGC medium rates or no AGC were associated with increased death rates by 12% or 20%, respectively. Treatment in hospitals with low rates of TSR was associated with a 8% higher risk of care home admission and a 10% increased risk of death compared to treatment in hospitals with high rates of TSR. CONCLUSIONS Our study suggests potential effects of geriatric treatment: reduction of mortality in hospitals with high rates of AGC or reduction of care home admission and mortality in hospitals with high rates of TSR.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr.110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr.110, 70376, Stuttgart, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Center for Trauma Research, Ulm University, Ulm, Germany
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friess
- AUC - Akademie der Unfallchirurgie GmbH, Wilhelm-Hale-Straße 46b, 80639, München, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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4
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Rehm M, Rothenbacher D, Iacoviello L, Costanzo S, Tunstall‐Pedoe H, Fitton CA, Söderberg S, Hultdin J, Salomaa V, Jousilahti P, Palosaari T, Kuulasmaa K, Waldeyer C, Schnabel RB, Zeller T, Blankenberg S, Koenig W. Chronic kidney disease and risk of atrial fibrillation and heart failure in general population-based cohorts: the BiomarCaRE project. ESC Heart Fail 2022; 9:57-65. [PMID: 34825788 PMCID: PMC8788046 DOI: 10.1002/ehf2.13699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Chronic kidney disease (CKD) has a complicated relationship with the heart, leading to many adverse outcomes. The aim of this study was to evaluate the relationship between CKD and the incidence of atrial fibrillation (AF) and heart failure (HF) along with mortality as a competing risk in general population cohorts. We also included an assessment of baseline biomarkers of inflammation, myocardial injury, and left ventricular dysfunction with risk of AF and HF, respectively, to shed light on the potential underlying pathophysiology. METHODS AND RESULTS This study was conducted within the BiomarCaRE project using harmonized data from 12 European population-based cohorts (n = 48 518 participants). Renal function was assessed by glomerular filtration rate estimated using the combined Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation with standardized serum creatinine (Cr) and non-standardized serum cystatin C (CysC). Incidence of AF and HF respectively, during a median follow-up of 8 years was recorded. Cox proportional hazards models were used to determine hazard ratios (HRs) for the incidence of AF and HF in CKD and the competing risk of mortality after adjustment for covariates. The mean age at baseline was 51.4 (standard deviation 12.1) years, 49% were men. Overall, 4.3% of subjects had CKD at baseline. The rate for AF was 3.8 per 1000 person-years during follow-up. The HR for AF in patients with CKD compared with patients without CKD was 1.28 (95% confidence interval 1.07-1.54) after adjustment for covariates. The rate for incident HF was 4.1 per 1000 person-years and the HR of CKD for HF was 1.71 (95% confidence interval 1.45-2.01. In subjects with CKD, N-terminal-pro-brain natriuretic peptide (NT-proBNP) showed an association with AF, whereas NT-proBNP and C-reactive protein were associated with HF. CONCLUSIONS Chronic kidney disease is an independent risk factor for subsequent AF and is even more closely associated with HF. In these relatively young participants with CKD, NT-proBNP was strongly associated with subsequent risk of AF. For HF, in addition, elevated levels of hs-C-reactive protein at baseline were related to incident events.
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Affiliation(s)
- Martin Rehm
- Institute of Epidemiology and Medical BiometryUlm UniversityHelmholtzstr. 22UlmD‐89081Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical BiometryUlm UniversityHelmholtzstr. 22UlmD‐89081Germany
| | - Licia Iacoviello
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilliItaly
- Research Center in Epidemiology and Preventive Medicine (EPIMED). Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Simona Costanzo
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilliItaly
| | - Hugh Tunstall‐Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular ResearchUniversity of DundeeDundeeUK
| | | | - Stefan Söderberg
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical ChemistryUmeå UniversityUmeåSweden
| | | | | | | | | | - Christoph Waldeyer
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Renate B. Schnabel
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Tanja Zeller
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Stefan Blankenberg
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical BiometryUlm UniversityHelmholtzstr. 22UlmD‐89081Germany
- Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
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5
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Klimek M, Büchele G, Rehm M, Beyersmann J, Günther KP, Brenner H, Stürmer T, Brenner RE, Rothenbacher D. Long-term mortality of patients with osteoarthritis after joint replacement: Prognostic value of pre- and postoperative pain and function. Arthritis Care Res (Hoboken) 2021; 75:869-875. [PMID: 34738320 DOI: 10.1002/acr.24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate whether osteoarthritis (OA)-specific assessment values (i.e. Western Ontario and McMaster University Osteoarthritis Index [WOMAC]) and generic pain and function (visual analog scale [VAS], Hanover Functionality Status Questionnaire [FFbH]) measured before and 12 months after arthroplasty are associated with the risk of long-term mortality in a cohort of patients with advanced OA of the hip or knee. METHODS The Ulm Osteoarthritis Study was a prospective cohort study of OA patients with unilateral total hip or knee replacement between January 1995 and December 1996. Correlation coefficients were calculated to describe the agreement between the different assessments. Mortality was assessed during the follow-up period (last update: July 2019). Cox proportional regression models were used to estimate hazard ratios (HRs) for mortality after adjusting for covariates. RESULTS Arthroplasty was accompanied by a clear reduction in pain and improved function throughout all assessments in the 706 included patients. The results of the adjusted Cox models showed no relationship between baseline and follow-up joint-specific WOMAC assessments and long-term mortality. However, an independent increased risk of mortality was found with generic function assessments. In the final adjusted model, the HR for the 12-month follow-up value was 1.79 (95% confidence interval, 1.24-2.60) in the group with clinically relevant impairment versus the reference group. CONCLUSIONS Poor function based on the generic assessment was associated with increased long-term mortality, suggesting that functional impairments in daily life activities may be more important for long-term survival than OA-specific impairments in this patient group. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthias Klimek
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rolf E Brenner
- Department of Orthopedics, Division for Biochemistry of Joint and Connective Tissue Diseases, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Centre for Trauma Research, Ulm University, Ulm, Germany
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6
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Hofmann-Kiefer KF, Kemming GI, Chappell D, Flondor M, Kisch-Wedel H, Hanser A, Pallivathukal S, Conzen P, Rehm M. Correction to: Serum heparan sulfate levels are elevated in endotoxemia. Eur J Med Res 2021; 26:126. [PMID: 34717754 PMCID: PMC8556908 DOI: 10.1186/s40001-021-00600-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- K F Hofmann-Kiefer
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany.
| | - G I Kemming
- Department of Anesthesiology and Intensive Care Medicine, Kreiskliniken Günzburg-Krumbach, Günzburg, Germany.,Institute for Surgical Research, Ludwig-Maximilians-University, Munich, Germany
| | - D Chappell
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany
| | - M Flondor
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany.,Institute for Surgical Research, Ludwig-Maximilians-University, Munich, Germany
| | - H Kisch-Wedel
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany.,Institute for Surgical Research, Ludwig-Maximilians-University, Munich, Germany
| | - A Hanser
- Clinic of Pediatrics, Common Hospital, Augsburg, Germany.,Institute for Surgical Research, Ludwig-Maximilians-University, Munich, Germany
| | - S Pallivathukal
- Department of Neonatology, Clinic of Gynaecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany.,Institute for Surgical Research, Ludwig-Maximilians-University, Munich, Germany
| | - P Conzen
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany
| | - M Rehm
- Clinic of Anesthesiology/Critical Care Medicine and Pain therapy (M.A.B., P.C), Ludwig-Maximilians-University, Munich, Germany
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7
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Rehm M, Rothenbacher D, Iacoviello L, Costanzo S, Tunstall-Pedoe H, Fitton C, Soederberg S, Hultdin J, Salomaa V, Palosaari T, Waldeyer C, Schnabel R, Zeller T, Blankenberg S, Koenig W. Chronic kidney disease and risk of atrial fibrillation and heart failure in general population-based cohorts – the BiomarCaRE project. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) has a complicated relationship with the heart, leading to many adverse outcomes.
Purpose
The aim of the study was to evaluate the relationship between CKD and the incidence of atrial fibrillation (AF) and heart failure (HF) along with mortality as a competing risk in general population cohorts.
