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Jahn N, Longin CFH, Scherf KA, Geisslitz S. No correlation between amylase/trypsin-inhibitor content and amylase inhibitory activity in hexaploid and tetraploid wheat species. Curr Res Food Sci 2023; 7:100542. [PMID: 38115899 PMCID: PMC10728332 DOI: 10.1016/j.crfs.2023.100542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 12/21/2023] Open
Abstract
Wheat amylase/trypsin-inhibitors (ATI) are known triggers for wheat-related disorders. The aims of our study were to determine (1) the inhibitory activity against different α-amylases, (2) the content of albumins and globulins (ALGL) and total ATI and (3) to correlate these parameters in wholegrain flour of hexaploid, tetraploid and diploid wheat species. The amount of ATI within the ALGL fraction varied from 0.8% in einkorn to 20% in spelt. ATI contents measured with reversed-phase high-performance liquid chromatography (RP-HPLC) revealed similar contents (1.2-4.2 mg/g) compared to the results determined by LC-MS/MS (0.2-5.2 mg/g) for all wheat species except einkorn. No correlation was found between ALGL content and inhibitory activity. In general, hexaploid cultivars of spelt and common wheat had the highest inhibitory activities, showing values between 897 and 3564 AIU/g against human salivary α-amylase. Tetraploid wheat species durum and emmer had lower activities (170-1461 AIU/g), although a few emmer cultivars showed similar activities at one location. In einkorn, no inhibitory activity was found. No correlation was observed between the ATI content and the inhibitory activity against the used α-amylases, highlighting that it is very important to look at the parameters separately.
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Affiliation(s)
- Nora Jahn
- Department of Bioactive and Functional Food Chemistry, Institute of Applied Biosciences, Karlsruhe Institute of Technology (KIT), Adenauerring 20 a, 76131, Karlsruhe, Germany
| | | | - Katharina A. Scherf
- Department of Bioactive and Functional Food Chemistry, Institute of Applied Biosciences, Karlsruhe Institute of Technology (KIT), Adenauerring 20 a, 76131, Karlsruhe, Germany
| | - Sabrina Geisslitz
- Department of Bioactive and Functional Food Chemistry, Institute of Applied Biosciences, Karlsruhe Institute of Technology (KIT), Adenauerring 20 a, 76131, Karlsruhe, Germany
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Krug N, Bercker S, Busch T, Friese S, Jahn N, Voelker MT. Non-thyroidal Illness Syndrome (NTIS) is no independent predictor for mortality in ICU patients. BMC Anesthesiol 2023; 23:103. [PMID: 37003983 PMCID: PMC10064728 DOI: 10.1186/s12871-023-02015-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Low T3-(/T4-) syndrome, also known as non-thyroidal Illness Syndrome (NTIS) describes a decrease in free serum thyroid hormones without a concomitant increase in TSH, frequently observed in critically ill patients. However, whether NTIS is only a metabolic adaption to stress in critically ill or plays a crucial role as an independent risk factor for ICU mortality, remains unknown. Our study aimed to evaluate NTIS as an independent risk factor for increased ICU mortality. METHODS All patients admitted to the interdisciplinary intensive care unit (ICU) at the University Hospital of Leipzig between 2008 and 2014 were retrospectively analyzed for thyroidal function. Baseline data, information on additional thyroid function tests, disease progression, hospital and ICU length of stay (LOS) and patient outcome were retrospectively analyzed from the hospitals digital information system. For statistical evaluation, univariate analysis, matched pairs analysis and multivariate logistic regression were conducted. RESULTS One thousand, seven hundred ninety patients were enrolled in the study, of which 665 showed NTIS. Univariate analysis revealed a positive association of NTIS with ICU- and hospital-LOS, need for mechanical ventilation, incidence of sepsis, acute respiratory distress syndrome, acute liver failure and increased ICU mortality. Results of matched pair analysis confirmed these findings. In multivariate logistic regression, NTIS was associated with an increased ICU-LOS, increased duration of mechanical ventilation, acute kidney injury and liver failure, but showed no independent association with increased ICU-mortality. CONCLUSION Duration of mechanical ventilation as well as incidence of acute kidney injury, sepsis and acute liver failure were detected as independent predictors of mortality in patients with NTIS. NTIS itself was no independent predictor of increased ICU-mortality.