Methods
This study was conducted as part of the BiomarCaRE project using harmonised data from 12 population-based cohorts (n=40,212) from Europe. Cox proportional hazards models were used to determine hazard ratios (HRs) for the incidence of AF and HF in CKD and with competing mortality risk after adjusting for covariates.
Results
Mean age at baseline was 51.1 (standard deviation 11.9) years, and 49.3% were men. Overall, 3.5% had CKD at baseline. The rate for incident AF was 3.9 per 1000 person-years during follow-up. The HR for AF for those with CKD compared with those without was 1.23 (95% CI 1.00–1.52, p=0.0465) after adjustment for covariates. The rate for incident HF was 3.9 per 1000 person-years and the associated risk in the presence of CKD was HR 1.67 (95% CI 1.39–2.01). In subjects with CKD, N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed an association with AF, while NT-proBNP and C-reactive protein (CRP) showed an association with HF.
Conclusion
CKD is an independent risk factor for subsequent AF and even more so for HF. In patients with CKD, NT-proBNP was clearly associated with subsequent risk of AF. In addition to this marker, hs-CRP was also associated with risk of subsequent HF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011_278913. Atrial Fibrillation and HF in CKD
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Affiliation(s)
- M Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - L Iacoviello
- IRCCS Neuromed, Department of Epidemiology and Prevention, Pozilli, Italy
| | - S Costanzo
- IRCCS Neuromed, Department of Epidemiology and Prevention, Pozilli, Italy
| | - H Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
| | - C.A Fitton
- University of Dundee, Division of Molecular and Clinical Medicine, Dundee, United Kingdom
| | - S Soederberg
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - J Hultdin
- Umea University, Department of Medical Biosciences, Clinical Chemistry, Umea, Sweden
| | - V Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Palosaari
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - C Waldeyer
- University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - R.B Schnabel
- University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - T Zeller
- University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - W Koenig
- German Heart Centre Munich, Munich, Germany
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8
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Hulde N, Rogenhofer N, Brettner F, Eckert NC, Fetz I, Buchheim JI, Kammerer T, Dendorfer A, Choukèr A, Hofmann-Kiefer KF, Rehm M, Thaler C. Effects of controlled ovarian stimulation on vascular barrier and endothelial glycocalyx: a pilot study. J Assist Reprod Genet 2021; 38:2273-2282. [PMID: 34286421 PMCID: PMC8490540 DOI: 10.1007/s10815-021-02233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/11/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Controlled ovarian stimulation significantly amplifies the number of maturing and ovulated follicles as well as ovarian steroid production. The ovarian hyperstimulation syndrome (OHSS) increases capillary permeability and fluid extravasation. Vascular integrity intensely is regulated by an endothelial glycocalyx (EGX) and we have shown that ovulatory cycles are associated with shedding of EGX components. This study investigates if controlled ovarian stimulation impacts on the integrity of the endothelial glycocalyx as this might explain key pathomechanisms of the OHSS. Methods Serum levels of endothelial glycocalyx components of infertility patients (n=18) undergoing controlled ovarian stimulation were compared to a control group of healthy women with regular ovulatory cycles (n=17). Results Patients during luteal phases of controlled ovarian stimulation cycles as compared to normal ovulatory cycles showed significantly increased Syndecan-1 serum concentrations (12.6 ng/ml 6.1125th–19.1375th to 13.9 ng/ml 9.625th–28.975th; p=0.026), indicating shedding and degradation of the EGX. Conclusion A shedding of EGX components during ovarian stimulation has not yet been described. Our study suggests that ovarian stimulation may affect the integrity of the endothelial surface layer and increasing vascular permeability. This could explain key features of the OHSS and provide new ways of prevention of this serious condition of assisted reproduction.
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Affiliation(s)
- Nikolai Hulde
- Department of Anesthesiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr 11, 32545, Bad Oeynhausen, Germany.
| | - N Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - F Brettner
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - N C Eckert
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - I Fetz
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - J-I Buchheim
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - T Kammerer
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - A Dendorfer
- Walter-Brendel-Centre of Experimental Medicine, Hospital of the University Munich, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - A Choukèr
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - K F Hofmann-Kiefer
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - M Rehm
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - C Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
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Rehm M, Moukarzel S, Daly AJ, del Fresno M. Exploring online social networks of school leaders in times of COVID-19. Br J Educ Technol 2021; 52:1414-1433. [PMID: 34219757 PMCID: PMC8237009 DOI: 10.1111/bjet.13099] [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: 11/11/2020] [Revised: 02/12/2021] [Accepted: 03/18/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has raised a wide range of challenges for school leaders that they now (rapidly) have to address. Consequently, they also turn to informal learning networks, in order to share and collect information and reach out to their communities. In this context, the current study investigates the underlying networks structures among school leaders, what type of information is being shared, and what differences can be identified when comparing a nation-wide and a localized sample. We collected data from a US nation-wide sample of 15 relevant Twitter conversations, as well as Tweets from an US urban mid-sized public school district. Using a mixed-methods approach, we discovered several key structural dimensions and a host of highly influential actors. Moreover, we found semantic evidence for users sharing information on topics such as status reports. Finally, we discovered that the urban sample did not overly use the nation-wide, very specific approach of including COVID-19 related hashtags. Instead, they used more localized terminologies. These findings are valuable for policy makers, as they map the underlying communication patterns and provide valuable insights into who is moving what types of resources as part of the emerging governance approach on social media.
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Affiliation(s)
- Martin Rehm
- Institute for Educational ConsultingPädagogische Hochschule WeingartenWeingartenGermany
| | - Sara Moukarzel
- Department of Education StudiesUniversity of CaliforniaSan DiegoCAUSA
| | - Alan J. Daly
- Department of Education StudiesUniversity of CaliforniaSan DiegoCAUSA
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10
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Rehm M, Büchele G, Peter RS, Brenner RE, Günther KP, Brenner H, Koenig W, Rothenbacher D. Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis. PLoS One 2020; 15:e0242814. [PMID: 33264342 PMCID: PMC7710029 DOI: 10.1371/journal.pone.0242814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is associated with adverse cardio-metabolic features. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponins T and I (hs-cTnT and hs-cTnI) are well-characterized cardiac markers and provide prognostic information. The objective was to assess the association of cardiac biomarker concentrations with long-term mortality in subjects with OA. In a cohort of 679 OA subjects, undergoing hip or knee replacement during 1995/1996, cardiac biomarkers were measured and subjects were followed over 20 years. During a median follow-up of 18.4 years, 332 (48.9%) subjects died. Median of hs-cTnT, hs-cTnI, and NT-proBNP at baseline was 3.2 ng/L, 3.9 ng/L, and 96.8 ng/L. The top quartile of NT-proBNP was associated with increased risk of mortality (Hazard Ratio (HR) 1.79, 95% confidence interval (CI) 1.17–2.73) after adjustment for covariates including troponins (hs-cTnT HR 1.30 (95% CI 0.90–1.89), hs-cTnI HR 1.32 (95% CI 0.87–2.00) for top category). When biomarker associations were evaluated as continuous variables, only NT-proBNP (HR per log-unit increment 1.34, 95% CI 1.16–1.54) and hs-cTnI (HR 1.38, 95% CI 1.11–1.72) showed robust results. Elevated cardiac biomarker concentrations predicted an increased risk of long-term mortality and strongest for NT-proBNP and hs-cTnI. These results might help to identify subjects at risk and target preventive efforts early.
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Affiliation(s)
- Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rolf Erwin Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Ulm University, Ulm, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedic and Trauma Surgery, Technical University of Dresden, Dresden, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- * E-mail:
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11
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Rothenbacher D, Rehm M, Iacoviello L, Costanzo S, Tunstall-Pedoe H, Belch JJF, Söderberg S, Hultdin J, Salomaa V, Jousilahti P, Linneberg A, Sans S, Padró T, Thorand B, Meisinger C, Kee F, McKnight AJ, Palosaari T, Kuulasmaa K, Waldeyer C, Zeller T, Blankenberg S, Koenig W. Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project. BMC Med 2020; 18:300. [PMID: 33161898 PMCID: PMC7650190 DOI: 10.1186/s12916-020-01776-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease has emerged as a strong cardiovascular risk factor, and in many current guidelines, it is already considered as a coronary heart disease (CHD) equivalent. Routinely, creatinine has been used as the main marker of renal function, but recently, cystatin C emerged as a more promising marker. The aim of this study was to assess the comparative cardiovascular and mortality risk of chronic kidney disease (CKD) using cystatin C-based and creatinine-based equations of the estimated glomerular filtration rate (eGFR) in participants of population-based and disease cohorts. METHODS The present study has been conducted within the BiomarCaRE project, with harmonized data from 20 population-based cohorts (n = 76,954) from 6 European countries and 3 cardiovascular disease (CVD) cohorts (n = 4982) from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for the Systematic COronary Risk Evaluation (SCORE) variables and study center. Main outcome measures were cardiovascular diseases, cardiovascular death, and all-cause mortality. RESULTS The overall prevalence of CKD stage 3-5 by creatinine- and cystatin C-based eGFR, respectively, was 3.3% and 7.4% in the population-based cohorts and 13.9% and 14.4% in the disease cohorts. CKD was an important independent risk factor for subsequent CVD events and mortality. For example, in the population-based cohorts, the HR for CVD mortality was 1.72 (95% CI 1.53 to 1.92) with creatinine-based CKD and it was 2.14 (95% CI 1.90 to 2.40) based on cystatin-based CKD compared to participants without CKD. In general, the HRs were higher for cystatin C-based CKD compared to creatinine-based CKD, for all three outcomes and risk increased clearly below the conventional threshold for CKD, also in older adults. Net reclassification indices were larger for a cystatin-C based CKD definition. Differences in HRs (between the two CKD measures) in the disease cohorts were less pronounced than in the population-based cohorts. CONCLUSION CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of creatinine- and cystatin C-based CKD differed considerably between low- and high-risk populations. Especially in low-risk settings, the use of cystatin C-based CKD may result in more accurate risk estimates and have better prognostic value.
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Affiliation(s)
- Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany. .,Division of Clinical Epidemiology and Aging Research C070, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Jill J F Belch
- Vascular Medicine Unit, Institute of Cardiovascular Disease, University of Dundee, Dundee, UK
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Susana Sans
- Catalan Department of Health, 08005, Barcelona, Spain
| | - Teresa Padró
- Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Ludwig-Maximilians-Universität München, Chair of Epidemiology at UNIKA-T Augsburg, Augsburg, Germany
| | - Frank Kee
- Queen's University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
| | | | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Christoph Waldeyer
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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12
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Rogenhofer N, Hulde N, Brettner F, Götzfried I, Buchheim JI, Kammerer T, Dendorfer A, Chouker A, Hofmann-Kiefer KF, Rehm M, Thaler CJ. Effects of controlled ovarian stimulation on vascular barrier and endothelial glycocalyx a pilot study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717692] [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: 10/23/2022] Open
Affiliation(s)
- N Rogenhofer
- LMU Klinik für Frauenheilkunde und Geburtshilfe, Hormon- und Kinderwunschzentrum
| | - N Hulde
- LMU Klinik für Anästhesiologie
| | | | | | | | | | | | | | | | - M Rehm
- LMU Klinik für Anästhesiologie
| | - CJ Thaler
- LMU Klinik für Frauenheilkunde und Geburtshilfe, Hormon- und Kinderwunschzentrum
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13
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White K, Connor K, Clerkin J, Murphy BM, Salvucci M, O'Farrell AC, Rehm M, O'Brien D, Prehn JHM, Niclou SP, Lamfers MLM, Verreault M, Idbaih A, Verhaak R, Golebiewska A, Byrne AT. New hints towards a precision medicine strategy for IDH wild-type glioblastoma. Ann Oncol 2020; 31:1679-1692. [PMID: 32918998 DOI: 10.1016/j.annonc.2020.08.2336] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/13/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma represents the most common primary malignancy of the central nervous system in adults and remains a largely incurable disease. The elucidation of disease subtypes based on mutational profiling, gene expression and DNA methylation has so far failed to translate into improved clinical outcomes. However, new knowledge emerging from the subtyping effort in the IDH-wild-type setting may provide directions for future precision therapies. Here, we review recent learnings in the field, and further consider how tumour microenvironment differences across subtypes may reveal novel contexts of vulnerability. We discuss recent treatment approaches and ongoing trials in the IDH-wild-type glioblastoma setting, and propose an integrated discovery stratagem incorporating multi-omics, single-cell technologies and computational approaches.
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Affiliation(s)
- K White
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Connor
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Clerkin
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland; National Neurosurgical Department, Beaumont Hospital, Dublin, Ireland
| | - B M Murphy
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Salvucci
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A C O'Farrell
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Rehm
- Institute of Cell Biology and Immunology and Stuttgart Research Center Systems Biology, University of Stuttgart, Stuttgart, Germany
| | - D O'Brien
- National Neurosurgical Department, Beaumont Hospital, Dublin, Ireland
| | - J H M Prehn
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg
| | - M L M Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - M Verreault
- Sorbonne Université, Institut du Cerveau et de la Moelle Épinière, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie, Paris, France
| | - A Idbaih
- Sorbonne Université, Institut du Cerveau et de la Moelle Épinière, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie, Paris, France
| | - R Verhaak
- Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - A Golebiewska
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg
| | - A T Byrne
- Precision Cancer Medicine Group, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.
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14
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Moukarzel S, Rehm M, del Fresno M, Daly AJ. Diffusing science through social networks: The case of breastfeeding communication on Twitter. PLoS One 2020; 15:e0237471. [PMID: 32790712 PMCID: PMC7425887 DOI: 10.1371/journal.pone.0237471] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Breastfeeding is one of many health practices known to support the survival and health of mother and infant, yet low breastfeeding rates persist globally. These rates may be influenced by limited diffusion of evidence-based research and guidelines from the scientific community (SC). As recently highlighted by the National Academy of Sciences, there is a need for the SC to diffuse its findings to the public more effectively online, as means to counteract the spread of misinformation. In response to this call, we gathered data from Twitter for one month from major breastfeeding hashtags resulting in an interconnected social network (n = 3,798 users). We then identified 59 influencers who disproportionately influenced information flow using social network analysis. These influencers were from the SC (e.g. academics, researchers, health care practitioners), as well as interested citizens (IC) and companies. We then conducted an ego-network analysis of influencer networks, developed ego maps, and compared diffusion metrics across the SC, IC and company influencers. We also qualitatively analyzed their tweets (n = 711) to understand the type of information being diffused. SC influencers were the least efficient communicators. Although having the highest tweeting activity (80% of tweets), they did not reach more individuals compared to IC and companies (two-step ego size: 220± 99, 188 ± 124, 169 ± 97 respectively, P = 0.28). Content analysis of tweets suggest IC are more active than the SC in diffusing evidence-based breastfeeding knowledge, with 35% of their tweets around recent research findings compared to only 12% by the SC. Nonetheless, in terms of outreach to the general public, the two-step networks of SC influences were more heterogenous than ICs (55.7 ± 5.07, 50.9 ± 12.0, respectively, P<0.001). Collectively, these findings suggest SC influencers may possess latent potential to diffuse research and evidence- based practices. However, the research suggests specific ways to enhance diffusion.
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Affiliation(s)
- Sara Moukarzel
- Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, CA, United States of America
- Department of Education Studies, University of California San Diego, La Jolla, CA, United States of America
- * E-mail:
| | - Martin Rehm
- Institute of Educational Consulting, University of Education Weingarten, Weingarten, Germany
| | - Miguel del Fresno
- Department of Social Work, National Distance Education University, Madrid, Spain
| | - Alan J. Daly
- Department of Education Studies, University of California San Diego, La Jolla, CA, United States of America
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15
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Eichler J, Rehm M, Azad SC. „Legal Highs“ (neue psychoaktive Substanzen). Anaesthesist 2020; 69:599-608. [DOI: 10.1007/s00101-020-00790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Moukarzel S, Rehm M, Daly AJ. Breastfeeding promotion on Twitter: A social network and content analysis approach. Matern Child Nutr 2020; 16:e13053. [PMID: 32638522 PMCID: PMC7507587 DOI: 10.1111/mcn.13053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/22/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Abstract
The importance of breastfeeding for maternal and infant health is well‐established, yet complex and intertwined sociocultural barriers contribute to suboptimal breastfeeding rates in most countries. Large‐scale campaigns for evidence dissemination and promotion through targeted interventions on social media may help overcome some of these barriers. To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence‐based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared. The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non‐PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward‐oriented interaction (% composition, E‐I index: 47% professionals, −0.18; 41% interested citizens, −0.67; 12% companies, −0.18), limiting opportunities for evidence‐based dissemination to the lay public. Although more tweets about peer‐reviewed research findings were sent compared with tweets about nonevidence‐based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network‐based intervention.