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Affiliation(s)
- Natalie Krug
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Sven Bercker
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Thilo Busch
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Steffen Friese
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Nora Jahn
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
- Clinical Department of General Anaesthesiology, Emergency and Intensive Care Medicine, LKH-University Hospital of Graz, Medical University of Graz, Graz, Austria
| | - Maria Theresa Voelker
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Hau HM, Eckert M, Laudi S, Völker MT, Stehr S, Rademacher S, Seehofer D, Sucher R, Piegeler T, Jahn N. Predictive Value of HAS-BLED Score Regarding Bleeding Events and Graft Survival following Renal Transplantation. J Clin Med 2022; 11:jcm11144025. [PMID: 35887788 PMCID: PMC9319563 DOI: 10.3390/jcm11144025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/22/2022] [Accepted: 07/09/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: Due to the high prevalence and incidence of cardio- and cerebrovascular diseases among dialysis-dependent patients with end-stage renal disease (ERSD) scheduled for kidney transplantation (KT), the use of antiplatelet therapy (APT) and/or anticoagulant drugs in this patient population is common. However, these patients share a high risk of complications, either due to thromboembolic or bleeding events, which makes adequate peri- and post-transplant anticoagulation management challenging. Predictive clinical models, such as the HAS-BLED score developed for predicting major bleeding events in patients under anticoagulation therapy, could be helpful tools for the optimization of antithrombotic management and could reduce peri- and postoperative morbidity and mortality. Methods: Data from 204 patients undergoing kidney transplantation (KT) between 2011 and 2018 at the University Hospital Leipzig were retrospectively analyzed. Patients were stratified and categorized postoperatively into the prophylaxis group (group A)—patients without pretransplant anticoagulation/antiplatelet therapy and receiving postoperative heparin in prophylactic doses—and into the (sub)therapeutic group (group B)—patients with postoperative continued use of pretransplant antithrombotic medication used (sub)therapeutically. The primary outcome was the incidence of postoperative bleeding events, which was evaluated for a possible association with the use of antithrombotic therapy. Secondary analyses were conducted for the associations of other potential risk factors, specifically the HAS-BLED score, with allograft outcome. Univariate and multivariate logistic regression as well as a Cox proportional hazard model were used to identify risk factors for long-term allograft function, outcome and survival. The calibration and prognostic accuracy of the risk models were evaluated using the Hosmer−Lemshow test (HLT) and the area under the receiver operating characteristic curve (AUC) model. Results: In total, 94 of 204 (47%) patients received (sub)therapeutic antithrombotic therapy after transplantation and 108 (53%) patients received prophylactic antithrombotic therapy. A total of 61 (29%) patients showed signs of postoperative bleeding. The incidence (p < 0.01) and timepoint of bleeding (p < 0.01) varied significantly between the different antithrombotic treatment groups. After applying multivariate analyses, pre-existing cardiovascular disease (CVD) (OR 2.89 (95% CI: 1.02−8.21); p = 0.04), procedure-specific complications (blood loss (OR 1.03 (95% CI: 1.0−1.05); p = 0.014), Clavien−Dindo classification > grade II (OR 1.03 (95% CI: 1.0−1.05); p = 0.018)), HAS-BLED score (OR 1.49 (95% CI: 1.08−2.07); p = 0.018), vit K antagonists (VKA) (OR 5.89 (95% CI: 1.10−31.28); p = 0.037), the combination of APT and therapeutic heparin (OR 5.44 (95% CI: 1.33−22.31); p = 0.018) as well as postoperative therapeutic heparin (OR 3.37 (95% CI: 1.37−8.26); p < 0.01) were independently associated with an increased risk for bleeding. The intraoperative use of heparin, prior antiplatelet therapy and APT in combination with prophylactic heparin was not associated with increased bleeding risk. Higher recipient body mass index (BMI) (OR 0.32 per 10 kg/m2 increase in BMI (95% CI: 0.12−0.91); p = 0.023) as well as living donor KT (OR 0.43 (95% CI: 0.18−0.94); p = 0.036) were associated with a decreased risk for bleeding. Regarding bleeding events and graft failure, the HAS-BLED risk model demonstrated good calibration (bleeding and graft failure: HLT: chi-square: 4.572, p = 0.802, versus chi-square: 6.52, p = 0.18, respectively) and moderate predictive performance (bleeding AUC: 0.72 (0.63−0.79); graft failure: AUC: 0.7 (0.6−0.78)). Conclusions: In our current study, we could demonstrate the HAS-BLED risk score as a helpful tool with acceptable predictive accuracy regarding bleeding events and graft failure following KT. The intensified monitoring and precise stratification/assessment of bleeding risk factors may be helpful in identifying patients at higher risks of bleeding, improved individualized anticoagulation decisions and choices of antithrombotic therapy in order to optimize outcome after kidney transplantation.
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Affiliation(s)
- Hans Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.M.H.); (S.R.); (D.S.); (R.S.)
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Markus Eckert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
| | - Maria Theresa Völker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.M.H.); (S.R.); (D.S.); (R.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.M.H.); (S.R.); (D.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.M.H.); (S.R.); (D.S.); (R.S.)
| | - Tobias Piegeler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; (M.E.); (S.L.); (M.T.V.); (S.S.); (T.P.)
- Correspondence: ; Tel.: +49-(0)-0341/97-10759; Fax: +49-(0)-0341/97-17709
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Sucher R, Schiemanck T, Hau HM, Laudi S, Stehr S, Sucher E, Rademacher S, Seehofer D, Jahn N. Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas-Kidney Transplant Recipients. J Clin Med 2022; 11:jcm11071966. [PMID: 35407575 PMCID: PMC8999645 DOI: 10.3390/jcm11071966] [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: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas−kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1−10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0−4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.
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Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (R.S.); (T.S.); (H.M.H.); (S.R.); (D.S.)
| | - Tina Schiemanck
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (R.S.); (T.S.); (H.M.H.); (S.R.); (D.S.)
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.L.); (S.S.)
| | - Hans Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (R.S.); (T.S.); (H.M.H.); (S.R.); (D.S.)
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.L.); (S.S.)
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.L.); (S.S.)
| | - Elisabeth Sucher
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectiology, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (R.S.); (T.S.); (H.M.H.); (S.R.); (D.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (R.S.); (T.S.); (H.M.H.); (S.R.); (D.S.)
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.L.); (S.S.)
- Correspondence: ; Tel.: +49-(0)341-97-10759; Fax: +49-(0)341-97-17709
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Sommer GM, Broschewitz J, Huppert S, Sommer CG, Jahn N, Jansen-Winkeln B, Gockel I, Hau HM. The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: Visual spatial ability as a predictor for improved surgical performance: a randomized trial. Medicine (Baltimore) 2021; 100:e27844. [PMID: 34918632 PMCID: PMC8677906 DOI: 10.1097/md.0000000000027844] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 10/25/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training. METHODS In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities. RESULTS Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training. CONCLUSIONS Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.