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Affiliation(s)
- Sara Moukarzel
- Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, California, USA.,Department of Education Studies, University of California San Diego, La Jolla, California, USA
| | - Martin Rehm
- Institute of Educational Consulting, University of Education Weingarten, Weingarten, Germany
| | - Alan J Daly
- Department of Education Studies, University of California San Diego, La Jolla, California, USA
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17
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Tsur N, Kogan Y, Rehm M, Agur Z. Response of patients with melanoma to immune checkpoint blockade – insights gleaned from analysis of a new mathematical mechanistic model. J Theor Biol 2020; 485:110033. [DOI: 10.1016/j.jtbi.2019.110033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/05/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022]
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18
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Fleischhacker E, Trentzsch H, Kuppinger D, Piltz S, Beyer F, Meigel F, Kammerer T, Rehm M, Hartl WH. Fluid resuscitation after severe trauma injury : U-shaped associations between tetrastarch dose and survival time or frequency of acute kidney failure. Med Klin Intensivmed Notfmed 2019; 115:591-599. [PMID: 31696249 DOI: 10.1007/s00063-019-00625-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/28/2019] [Revised: 08/08/2019] [Accepted: 08/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Using tetrastarch for fluid resuscitation after a severe trauma injury may increase risks of death and acute kidney injury. The importance of tetrastarch dose, however, is unknown. METHODS A retrospective observational study was performed in two trauma centres using data on type and amount of fluids (balanced crystalloids or tetrastarch) used for pre- and acute in-hospital shock management. We evaluate independent associations between the relative and absolute volumes of tetrastarch and 90-day survival time or the frequency of severe acute kidney failure (AKF). RESULTS We studied 271 patients who had sustained a severe blunt trauma injury (average predicted mortality according to the Revised Injury Severity Classification Score (RISC) 15.1 ± 1.4% [mean, standard deviation]), and who had required more than 2 days of intensive care therapy. In all, 75.3% of patients had received tetrastarch with a crystalloid/colloid ratio of 2.93 ± 2.60. The 90-day mortality was 11.1%, and 7.8% of the patients developed severe AKF. After adjusting for confounders, we found a U-shaped, nonlinear association between absolute or relative volumes of tetrastarch and survival time (p = 0.003 and 0.025, respectively). Optimal relative volumes of tetrastarch approximately ranged from 20 to 30% of total fluids. Giving less than about 1000 ml, or more than about 2000 ml tetrastarch was significantly associated with an increased risk of developing severe AKF (p = 0.023). CONCLUSIONS There was a complex U‑shaped association between the tetrastarch dose and morbidity/mortality of patients after a severe trauma injury. The optimal crystalloid/tetrastarch ratio for acute shock management appears to range from about 2.5 to 4.0.
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Affiliation(s)
- E Fleischhacker
- Department of General, Trauma and Reconstruction Surgery with Integrated Fracture Liaison Service, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Munich, Germany
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians Universität, Munich, Germany
| | - D Kuppinger
- Department of General, Visceral and Transplantation Surgery, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
| | - S Piltz
- Department of General, Trauma and Reconstruction Surgery with Integrated Fracture Liaison Service, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Munich, Germany
- Department of Orthopaedic Surgery, Municipal Hospital Coburg, Coburg, Germany
| | - F Beyer
- Department of General, Visceral and Transplantation Surgery, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
- Department of Orthopaedic Surgery, Municipal Hospital Schrobenhausen, Schrobenhausen, Germany
| | - F Meigel
- Department of General, Visceral and Transplantation Surgery, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Marchioninistr. 15, 81377, Munich, Germany
- Department of Gynaecology, Municipal Hospital Traunstein, Traunstein, Germany
| | - T Kammerer
- Department of Anaesthesiology, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Munich, Germany
- Department of Anaesthesiology and Pain Therapy, Cardiac and Diabetes Centre North Rhine-Westphalia, Bochum, Germany
| | - M Rehm
- Department of Anaesthesiology, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Munich, Germany
| | - W H Hartl
- Department of General, Visceral and Transplantation Surgery, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Marchioninistr. 15, 81377, Munich, Germany.
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Kurz CF, Rehm M, Holle R, Teuner C, Laxy M, Schwarzkopf L. The effect of bariatric surgery on health care costs: A synthetic control approach using Bayesian structural time series. Health Econ 2019; 28:1293-1307. [PMID: 31489749 DOI: 10.1002/hec.3941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/07/2018] [Revised: 05/07/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
Surgical measures to combat obesity are very effective in terms of weight loss, recovery from diabetes, and improvement in cardiovascular risk factors. However, previous studies found both positive and negative results regarding the effect of bariatric surgery on health care utilization. Using claims data from the largest health insurance provider in Germany, we estimated the causal effect of bariatric surgery on health care costs in a time period ranging from 2 years before to 3 years after bariatric intervention. Owing to the absence of a control group, we employed a Bayesian structural forecasting model to construct a synthetic control. We observed a decrease in medication and physician expenditures after bariatric surgery, whereas hospital expenditures increased in the post-intervention period. Overall, we found a slight increase in total costs after bariatric surgery, but our estimates include a high degree of uncertainty.
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Affiliation(s)
- Christoph F Kurz
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Martin Rehm
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christina Teuner
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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Rothenbacher D, Rehm M, Iacoviello L, Tunstall-Pedoe H, Soederberg S, Salomaa V, Linneberg A, Sans S, Thorand B, Kee F, Kuulasmaa K, Waldeyer C, Zeller T, Blankenberg S, Koenig W. P3398Cystatin C based eGFR estimation compared to crea-based estimation equation for assessing risk of cardiovascular and total mortality in population-based studies and patients with manifest CVD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Chronic kidney disease (CKD) represents a global public health problem and affects a large proportion of the adult population worldwide. Early detection, adequate risk stratification and specific treatment can prevent or delay the adverse effects of CKD.
Purpose
To assess cardiovascular risk and total mortality of subjects with CKD using cystatin C based and Crea-based estimated glomerular filtration rate (eGFR) equations (CKDEpi) in the general population, in diseased cohorts, and in specific subgroups.
Methods
The present study has been conducted within the BiomarCaRE project, with harmonized data from 21 population-based cohorts from 6 European countries and 3 cardiovascular disease (CVD) cohorts from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for age, sex, cohort, smoking status, body mass index, history of diabetes, history of hypertension, and total cholesterol.
Results
21 population-based cohorts (n=76,954, median age 51 years, 52.2% men, 4.4% diabetic) and 3 diseased cohorts (n=4,982, median age 63 years, 75.6% men, 18.7% diabetic) with an average follow-up between 2.8 and 23.5 years and between 0.5 and 9.4 years, respectively, were included in the analysis. Prevalence of CKD-stage 3–5 by CKD-EPIcrea and CKD-EPIcys eGFR respectively, was 3.4% and 7.3% in the population-based cohorts and 13.9% and 14.4% in the diseased cohorts. In the population-based cohorts the incidence (per 1000 person years) of a non-fatal or fatal CVD event and total mortality respectively, was 10.0 and 11.8, whereas it was 21.2 and 17.8 in the diseased cohorts. In the population-based cohorts the HR for a CVD-event was 1.32 (95% CI 1.21–1.44) for the population with CKD-EPIcrea stage 3–5 and it was 1.47 (95% CI 1.35–1.60) based on CKD-EPIcys after adjustment for covariates. The HR for total mortality for those with CKD-EPIcrea stage 3–5 was 1.31 (1.21–1.41) and for CKD-EPIcys it was 1.86 (95% CI 1.73–2.00). Discrepancies between CKD-EPIcrea and CKD-EPIcys were even more striking across subgroups with and without diabetes or across specific age groups.
Conclusion
CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of CKD-EPIcrea and CKD-EPIcys eGFR differ considerably between specific risk groups. Therefore, the clinical utility of both equations in different risk groups has to be considered and should be evaluated further.
Acknowledgement/Funding
7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011-278913
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Affiliation(s)
- D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - M Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - L Iacoviello
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Department of Epidemiology and Prevention, Laboratory of Molecular and Nutritional Epidemiology, Pozzilli, Italy
| | - H Tunstall-Pedoe
- University of Dundee, Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, Dundee, United Kingdom
| | - S Soederberg
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - A Linneberg
- Bispebjerg and Frederiksberg Hospital, Center for Clinical Research and Prevention, Copenhagen, Denmark
| | - S Sans
- Catalan Department of Health, Barcelona, Spain
| | - B Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - F Kee
- Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, United Kingdom
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - C Waldeyer
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - T Zeller
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - W Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Raps J, Groene P, Rehm M, Hofmann-Kiefer K. [52-year-old female with latent hypovolemia : Preparation for the medical specialist examination: Part 9]. Anaesthesist 2019; 68:118-122. [PMID: 30989291 DOI: 10.1007/s00101-019-0553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Raps
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland
| | - M Rehm
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland.
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Schulz C, Büchele G, Rehm M, Rothenbacher D, Roigk P, Rapp K, Günster C, König HH, Reber K. Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany. J Am Med Dir Assoc 2018; 20:451-455.e3. [PMID: 30448158 DOI: 10.1016/j.jamda.2018.09.029] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. MEASURES The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. RESULTS Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. CONCLUSIONS/IMPLICATIONS This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
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Affiliation(s)
- Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Patrick Roigk
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | - Kilian Rapp
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Reber
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Apolle R, Rehm M, Thiele J, Brückner S, Hampe J, Troost E. PO-0954: Fiducial markers and daily kV imaging improve patient setup during proton RT of esophageal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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24
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Stefanowicz S, Zschaeck S, Rehm M, Jakobi A, Stützer K, Troost E. EP-1867: Comparison of robust optimized proton planning strategies for dose escalation in pancreatic cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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25
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Lauther H, Polacsek R, Rehm M. VALID. Ein allgemein anwendbares Programmsystem zur Herstellung von Literaturverzeichnissen und zur Durchführung von Literaturrecherchen. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1635969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Es wird ein Programmsystem mit dem Namen VALID (= VAriable Literature Data) vorgestellt, das die Herstellung von Literaturverzeichnissen und die Durchführung von Literaturrecherchen ermöglicht. Das System verarbeitet jede beliebige Organisation von Daten, die zur formalen und sachlichen Beschreibung eines Dokuments maschinenlesbar erfaßt sind. Das Normierungsprogramm des Systems wandelt die in unterschiedlicher Weise erfaßten Daten in das einheitliche Format des allgemeinen Bandsatzes um. Die das System VALID benutzenden Bibliotheken und Dokumentationsstellen geben ihre Wünsche bezüglich Sortierung, Selektion und Druckbild in einer sogenannten Katalogwunschformulierung an. Diese Angaben modifizieren als Parameter die allgemeinen Programme.
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Abstract
Adequate fluid therapy is highly important for the perioperative outcome of our patients. Both, hypovolemia and hypervolemia can lead to an increase in perioperative complications and can impair the outcome. Therefore, perioperative infusion therapy should be target-oriented. The main target is to maintain the patient's preoperative normovolemia by using a sophisticated, rational infusion strategy.Perioperative fluid losses should be discriminated from volume losses (surgical blood loss or interstitial volume losses containing protein). Fluid losses as urine or perspiratio insensibilis (0.5-1.0 ml/kg/h) should be replaced by balanced crystalloids in a ratio of 1:1. Volume therapy step 1: Blood loss up to a maximum value of 20% of the patient's blood volume should be replaced by balanced crystalloids in a ratio of 4(-5):1. Volume therapy step 2: Higher blood losses should be treated by using iso-oncotic, preferential balanced colloids in a ratio of 1:1. For this purpose hydroxyethyl starch can also be used perioperatively if there is no respective contraindication, such as sepsis, burn injuries, critically ill patients, renal impairment or renal replacement therapy, and severe coagulopathy. Volume therapy step 3: If there is an indication for red cell concentrates or coagulation factors, a differentiated application of blood and blood products should be performed.
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Affiliation(s)
- M Rehm
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - N Hulde
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - T Kammerer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - A S Meidert
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Rehm M, Mulder RH, Gijselaers W, Segers M. The impact of hierarchical positions on the type of communication within online Communities of Learning. Computers in Human Behavior 2016. [DOI: 10.1016/j.chb.2015.12.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Wilbring M, Rehm M, Matschke K, Kappert U. Identification of Different Arch Types and Possible Implications for Endovascular Repair of the Aortic Arch. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Zakaria Z, Tivnan A, Flanagan L, Murray DW, Salvucci M, Stringer BW, Day BW, Boyd AW, Kögel D, Rehm M, O'Brien DF, Byrne AT, Prehn JHM. Patient-derived glioblastoma cells show significant heterogeneity in treatment responses to the inhibitor-of-apoptosis-protein antagonist birinapant. Br J Cancer 2015; 114:188-98. [PMID: 26657652 PMCID: PMC4815807 DOI: 10.1038/bjc.2015.420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 09/18/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Resistance to temozolomide (TMZ) greatly limits chemotherapeutic effectiveness in glioblastoma (GBM). Here we analysed the ability of the Inhibitor-of-apoptosis-protein (IAP) antagonist birinapant to enhance treatment responses to TMZ in both commercially available and patient-derived GBM cells. Methods: Responses to TMZ and birinapant were analysed in a panel of commercial and patient-derived GBM cell lines using colorimetric viability assays, flow cytometry, morphological analysis and protein expression profiling of pro- and antiapoptotic proteins. Responses in vivo were analysed in an orthotopic xenograft GBM model. Results: Single-agent treatment experiments categorised GBM cells into TMZ-sensitive cells, birinapant-sensitive cells, and cells that were insensitive to either treatment. Combination treatment allowed sensitisation to therapy in only a subset of resistant GBM cells. Cell death analysis identified three principal response patterns: Type A cells that readily activated caspase-8 and cell death in response to TMZ while addition of birinapant further sensitised the cells to TMZ-induced cell death; Type B cells that readily activated caspase-8 and cell death in response to birinapant but did not show further sensitisation with TMZ; and Type C cells that showed no significant cell death or moderately enhanced cell death in the combined treatment paradigm. Furthermore, in vivo, a Type C patient-derived cell line that was TMZ-insensitive in vitro and showed a strong sensitivity to TMZ and TMZ plus birinapant treatments. Conclusions: Our results demonstrate remarkable differences in responses of patient-derived GBM cells to birinapant single and combination treatments, and suggest that therapeutic responses in vivo may be greatly affected by the tumour microenvironment.