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Affiliation(s)
- Guillermo Marcos Sommer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Johannes Broschewitz
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Sabine Huppert
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Christina Gesine Sommer
- Department of National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Lange UG, Rademacher S, Zirnstein B, Sucher R, Semmling K, Bobbert P, Lederer AA, Buchloh D, Seidemann L, Seehofer D, Jahn N, Hau HM. Cardiovascular outcomes after simultaneous pancreas kidney transplantation compared to kidney transplantation alone: a propensity score matching analysis. BMC Nephrol 2021; 22:347. [PMID: 34674648 PMCID: PMC8529792 DOI: 10.1186/s12882-021-02522-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Coronary heart disease due to arteriosclerosis is the leading cause of death in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to evaluate the effect of simultaneous pancreas kidney transplantation (SPKT) compared to kidney transplantation alone (KTA) on survival, cardiovascular function and metabolic outcomes. Methods A cohort of 127 insulin-dependent diabetes mellitus (IDDM) patients with ESRD who underwent either SPKT (n = 100) or KTA (n = 27) between 1998 and 2019 at the University Hospital of Leipzig were retrospectively evaluated with regard to cardiovascular and metabolic function/outcomes as well as survival rates. An additional focus was placed on the echocardiographic assessment of systolic and diastolic cardiac function pretransplant and during follow-up. To avoid selection bias, a 2:1 propensity score matching analysis (PSM) was performed. Results After PSM, a total of 63 patients were identified; 42 patients underwent SPKT, and 21 patients received KTA. Compared with the KTA group, SPKT recipients received organs from younger donors (p < 0.05) and donor BMI was higher (p = 0.09). The risk factor-adjusted hazard ratio for mortality in SPKT recipients compared to KTA recipients was 0.63 (CI: 0.49–0.89; P < 0.05). The incidence of pretransplant cardiovascular events was higher in the KTA group (KTA: n = 10, 47% versus SPKT: n = 10, 23%; p = 0.06), but this difference was not significant. However, the occurrence of cardiovascular events in the SPKT group (n = 3, 7%) was significantly diminished after transplantation compared to that in the KTA recipients (n = 6, 28%; p = 0.02). The cardiovascular death rate was higher in KTA recipients (19%) than in SPK recipients with functioning grafts (3.3%) and comparable to that in patients with failed SPKT (16.7%) (p = 0.16). In line with pretransplant values, SPKT recipients showed significant improvements in Hb1ac values (p = 0.001), blood pressure control (p = < 0.005) and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (p = < 0.005) 5 years after transplantation. With regard to echocardiographic assessment, SPKT recipients showed significant improvements in left ventricular systolic parameters during follow-up. Conclusions Normoglycaemia and improvement of lipid metabolism and blood pressure control achieved by successful SPKT are associated with beneficial effects on survival, cardiovascular outcomes and systolic left ventricular cardiac function. Future studies with larger samples are needed to make predictions regarding cardiovascular events and graft survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02522-8.
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Affiliation(s)
- U G Lange
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - S Rademacher
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - B Zirnstein
- Sana Hospital Borna, Clinic of Anaesthesia, Intensive Care and Palliative Medicine, Rudolf-Virchow-Strasse 2, 04552, Borna, Saxony, Germany
| | - R Sucher
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - K Semmling
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - P Bobbert
- Ev. Hubertus Hospital Berlin, Clinic of Internal Medicine and Angiology, Spanische Allee 10-14, 14129, Berlin, Berlin, Germany
| | - A A Lederer
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - D Buchloh
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - L Seidemann
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - D Seehofer
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany
| | - N Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - H-M Hau
- University Hospital Leipzig, Clinic of Visceral, Transplant, Thoracic and Vascular Surgery, Liebigstrasse 20, 04103, Leipzig, Saxony, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Hau HM, Devantier M, Jahn N, Sucher E, Rademacher S, Seehofer D, Sucher R. Impact of Body Mass Index on Tumor Recurrence in Patients Undergoing Liver Resection for Perihilar Cholangiocarcinoma (pCCA). Cancers (Basel) 2021; 13:cancers13194772. [PMID: 34638257 PMCID: PMC8507532 DOI: 10.3390/cancers13194772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Perihilar cholangiocarcinoma (pCCA) is a relatively rare and aggressive hepatobiliary tumor with a general poor prognosis. Surgical therapy remains the only curative treatment option with the best prospects for long-term survival. However, tumor recurrence is frequent, and is associated with a poor prognosis. The identification of risk factors as well as appropriate selection of surgical candidates is essential to accurately predict prognosis and to maximize survival while decreasing tumor recurrence rates. Previous studies have already established a link between an increased BMI and the occurrence of various tumors. At present, data on BMI-associated long-term outcome following curative liver resection in pCCA patients are warranted. This study aims to investigate the impact of increased BMI on patient’s outcome, especially on tumor recurrence, following liver resection in patients with pCCA as well as to evaluate prognostic and risk factors for accurate prediction of outcome in this selective group of patients. Abstract Background: The association of body mass index (BMI) and long-term prognosis and outcome of patients with perihilar cholangiocarcinoma (pCCA) has not been well defined. The aim of this study was to evaluate clinicopathologic and oncologic outcomes with pCCA undergoing resection, according to their BMI. Methods: Patients undergoing liver resection in curative intention for pCCA at a tertiary German hepatobiliary (HPB) center were identified from a prospective database. Patients were classified as normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2) and obese (>30 kg/m2) according to their BMI. Impact of clinical and histo-pathological characteristics on recurrence-free survival (RFS) were assessed using Cox proportional hazard regression analysis among patients of all BMI groups. Results: Among a total of 95 patients undergoing liver resection in curative intention for pCCA in the analytic cohort, 48 patients (50.5%) had normal weight, 33 (34.7%) were overweight and 14 patients (14.7%) were obese. After a median follow-up of 4.3 ± 2.9 years, recurrence was observed in totally 53 patients (56%). The cumulative recurrence probability was higher in obese and overweight patients than normal weight patients (5-year recurrence rate: obese: 82% versus overweight: 81% versus normal weight: 58% at 5 years; p = 0.02). Totally, 1-, 3-, 5- and 10-year recurrence-free survival rates were 68.5%, 44.6%, 28.9% and 13%, respectively. On multivariable analysis, increased BMI (HR 1.08, 95% CI: 1.01–1.16; p = 0.021), poor/moderate tumor differentiation (HR 2.49, 95% CI: 1.2–5.2; p = 0.014), positive lymph node status (HR 2.01, 95% CI: 1.11–3.65; p = 0.021), positive resection margins (HR 1.89, 95% CI:1.02–3.4; p = 0.019) and positive perineural invasion (HR 2.92, 95% CI: 1.02–8.3; p = 0.045) were independent prognostic risk factors for inferior RFS. Conclusion: Our study shows that a high BMI is significantly associated with an increased risk of recurrence after liver resection in curative intention for pCCA. This factor should be considered in future studies to better predict patient’s individual prognosis and outcome based on their BMI.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.-M.H.); (M.D.); (S.R.); (D.S.)
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mareen Devantier
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.-M.H.); (M.D.); (S.R.); (D.S.)
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Elisabeth Sucher
- Department of Oncology, Gastroenterology, Hepatology, Pneumology, Infectiology, and Nutritional Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.-M.H.); (M.D.); (S.R.); (D.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.-M.H.); (M.D.); (S.R.); (D.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (H.-M.H.); (M.D.); (S.R.); (D.S.)
- Correspondence: ; Tel.: +49-(0)341-9720-860; Fax: +49-(0)341-9717-209
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Hau HM, Jahn N, Rademacher S, Sucher E, Babel J, Mehdorn M, Lederer A, Seehofer D, Scheuermann U, Sucher R. The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival. J Clin Med 2021; 10:1632. [PMID: 33921391 PMCID: PMC8070486 DOI: 10.3390/jcm10081632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. MATERIAL AND METHODS 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. RESULTS Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3-17.1, p = 0.026) and five years (HR 3.7, 2.1-23.4, p = 0.040). CONCLUSION Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Elisabeth Sucher
- Department of Gastroenterology, Section of Hepatology, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Jonas Babel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Matthias Mehdorn
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (J.B.); (M.M.); (A.L.); (D.S.); (U.S.); (R.S.)
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Marx G, Bickenbach J, Fritsch SJ, Kunze JB, Maassen O, Deffge S, Kistermann J, Haferkamp S, Lutz I, Voellm NK, Lowitsch V, Polzin R, Sharafutdinov K, Mayer H, Kuepfer L, Burghaus R, Schmitt W, Lippert J, Riedel M, Barakat C, Stollenwerk A, Fonck S, Putensen C, Zenker S, Erdfelder F, Grigutsch D, Kram R, Beyer S, Kampe K, Gewehr JE, Salman F, Juers P, Kluge S, Tiller D, Wisotzki E, Gross S, Homeister L, Bloos F, Scherag A, Ammon D, Mueller S, Palm J, Simon P, Jahn N, Loeffler M, Wendt T, Schuerholz T, Groeber P, Schuppert A. Algorithmic surveillance of ICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy. BMJ Open 2021; 11:e045589. [PMID: 34550901 PMCID: PMC8039261 DOI: 10.1136/bmjopen-2020-045589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure. METHODS AND ANALYSIS In this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested. ETHICS AND DISSEMINATION Ethical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00014330.
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Affiliation(s)
- Gernot Marx
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Sebastian Johannes Fritsch
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - Julian Benedict Kunze
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Oliver Maassen
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Saskia Deffge
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Jennifer Kistermann
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Silke Haferkamp
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Irina Lutz
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Nora Kristiana Voellm
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Volker Lowitsch
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Healthcare IT Solutions GmbH, Aachen, Germany
| | - Richard Polzin
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
| | - Konstantin Sharafutdinov
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
| | - Hannah Mayer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Lars Kuepfer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Rolf Burghaus
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Walter Schmitt
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Clinical Pharmacometry, Bayer AG, Leverkusen, Germany
| | - Joerg Lippert
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Clinical Pharmacometry, Bayer AG, Leverkusen, Germany
| | - Morris Riedel
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - Chadi Barakat
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - André Stollenwerk
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Informatik 11 - Embedded Software, RWTH Aachen University, Aachen, Germany
| | - Simon Fonck
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Informatik 11 - Embedded Software, RWTH Aachen University, Aachen, Germany
| | - Christian Putensen
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Sven Zenker
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Felix Erdfelder
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rainer Kram
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Susanne Beyer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Knut Kampe
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Erik Gewehr
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Research IT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Salman
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Juers
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Research IT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Tiller
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, University Hospital Halle, Halle, Germany
| | - Emilia Wisotzki
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, University Hospital Halle, Halle, Germany
| | - Sebastian Gross
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Halle, Germany
| | - Lorenz Homeister
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Halle, Germany
| | - Frank Bloos
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - André Scherag
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Danny Ammon
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, Jena University Hospital, Jena, Germany
| | - Susanne Mueller
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Julia Palm
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Philipp Simon
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Nora Jahn
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Markus Loeffler
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Thomas Wendt
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Data Integration Center, IT Department, University Hospital Leipzig, Leipzig, Germany
| | - Tobias Schuerholz
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Petra Groeber
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Rostock University Medical Center, Rostock, Germany
| | - Andreas Schuppert
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
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Hau HM, Jahn N, Brunotte M, Wagner T, Rademacher S, Branzan D, Sucher E, Seehofer D, Sucher R. Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas-kidney transplant recipients: a simple and elegant strategy! BMC Surg 2021; 21:156. [PMID: 33752640 PMCID: PMC7983212 DOI: 10.1186/s12893-021-01159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. Results Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019). Conclusions Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Department of Surgery, University Hospital of Dresden, Fetscherstrasse 74, 03107, Dresden, Germany.