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Affiliation(s)
- Z Zakaria
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,National Centre for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - A Tivnan
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - L Flanagan
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - D W Murray
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - M Salvucci
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - B W Stringer
- Brain Cancer Research Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - B W Day
- Brain Cancer Research Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - A W Boyd
- Brain Cancer Research Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - D Kögel
- Experimental Neurosurgery, Neuroscience Center, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - M Rehm
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - D F O'Brien
- National Centre for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - A T Byrne
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J H M Prehn
- Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Fleckenstein J, Kohls N, Evtouchenko E, Lehmeyer L, Kramer S, Lang P, Siebeck M, Mussack T, Hatz R, Heindl B, Conzen P, Rehm M, Czerner S, Zwißler B, Irnich D. No effect of the cyclooxygenase-2 inhibitor etoricoxib on pre-emptive and post-operative analgesia in visceral surgery: results of a randomized controlled trial. Eur J Pain 2015; 20:186-95. [DOI: 10.1002/ejp.699] [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] [Accepted: 02/11/2015] [Indexed: 11/06/2022]
Affiliation(s)
- J. Fleckenstein
- Department of Anaesthesiology; University of Munich; Germany
| | - N. Kohls
- Division Integrative Health Promotion; University of Applied Sciences and Arts Coburg; Germany
- Brain, Mind & Healing Program; Samueli Institute; Alexandria USA
| | - E. Evtouchenko
- Department of Anaesthesiology; University of Munich; Germany
| | - L. Lehmeyer
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Kramer
- Department of Anaesthesiology; University of Munich; Germany
| | - P.M. Lang
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Siebeck
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - T. Mussack
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - R. Hatz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery; Ludwig Maximilians University; Munich Germany
| | - B. Heindl
- Department of Anaesthesiology; University of Munich; Germany
| | - P. Conzen
- Department of Anaesthesiology; University of Munich; Germany
| | - M. Rehm
- Department of Anaesthesiology; University of Munich; Germany
| | - S. Czerner
- Department of Anaesthesiology; University of Munich; Germany
| | - B. Zwißler
- Department of Anaesthesiology; University of Munich; Germany
| | - D. Irnich
- Department of Anaesthesiology; University of Munich; Germany
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Wilbring M, Rehm M, Matschke K, Kappert U. Actual Anatomical Studies of the Ascending Aorta and Aortic Arch by Computed Tomography. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544402] [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: 10/20/2022]
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33
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Rogenhofer N, Eckert N, Götzfried I, Nguyen T, Pagel J, Kammerer T, Hilferink S, Klug F, Hofmann-Kiefer K, Chouker A, Rehm M, Thaler CJ. Effects of the menstrual cycle on the endothelial glycocalyx (EGX) and leucocyte function. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1387999] [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: 10/24/2022] Open
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Würstle ML, Zink E, Prehn JHM, Rehm M. From computational modelling of the intrinsic apoptosis pathway to a systems-based analysis of chemotherapy resistance: achievements, perspectives and challenges in systems medicine. Cell Death Dis 2014; 5:e1258. [PMID: 24874730 PMCID: PMC4047923 DOI: 10.1038/cddis.2014.36] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/20/2013] [Accepted: 01/02/2014] [Indexed: 12/14/2022]
Abstract
Our understanding of the mitochondrial or intrinsic apoptosis pathway and its role in chemotherapy resistance has increased significantly in recent years by a combination of experimental studies and mathematical modelling. This combined approach enhanced the quantitative and kinetic understanding of apoptosis signal transduction, but also provided new insights that systems-emanating functions (i.e., functions that cannot be attributed to individual network components but that are instead established by multi-component interplay) are crucial determinants of cell fate decisions. Among these features are molecular thresholds, cooperative protein functions, feedback loops and functional redundancies that provide systems robustness, and signalling topologies that allow ultrasensitivity or switch-like responses. The successful development of kinetic systems models that recapitulate biological signal transduction observed in living cells have now led to the first translational studies, which have exploited and validated such models in a clinical context. Bottom-up strategies that use pathway models in combination with higher-level modelling at the tissue, organ and whole body-level therefore carry great potential to eventually deliver a new generation of systems-based diagnostic tools that may contribute to the development of personalised and predictive medicine approaches. Here we review major achievements in the systems biology of intrinsic apoptosis signalling, discuss challenges for further model development, perspectives for higher-level integration of apoptosis models and finally discuss requirements for the development of systems medical solutions in the coming years.
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Affiliation(s)
- M L Würstle
- 1] Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland [2] Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Zink
- 1] Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland [2] Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J H M Prehn
- 1] Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland [2] Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Rehm
- 1] Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland [2] Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rehm M. [Hydroxyethyl starch. Reply]. Anaesthesist 2013; 62:928-930. [PMID: 24416780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Feuerecker M, Feuerecker B, Matzel S, Long M, Strewe C, Kaufmann I, Hoerl M, Schelling G, Rehm M, Choukèr A. Five days of head-down-tilt bed rest induces noninflammatory shedding of L-selectin. J Appl Physiol (1985) 2013; 115:235-42. [DOI: 10.1152/japplphysiol.00381.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Head-down-tilt bed rest (HDTBR) is a popular model, simulating alterations of gravitation during space missions. The aim of this study was to obtain a better insight into the complexly orchestrated regulations of HDTBR-induced immunological responses, hypothesizing that artificial gravity can mitigate these HDTBR-related physiological effects. This crossover-designed 5 days of HDTBR study included three protocols with no, or daily 30 min of centrifugation or 6 × 5 min of centrifugation. Twelve healthy, male participants donated blood pre-HDTBR, post-HDTBR, and twice during HDTBR. Cellular immune changes were assessed either by enumerative and immune cell phenotyping assays or by functional testing of responses to either recall antigens or receptor-dependent activation by chemotactic agents N-formyl-methionyl-leucyl-phenylalanine (fMLP) and with TNF-α. The expression of the adhesion molecule L-selectin (CD62L) on the surface of granulocytes and its shedding into plasma samples were measured. In parallel, other humoral factor, such as interleukin-6 and interleukin-8, parameters of endothelial damage (glycocalyx) were determined. Hematocrit and hemoglobin were significantly increased during HDTBR. Although immune functional tests did not indicate a change in the immune performance, the expression of CD62L on resting granulocytes was significantly shed by 50% during HDTBR. Although the latter is normally associated to an activation of inflammatory innate immune responses and during interaction of granulocytes with the endothelium, CD62L shedding was, however, not related either to a systemic inflammatory alteration or to shedding of the endothelial glycocalyx during bed rest. This suggests a noninflammatory or “mechanical” shedding related to fluid shifts during head-down intervention and not to an acute inflammatory process.
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Affiliation(s)
- M. Feuerecker
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - B. Feuerecker
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - S. Matzel
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - M. Long
- National Microgravity Laboratory and Center for Biomechanics and Bioengineering, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
| | - C. Strewe
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - I. Kaufmann
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - M. Hoerl
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - G. Schelling
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - M. Rehm
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
| | - A. Choukèr
- Department of Anaesthesiology, Klinikum Groβhadern, University of Munich, Munich, Germany; and
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Hofmann-Kiefer KF, Chappell D, Knabl J, Frank HG, Martinoff N, Conzen P, Becker BF, Rehm M. Placental syncytiotrophoblast maintains a specific type of glycocalyx at the fetomaternal border: the glycocalyx at the fetomaternal interface in healthy women and patients with HELLP syndrome. Reprod Sci 2013; 20:1237-45. [PMID: 23585336 DOI: 10.1177/1933719113483011] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies showed that considerable amounts of glycosaminoglycans are released into maternal blood during normal pregnancy and in hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Maternal endothelia and the syncytiotrophoblast layer have been discussed as a possible origin of these glycocalyx components. Our study aimed to visualize the glycocalyx on the syncytiotrophoblast by electron microscopy, to analyze its structure and composition by immunohistochemistry, and to determine potential differences between healthy women and women with HELLP syndrome. For electron microscopy, a cotyledon was fixed by perfusion of the intervillous space with a 2% lanthanum-nitrate glutaraldehyde solution followed by immersion fixation in the same fixative. For immunohistochemistry, sections of 16 placentas (HELLP patients/healthy women, n = 8 each) were stained with monoclonal antibodies against the main glycocalyx constituents syndecan 1, hyaluronic acid, and heparan sulfate. Semiquantitative evaluation of staining intensity focused on the apical surface of the syncytiotrophoblast and fetal intravillous endothelia as possible localizations of a placental glycocalyx. Electron microscopy revealed a glycocalyx of approximately 250 nm, covering the syncytiotrophoblast layer. This was found to contain large amounts of syndecan 1, but neither hyaluronic acid nor heparan sulfate as major components. Intravillous fetal endothelium did not express any of the investigated glycosaminoglycans. Healthy women and patients with HELLP showed no differences concerning glycocalyx composition and thickness of the syncytiotrophoblast. The composition of the "placental" glycocalyx differs from the adult and fetal vascular glycocalyx. Obviously, the human placental syncytiotrophoblast maintains a special kind of glycocalyx at the fetomaternal interface.