| | - Nora Jahn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Max Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
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Hau HM, Meyer F, Jahn N, Rademacher S, Sucher R, Seehofer D. Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma. J Clin Med 2020; 9:E3152. [PMID: 33003424 PMCID: PMC7599593 DOI: 10.3390/jcm9103152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES In our study, we evaluated and compared the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system in patients undergoing surgery for perihilar cholangiocarcinoma (PHC). METHODS Patients undergoing liver surgery with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. RESULTS Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1-33.9), and the three- and five-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition vs. the 7th edition resulted in the reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th editions were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system showed a trend to better discrimination, with an AUC of 0.69 (95% CI: 0.52-0.84) compared to 0.61 (95% CI: 0.51-0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age >65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, and lymph node involvement, such as no caudate lobe resection, as independent predictors of poor survival (p < 0.05). CONCLUSIONS In the current study, the newly released 8th edition of AJCC staging system showed no significant benefit compared to the previous 7th edition in predicting the prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma. Further research may help to improve the prognostic value of the AJCC staging system for PHC-for instance, by identifying new prognostic markers or staging criteria, which may improve that individual patient's outcome.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (F.M.); (S.R.); (R.S.); (D.S.)
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Felix Meyer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (F.M.); (S.R.); (R.S.); (D.S.)
| | - Nora Jahn
- Department of Anesthesiology, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (F.M.); (S.R.); (R.S.); (D.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (F.M.); (S.R.); (R.S.); (D.S.)
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (F.M.); (S.R.); (R.S.); (D.S.)
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Scheuermann U, Rademacher S, Jahn N, Sucher E, Seehofer D, Sucher R, Hau HM. Impact of pre-transplant dialysis modality on the outcome and health-related quality of life of patients after simultaneous pancreas-kidney transplantation. Health Qual Life Outcomes 2020; 18:303. [PMID: 32912255 PMCID: PMC7488156 DOI: 10.1186/s12955-020-01545-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Simultaneous pancreas-kidney transplantation (SPKT) profoundly improves the health-related quality of life (HRQoL) of recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL remains unknown. Methods We analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed in our hospital between 2000 and 2016. Prior to transplant, 64 patients received hemodialysis (HD) and nineteen patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey. Results Peri- and postoperative complications, as well as patient and graft survival were similar between the two groups. Both groups showed an improvement of HRQoL in all SF-36 domains after transplantation. Compared with patients who received HD before transplantation, PD patients showed significantly better results in four of the eight SF-36 domains: physical functioning (mean difference HD - PD: − 12.4 ± 4.9, P = < 0.01), bodily pain (− 14.2 ± 6.3, P < 0.01), general health (− 6.3 ± 2.8, P = 0.04), vitality (− 6.8 ± 2.6, P = 0.04), and PCS (− 5.2 ± 1.5, P < 0.01) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01). Conclusions The results of this analysis show that pre-transplant dialysis modality has no influence on the outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seem to have a slight advantage compared with patients with HD before transplantation.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Hau HM, Jahn N, Brunotte M, Lederer AA, Sucher E, Rasche FM, Seehofer D, Sucher R. Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft. BMC Endocr Disord 2020; 20:30. [PMID: 32106853 PMCID: PMC7045477 DOI: 10.1186/s12902-020-0506-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In contrast to insulin-dependent type 1 diabetes mellitus (T1DM), the indication for Simultaneous pancreas-kidney transplantation (SPK) in patients with type 2 diabetes mellitus (T2DM) is still ambiguous and wisely Eurotransplant (ET) only granted transplant-permission in a selected group of patients. However, with regard to improvement of metabolic conditions SPK might still be a considerable treatment option for lean insulin dependent type 2 diabetics suffering from renal disease. METHODS Medical data (2001-2013) from all consecutive T1DM and T2DM patients who received a SPK or kidney transplant alone (KTA) at the University Hospital of Leipzig were analyzed. Donor, recipients and long-term endocrine, metabolic and graft outcomes were investigated for T1DM and T2DM-SPK recipients (transplanted upon a special request allocation by ET) and T2DM patients who received a KTA during the same period. RESULTS Eighty nine T1DM and 12 T2DM patients received a SPK and 26 T2DM patients received a KTA. Patient survival at 1 and 5 years was 89.9 and 88.8% for the T1DM group, 91.7 and 83.3% for the T2DM group, and 92.3 and 69.2% for the T2DM KTA group, respectively (p < 0.01). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was 83.1 and 78.7% for the T1DM group and 91.7 and 83.3% for the T2DM group, respectively (p = 0.71). Kidney allograft survival at 5 years was 79.8% for T1DM, 83.3% for T2DM, and 65.4% for T2DM KTA (p < 0.01). Delayed graft function (DGF) rate was significantly higher in type 2 diabetics received a KTA. Surgical, immunological and infectious complications showed similar results for T1DM and T2DM recipients after SPK transplant and KTA, respectively. With regard to the lipid profile, the mean high-density lipoprotein (HDL)- cholesterol levels were significantly higher in T1DM recipients compared to T2DM patients before transplantation (p = 0.02) and remained significantly during follow up period. CONCLUSION Our data demonstrate that with regard to metabolic function a selected group of patients with T2DM benefit from SPK transplantation. Consensus guidelines and further studies for SPK transplant indications in T2DM patients are still warranted.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Dresden, Fetcherstrasse 74, 01307 Dresden, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Maximilian Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
- Department of Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andri Arnosson Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology and Rheumatology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Franz Maximilian Rasche
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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Sucher R, Rademacher S, Jahn N, Brunotte M, Wagner T, Alvanos A, Sucher E, Seehofer D, Scheuermann U, Hau HM. Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases. BMC Nephrol 2019; 20:453. [PMID: 31815616 PMCID: PMC6902504 DOI: 10.1186/s12882-019-1649-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/27/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background The effects of Simultaneous Pancreas Kidney Transplantation (SPKT) on Peripheral Vascular Disease (PVD) warrants additional study and more target focus, since little is known about the mid- and long-term effects on the progression of PVD after transplantation. Methods 101 SPKT and 26 Kidney Transplantation Alone (KTA) recipients with insulin-dependent diabetes mellitus (IDDM) were retrospectively evaluated with regard to graft and metabolic outcome. Special subgroup analysis was directed towards the development and progression of peripheral vascular complications (PVC) (amputation, ischemic ulceration, lower extremity angioplasty/ bypass surgery) after transplantation. Results The 10-year patient survival was significantly higher in the SPKT group (SPKT: 82% versus KTA 40%; P < 0.001). KTA recipients had a higher prevalence of atherosclerotic risk factors, including coronary artery disease (P < 0.001), higher serum triglyceride levels (P = 0.049), higher systolic (P = 0.03) and diastolic (P = 0.02) blood pressure levels. The incidence of PVD before transplantation was comparable between both groups (P = 0.114). Risk factor adjusted multivariate analysis revealed that patients with SPKT had a significant lower amount (32%) of PVCs (32 PVCs in 21 out of 101 SPKT; P < 0.001) when compared to the KTA patients who developed a significant increase in PVCs to 69% of cases (18 PVCs in 11 out of 26 KTA; P < 0.001). In line mean values of HbA1c (P < 0.01) and serum triglycerides (P < 0.01) were significantly lower in patients with SPKT > 8 years after transplantation. Conclusion SPKT favorably slows down development and progression of PVD by maintaining a superior metabolic vascular risk profile in patients with IDDM1.
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Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Max Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Athanasios Alvanos
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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Döhner K, Thiede C, Jahn N, Ekaterina P, Gambietz A, Prior T, Marcucci G, Jones D, Krauter J, Michael H, Lo-Coco F, Ottone T, Nomdedeu J, Mandrekar S, Huebner L, Laumann K, Geyer S, Klisovic R, Wei A, Sierra J, Sanz M, Brandwein J, de Witte T, Jansen J, Niederwieser D, Appelbaum F, Medeiros B, Tallman M, Schlenk R, Ganser A, Serve H, Ehninger G, Amadori S, Gathmann I, Axel B, Pallaud C, Larson R, Stone R, Döhner H, Bloomfield C. PF260 PROGNOSTIC AND PREDICTIVE IMPACT OF NPM1/FLT3-ITD GENOTYPES AS DEFINED BY 2017 EUROPEAN LEUKEMIANET RISK CATEGORIZATION FROM AML PATIENTS TREATED WITHIN THE INTERNATIONAL RATIFY STUDY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559252.96061.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
In patients with severely compromised gas exchange, interhospital transportation is frequently necessary due to the need to provide access to specialized care. Risks are inherent during transport, so the anticipated benefits of transportation must be weighed against the possible negative outcome during the transport. The use of specialized teams during transportation can help to reduce adverse events. Diligent planning of the transportation, monitoring and medical staff during transport can decrease adverse events and reduce risks. This article defines the group of patients that may benefit from referral. This article discusses the risks associated with the transportation of patients with severely impaired gas exchange and the risks related to different means of transportation. The decisions required before transportation are described as well as the practical approach starting at the transferring hospital until arrival at the admitting hospital.