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Hofmann-Kiefer KF, Kemming GI, Chappell D, Flondor M, Kisch-Wedel H, Hauser A, Pallivathukal S, Conzen P, Rehm M. Serum heparan sulfate levels are elevated in endotoxemia. Eur J Med Res 2013; 14:526-31. [PMID: 20149986 PMCID: PMC3351938 DOI: 10.1186/2047-783x-14-12-526] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Increased vascular permeability is a characteristic feature of sepsis which, in the past, has been ascribed exclusively to a malfunction of endothelial cells. However, recently it has become evident that the endothelial glycocalyx is of considerable importance concerning various aspects of vascular physiology, e.g. the vascular barrier and inflammation. Heparan sulfate, one of its essential components is characteristically traceable in blood, in case the endothelial glycocalyx is damaged or destroyed. METHODS In 15 pigs we investigated whether the administration of endotoxin from gram-negative bacteria (Escherichia coli) results in increased serum levels of heparan sulfate, signalizing a shedding of the glycocalyx. In addition, markers of inflammation (white blood cell count, platelet count, tumour necrosis factor-α and interleukin-6) were evaluated over an observation period of 6 hours. RESULTS Serum heparan sulfate concentrations significantly increased over time in the endotoxin group and were significantly elevated in comparison to the control group 6 hours after administration of endotoxin (p<0.001). In the endotoxin group all markers of inflammation significantly changed during the time course. CONCLUSIONS The administration of bacterial endotoxin induced a significant rise in degradation products of the endothelial glycocalyx.
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Affiliation(s)
- Klaus F Hofmann-Kiefer
- Clinic of Anesthesiology/Critical Care Medicine and Pain Therapy (M.A.B., P.C), Ludwig-Maximilians-University, City of Munich, Germany.
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Hofmann-Kiefer KF, Knabl J, Martinoff N, Schiessl B, Conzen P, Rehm M, Becker BF, Chappell D. Increased Serum Concentrations of Circulating Glycocalyx Components in HELLP Syndrome Compared to Healthy Pregnancy: An Observational Study. Reprod Sci 2012; 20:318-25. [DOI: 10.1177/1933719112453508] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - J. Knabl
- Clinic of Gynecology and Obstetrics, Ludwig-Maximilians University, City of Munich, München, Germany
| | - N. Martinoff
- Clinic of Anesthesiology, Ludwig-Maximilians University, City of Munich, München, Germany
| | - B. Schiessl
- Clinic of Gynecology and Obstetrics, Ludwig-Maximilians University, City of Munich, München, Germany
| | - P. Conzen
- Clinic of Anesthesiology, Ludwig-Maximilians University, City of Munich, München, Germany
| | - M. Rehm
- Clinic of Anesthesiology, Ludwig-Maximilians University, City of Munich, München, Germany
| | - B. F. Becker
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians University, City of Munich, München, Germany
| | - D. Chappell
- Clinic of Anesthesiology, Ludwig-Maximilians University, City of Munich, München, Germany
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Annecke T, Fischer J, Hartmann H, Tschoep J, Rehm M, Conzen P, Sommerhoff CP, Becker BF. Shedding of the coronary endothelial glycocalyx: effects of hypoxia/reoxygenation vs ischaemia/reperfusion. Br J Anaesth 2011; 107:679-86. [PMID: 21890663 DOI: 10.1093/bja/aer269] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular endothelium is covered by a glycocalyx. Damage to the glycocalyx after systemic inflammation or ischaemia/reperfusion contributes to increased vascular permeability and leucocyte adhesion. The underlying mechanisms leading to ischaemia/reperfusion-induced glycocalyx shedding are incompletely understood, in terms of lack of oxygen, absence of flow, or return of oxygen. METHODS Isolated guinea pig hearts perfused with Krebs-Henseleit buffer at 37°C underwent 20 min of either stopped-flow ischaemia or hypoxic perfusion with subsequent reperfusion/reoxygenation (n = 6 each). Hearts perfused with normoxic buffer served as time controls. Epicardial transudate was collected to assess coronary net fluid filtration, colloid extravasation, and histamine release by mast cells. Syndecan-1 and heparan sulphate were measured in coronary effluent, together with lactate, purines, and the release of mast-cell tryptase β. Additional hearts were perfusion-fixed to visualize the glycocalyx. RESULTS Both ischaemia and hypoxia with reperfusion/reoxygenation resulted in significant increases in net fluid filtration (P < 0.05) and release of syndecan-1 and heparan sulphate in coronary effluent. These effects were already seen with the onset of hypoxic perfusion. Histamine was released during hypoxia and reoxygenation and also reperfusion, as was tryptase β, and high concentrations of adenosine (>1 µmol litre⁻¹, hypoxia group) and inosine (> 7 µmol litre⁻¹, ischaemia group) were measured in effluent (P < 0.05). Damage to the coronary glycocalyx was evident upon electron microscopy. CONCLUSIONS Both ischaemic and hypoxic hypoxia initiate glycocalyx degradation, promoting an increase in permeability. A contributing mechanism could be purine-mediated degranulation of resident mast cells, with liberated tryptase β acting as potential 'sheddase'.
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Affiliation(s)
- T Annecke
- Department of Anaesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany.
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Laussmann MA, Passante E, Düssmann H, Rauen JA, Würstle ML, Delgado ME, Devocelle M, Prehn JHM, Rehm M. Proteasome inhibition can induce an autophagy-dependent apical activation of caspase-8. Cell Death Differ 2011; 18:1584-97. [PMID: 21455219 DOI: 10.1038/cdd.2011.27] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Antiapoptotic Bcl-2 family proteins are often highly expressed in chemotherapy-resistant cancers and impair mitochondrial outer membrane permeabilisation (MOMP), an important requirement for caspase activation via the intrinsic apoptosis pathway. Interestingly, although Bcl-2 overexpression in HeLa cervical cancer cells abrogated caspase processing in response to intrinsic apoptosis induction by staurosporine, tunicamycin or etoposide, residual caspase processing was observed following proteasome inhibition by bortezomib ([(1R)-3-methyl-1-({(2S)-3-phenyl-2-[(pyrazin-2-ylcarbonyl)amino]propanoyl}amino)butyl]boronic acid), epoxomicin (N-acetyl-N-methyl-lisoleucyl-L-isoleucyl-N-[(1S)-3-methyl-1-[[(2R)-2-methyloxiranyl]carbonyl]butyl]-L-threoninamide) or MG-132 (N-(benzyloxycarbonyl)leucinylleucinylleucinal). Similar responses were found in Bcl-2-overexpressing H460 NSCLC cells and Bax/Bak-deficient mouse embyronic fibroblasts. Mild caspase processing resulted in low DEVDase activities, which were MOMP independent and persisted for long periods without evoking immediate cell death. Surprisingly, depletion of caspase-3 and experiments in caspase-7-depleted MCF-7-Bcl-2 cells indicated that the DEVDase activity did not originate from effector caspases. Instead, Fas-associated death domain (FADD)-dependent caspase-8 activation was the major contributor to the slow, incomplete substrate cleavage. Caspase-8 activation was independent of death ligands, but required the induction of autophagy and the presence of Atg5. Depletion of XIAP or addition of XIAP-antagonising peptides resulted in a switch towards efficient apoptosis execution, suggesting that the requirement for MOMP was bypassed by activating the caspase-8/caspase-3 axis. Combination treatments of proteasome inhibitors and XIAP antagonists therefore represent a promising strategy to eliminate highly resistant cancer cells, which overexpress antiapoptotic Bcl-2 family members.