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Affiliation(s)
- N Jahn
- Klinik und Poliklinik für Anästhesie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - M T Voelker
- Klinik und Poliklinik für Anästhesie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Bercker
- Klinik und Poliklinik für Anästhesie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - U Kaisers
- Klinik und Poliklinik für Anästhesie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Laudi
- Klinik und Poliklinik für Anästhesie und Intensivtherapie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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Jahn N. Seiteneinsteigendenuntersuchungen in Niedersachsen. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1639249] [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: 10/28/2022]
Affiliation(s)
- N Jahn
- Niedersächsisches Landesgesundheitsamt (NLGA), Gesundheitsberichterstattung, Hannover, Germany
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Jahn N, Zühlke C, Bartels R. Hindernisse und Chancen bei der Einführung der Gesundheitsberatung nach §10 ProstSchG Erfahrungen von Gesundheitsämtern ausgewählter Kommunen in Niedersachsen. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1639244] [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: 10/28/2022]
Affiliation(s)
- N Jahn
- Niedersächsisches Landesgesundheitsamt (NLGA), Gesundheitsberichterstattung, Hannover, Germany
| | - C Zühlke
- Niedersächsisches Landesgesundheitsamt (NLGA), Gesundheitsberichterstattung, Hannover, Germany
| | - R Bartels
- Niedersächsisches Landesgesundheitsamt (NLGA), Gesundheitsberichterstattung, Hannover, Germany
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Voelker MT, Bergmann A, Busch T, Jahn N, Laudi S, Noreikat K, Simon P, Bercker S. The effects of hemoglobin glutamer-200 and iNO on pulmonary vascular tone and arterial oxygenation in an experimental acute respiratory distress syndrome. Pulm Pharmacol Ther 2018; 49:130-133. [DOI: 10.1016/j.pupt.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/16/2017] [Accepted: 01/25/2018] [Indexed: 11/17/2022]
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Hau HM, Kloss A, Wiltberger G, Jahn N, Krenzien F, Benzing C, Schmelzle M, Seehofer D, Atanasov G, Bartels M. The challenge of liver resection in benign solid liver tumors in modern times - in which cases should surgery be done? Z Gastroenterol 2017; 55:639-652. [PMID: 28709169 DOI: 10.1055/s-0043-110145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Due to improved diagnostical and therapeutical approaches, benign liver tumors represent a challenge in clinical management. We here report our experience with patients undergoing liver resection for benign liver tumors. Methods 188 One hundred eighty-eight consecutive patients, who underwent surgery for solid benign liver tumors from 1992 - 2014, were analyzed retrospectively. The focus was on diagnostic pathways, indications for surgery, and perioperative and postoperative quality of life (QoL). Results Of 188 patients, 100 had focal nodular hyperplasia (FNH) (53.2 %), 33 had hepatocellular adenoma (17.5 %), and 55 had hemangioma (29.3 %). In most patients, there was more than one 1 indication for liver resection, including tumor-associated symptoms (n = 82, 43.6 %), suspicion of malignancy (n = 104, 55.3 %), tumor disease in the medical history (n = 48, 25.5 %), or tumor enlargement (n = 27, 14.4 %). Serious complications (>grade III;, Clavien-Dindo) occurred in 9.5 % of patients. Perioperative mortality was 0.5 %. Patient pain scores decreased over time (p < 0.001). QoL after liver resection significantly improved (p = 0.007). Conclusion Uncertainty of the tumor entity remains an issue in preoperative diagnostics. If indicated, liver resection for benign liver tumors represents a safe approach and leads to significant improvements of QoL.
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Affiliation(s)
- Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Anne Kloss
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Georg Wiltberger
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Felix Krenzien
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Hospital of Berlin, Berlin, Germany
| | - Christian Benzing
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Hospital of Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Hospital of Berlin, Berlin, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
| | - Georgi Atanasov
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany.,Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Hospital of Berlin, Berlin, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany
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Jahn N, Agrawal M, Bullinger L, Weber D, Corbacioglu A, Gaidzik VI, Schmalbrock L, Thol F, Heuser M, Krauter J, Göhring G, Kündgen A, Fiedler W, Wattad M, Held G, Köhne CH, Horst HA, Lübbert M, Ganser A, Schlenk RF, Döhner H, Döhner K, Paschka P. Incidence and prognostic impact of ASXL2 mutations in adult acute myeloid leukemia patients with t(8;21)(q22;q22): a study of the German-Austrian AML Study Group. Leukemia 2017; 31:1012-1015. [PMID: 28090090 DOI: 10.1038/leu.2017.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- N Jahn
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - M Agrawal
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - L Bullinger
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - D Weber
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - A Corbacioglu
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - V I Gaidzik
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - L Schmalbrock
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - F Thol
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - M Heuser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - J Krauter
- Medizinische Klinik III, Klinikum Braunschweig, Braunschweig, Germany
| | - G Göhring
- Institut für Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - A Kündgen
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - W Fiedler
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - M Wattad
- Klinik für Hämatologie, internistische Onkologie und Stammzellentransplantation, Evangelisches Krankenhaus Essen-Werden, Essen, Germany
| | - G Held
- Innere Medizin I, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - C-H Köhne
- Universitätsklinik für Innere Medizin - Onkologie und Hämatologie, Klinikum Oldenburg, Oldenburg, Germany
| | - H-A Horst
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - M Lübbert
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Germany
| | - A Ganser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - R F Schlenk
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - H Döhner
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - K Döhner
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - P Paschka
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
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Jahn N, Lamberts RR, Busch CJ, Voelker MT, Busch T, Koel-Simmelink MJA, Teunissen CE, Oswald DD, Loer SA, Kaisers UX, Weimann J. Inhaled carbon monoxide protects time-dependently from loss of hypoxic pulmonary vasoconstriction in endotoxemic mice. Respir Res 2015; 16:119. [PMID: 26415503 PMCID: PMC4587582 DOI: 10.1186/s12931-015-0274-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022] Open
Abstract
Background Inhaled carbon monoxide (CO) appears to have beneficial effects on endotoxemia-induced impairment of hypoxic pulmonary vasoconstriction (HPV). This study aims to specify correct timing of CO application, it’s biochemical mechanisms and effects on inflammatory reactions. Methods Mice (C57BL/6; n = 86) received lipopolysaccharide (LPS, 30 mg/kg) intraperitoneally and subsequently breathed 50 ppm CO continuously during defined intervals of 3, 6, 12 or 18 h. Two control groups received saline intraperitoneally and additionally either air or CO, and one control group received LPS but breathed air only. In an isolated lung perfusion model vasoconstrictor response to hypoxia (FiO2 = 0.01) was quantified by measurements of pulmonary artery pressure. Pulmonary capillary pressure was estimated by double occlusion technique. Further, inflammatory plasma cytokines and lung tissue mRNA of nitric-oxide-synthase-2 (NOS-2) and heme oxygenase-1 (HO-1) were measured. Results HPV was impaired after LPS-challenge (p < 0.01). CO exposure restored HPV-responsiveness if administered continuously for full 18 h, for the first 6 h and if given in the interval between the 3rd and 6th hour after LPS-challenge (p < 0.05). Preserved HPV was attributable to recovered arterial resistance and associated with significant reduction in NOS-2 mRNA when compared to controls (p < 0.05). We found no effects on inflammatory plasma cytokines. Conclusion Low-dose CO prevented LPS-induced impairment of HPV in a time-dependent manner, associated with a decreased NOS-2 expression.