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Affiliation(s)
- M A Laussmann
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rehm M, Rentsch A, Trautmann K, Hornemann B, Schuler U, Ehninger G, Folprecht G. Patients' perspective on palliative chemotherapy of colorectal and non-colorectal tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.581] [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: 11/20/2022] Open
Abstract
581 Background: In contrast to trials investigating treatment efficacy, patients perspective on given chemotherapy is less studied. Known surveys indicate that patients accept therapy for very limited benefit. Methods: Patients who had received 3 or more months of systemic, palliative therapy for colorectal (CRC) or non-colorectal (upper GI, NSCLC, SCCHN) cancer were eligible. They completed a questionnaire including their retrospective report on symptomatic toxicity (according to NCI-CTC) and using numeric ranking scales their burden from the toxicity and the comparison to the informed consent. Depression and anxiety was measured by HADS. Finally, the patients were asked for the minimal gain in life expectancy they would feel it worth to repeat the therapy for. Results: Between August 2008 and December 2009, 134 patients were enrolled. Median age was 63 (32-86); 71% of patients were male. Colorectal cancer patients would repeat their therapy for a minimal gain of life expectancy of 36.0 mo (14.0-57.0 mo), non-CRC patients for 15.9 [12.3-19.5] months (p = 0.01). Considering additional time with best supportive care, the minimal expectation from treatment trended to be longer than the actual survival of the same patients (39.3 [33.6-45.0] and 19.9 [16.3- 23.5] months for CRC and non-CRC patients, respectively), p = 0.08. Depression, diarrhea and tumor entity (CRC vs. non-CRC) were an independent factors for the minimal expected life expectancy in a multivariate analysis. Most frequent self reported toxicity (grade 3/4) was fatigue (9.0%), nausea (8.1%), diarrhea (8.5%) and stomatitis (8.3%), severe burden was felt from fatigue (14.3%) followed by neuropathy (12.0%), diarrhea (11.1%), nausea (9.8%) and stomatitis (8.8%). Fatigue was felt ′a little bit more′ or ′much more′ than in the patient information in 29.9%, followed by neuropathy (20.5%), acne (18.4%) and diarrhea (17.6%). Conclusions: Patients' expectations of life-prolonging systemic therapy are higher than expected from previous studies or the median survival in phase III studies. Compared to their actual survival it may be regarded as realistic. Fatigue might deserve more attention when toxicity of treatment and symptoms of disease are explained. [Table: see text]
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Affiliation(s)
- M. Rehm
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - A. Rentsch
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - K. Trautmann
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - B. Hornemann
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - U. Schuler
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - G. Ehninger
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - G. Folprecht
- University Hospital Carl Gustav Carus, Dresden, Germany
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T. Hellwig C, Passante E, Rehm M. The Molecular Machinery Regulating Apoptosis Signal Transduction and its Implication in Human Physiology and Pathophysiologies. Curr Mol Med 2011; 11:31-47. [DOI: 10.2174/156652411794474400] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/20/2010] [Indexed: 11/22/2022]
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Hofmann-Kiefer KF, Chappell D, Jacob M, Schülke A, Conzen P, Rehm M. [Hypernatremic alkalosis. Possible counterpart of hyperchloremic acidosis in intensive care patients?]. Anaesthesist 2010; 58:1210-5. [PMID: 19911108 DOI: 10.1007/s00101-009-1640-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND With broad acceptance of Stewart's acid-base model "hyperchloremic acidosis" is regarded as an independent form of metabolic disorder. It is unknown whether hypernatremia plays a corresponding role with respect to the development of alkalosis. METHODS A total of 201 artificially ventilated, critically ill patients were monitored for hypernatremic episodes. Inclusion criterion was a serum sodium concentration above 145 mmol/l. RESULTS In 20 patients a total of 78 periods of elevated plasma sodium levels lasting at least 24 h were observed. In 86% of these cases sodium and chloride concentrations were simultaneously increased. The development of alkalosis correlated with the strong ion difference (r=0.80, p<0.01) but not with the serum sodium concentration (r=-0.031, p=0.78). In cases without accompanying hyperchloremia (13%) metabolic alkalosis regularly occurred and a correlation between serum sodium concentration and base excess could be verified (r=0.66, p=0.03). Alkalosis occurred in 84.8% of cases where the strong on difference exceeded 39 mmol/l. CONCLUSION From the available data hypernatremic alkalosis could not be defined as an independent metabolic disorder. In would seem more appropriate to use the term "strong ion alkalosis" in this context.
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Affiliation(s)
- K F Hofmann-Kiefer
- Klinik für Anaesthesiologie, Intensivmedizin und Schmerztherapie, Ludwig-Maximilians-Universität, Klinikum Innenstadt, 80337 München.
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Annecke T, Chappell D, Chen C, Jacob M, Welsch U, Sommerhoff C, Rehm M, Conzen P, Becker B. Sevoflurane preserves the endothelial glycocalyx against ischaemia–reperfusion injury. Br J Anaesth 2010; 104:414-21. [DOI: 10.1093/bja/aeq019] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Düssmann H, Rehm M, Concannon CG, Anguissola S, Würstle M, Kacmar S, Völler P, Huber HJ, Prehn JHM. Single-cell quantification of Bax activation and mathematical modelling suggest pore formation on minimal mitochondrial Bax accumulation. Cell Death Differ 2009; 17:278-90. [PMID: 19745831 DOI: 10.1038/cdd.2009.123] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mitochondrial outer membrane permeabilisation (MOMP) during apoptosis is triggered by the activation and oligomerisation of Bax and Bak, but a quantification of these processes in individual cells has not yet been performed. Single-cell imaging of Bax translocation and oligomerisation in Bax-deficient DU-145 cells expressing CFP-Bax and YFP-Bax revealed that both processes started only minutes before or concomitantly with MOMP, with the majority of Bax translocation and oligomerisation occurring downstream of MOMP. Quantification of YFP-Bax concentrations at mitochondria revealed an increase of only 1.8 + or - 1.5% at MOMP onset. This was increased to 11.2 + or - 3.6% in bak-silenced cells. These data suggested that Bax activation exceeded by far the quantities required for MOMP induction, and that minimal Bax or Bak activation may be sufficient to trigger rapid pore formation. In a cellular automaton modelling approach that incorporated the quantities and movement probabilities of Bax and its inhibitors, activators and enablers in the mitochondrial membrane, we could re-model rapid pore formation kinetics at submaximal Bax activation.
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Affiliation(s)
- H Düssmann
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Rehm M, Huber HJ, Hellwig CT, Anguissola S, Dussmann H, Prehn JHM. Dynamics of outer mitochondrial membrane permeabilization during apoptosis. Cell Death Differ 2009; 16:613-23. [PMID: 19136937 DOI: 10.1038/cdd.2008.187] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Individual cells within a population undergo apoptosis at distinct, apparently random time points. By analyzing cellular mitotic history, we identified that sibling HeLa cell pairs, in contrast to random cell pairs, underwent apoptosis synchronously. This allowed us to use high-speed cellular imaging to investigate mitochondrial outer membrane permeabilization (MOMP), a highly coordinated, rapid process during apoptosis, at a temporal resolution approximately 100 times higher than possible previously. We obtained new functional and mechanistic insight into the process of MOMP: We were able to determine the kinetics of pore formation in the outer mitochondrial membrane from the initiation phase of cytochrome-c-GFP redistribution, and showed differential pore formation kinetics in response to intrinsic or extrinsic apoptotic stimuli (staurosporine, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)). We also detected that the onset of mitochondrial permeabilization frequently proceeded as a wave through the cytosol, and that the frequency of wave occurrence in response to TRAIL was reduced by inhibition of protein kinase CK2. Computational analysis by a partial differential equation model suggested that the spread of permeabilization signals could sufficiently be explained by diffusion-adsorption velocities of locally generated permeabilization inducers. Taken together, our study yielded the first comprehensive analysis of clonal cell-to-cell variability in apoptosis execution and allowed to visualize and explain the dynamics of MOMP in cells undergoing apoptosis.
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Affiliation(s)
- M Rehm
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Chappell D, Jacob M, Hofmann-Kiefer K, Rehm M, Welsch U, Conzen P, Becker BF. Antithrombin reduces shedding of the endothelial glycocalyx following ischaemia/reperfusion. Cardiovasc Res 2009; 83:388-96. [DOI: 10.1093/cvr/cvp097] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dreweck C, Lutz EM, Vogel S, Bachem I, Rehm M, Graf P, Zühl J. Internationale Gesundheitsvorschriften 2005– Kommunale Umsetzung im Referat für Gesundheit und Umwelt der Landeshauptstadt München. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1215500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rehm M, Seifert P, Meyer B. Theoretical and numerical investigation on the EDC-model for turbulence–chemistry interaction at gasification conditions. Comput Chem Eng 2009. [DOI: 10.1016/j.compchemeng.2008.11.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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