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Affiliation(s)
- Nora Jahn
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
| | - Regis R Lamberts
- Department of Anaesthesiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.
| | - Cornelius J Busch
- Department of Anaesthesiology, Ruprecht-Karls-University, Heidelberg, Germany.
| | - Maria T Voelker
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
| | - Thilo Busch
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
| | - Marleen J A Koel-Simmelink
- Department of Clinical Chemistry, Neurological Laboratory and Biobank, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Charlotte E Teunissen
- Department of Clinical Chemistry, Neurological Laboratory and Biobank, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Daniel D Oswald
- Department of Anaesthesiology, Universitätsklinikum, Münster, Germany.
| | - Stephan A Loer
- Department of Anaesthesiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.
| | - Udo X Kaisers
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
| | - Jörg Weimann
- Department of Anaesthesia and Intensive Care Medicine, Sankt Gertrauden-Krankenhaus, Berlin, Germany.
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Abstract
BACKGROUND Many missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem. AIM This article promotes the understanding of emergency service personnel for the associations between social problems and health. Solution strategies for frequent social emergencies are described. MATERIAL AND METHODS This article demonstrates the associations between socioeconomic status, health and disease. Typical indications for missions in which social aspects play an important role are presented and solution strategies for the approach are suggested. A discussion is presented on how to deal with cases of child abuse and domestic violence. Three classical psychiatric problem areas with common social components are explained: psychomotor state of excitation, suicide and alcohol-associated incidents and special attention is paid to danger to third parties and aggressive patients. In addition to the treatment of medical conditions, social problems play an important role particularly for the elderly and chronically ill patients. RESULTS AND CONCLUSION Emergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.
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Affiliation(s)
- Maria Theresa Völker
- Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, Uniklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland,
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24
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Hespe-Jungesblut K, Bruns-Philipps E, Jahn N, Zühlke C. Kindergesundheit im Einschulungsalter, Bericht zum Gesundheitszustand der Schulanfänger in Niedersachsen. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1337467] [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: 10/27/2022]
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25
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Abstract
Since October 2011 new guidelines exist for temperature management in critical care. According to the guidelines the term targeted temperature management (TTM) should replace the term therapeutic hypothermia. There is now a strong recommendation for TTM using 32-34°C as the preferred treatment for out-of-hospital adult cardiac arrest with a first registered electrocardiography rhythm of ventricular fibrillation or pulseless ventricular tachycardia and still unconscious after restoration of spontaneous circulation. A TTM of 32.5-35.5°C is also recommended for the treatment of term newborns who sustain asphyxia and exhibit acidosis and/or encephalopathy.
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Affiliation(s)
- N Jahn
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig (AöR), Liebigstr. 20, 04103, Leipzig, Deutschland
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26
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Austein T, Jahn N. [Pelleted skull in multiple myeloma]. Dtsch Med Wochenschr 2008; 133:775-6. [PMID: 18382951 DOI: 10.1055/s-2008-1075645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- T Austein
- Medizinische Klinik, St. Bernhard Hospital, Claussenstr. 3, 26919 Brake.
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27
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Purschwitz K, Rassoul F, Reuter W, Purschwitz R, Jahn N, Kellert D, Richter V. [Soluble leukocyte adhesion molecules in vegetarians of various ages]. Z Gerontol Geriatr 2001; 34:476-9. [PMID: 11828888 DOI: 10.1007/s003910170022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Upregulation of leukocyte adhesion molecules under atherogenic conditions is accompanied by the release of soluble forms of adhesion molecules into the bloodstream. Vegetarians have a favorable cardiovascular risk profile. The aim of the present study was to assess the levels of circulating E-selectin (cE-selectin), circulating intercellular adhesion molecule-1 (cICAM-1), and circulating vascular adhesion molecule-1 (cVCAM-1) in both vegetarians and subjects of the average population and furthermore to evaluate the age dependence of cell adhesion molecules. METHODS 24 male and 59 female vegetarians (mainly members of the German Society of Vegetarians) and 124 male and 179 female control subjects (volunteers, of the ILSE study Leipzig = Interdisciplinary Long Time Study of Health Adult Age and the Lipid-Study Leipzig), 18-89 years old were included in the study. The serum levels of circulating cell adhesion molecules were determined using monoclonal antibody-based ELISA assays (R & D Systems, Abingdon, Europe Ltd.). RESULTS Vegetarians were characterized by a favorable lipid profile and a low prevalence of common risk factors for atherosclerosis. This group showed a tendency towards lower cICAM-1 levels in comparison with control subjects. Furthermore, significantly lower cE-selectin levels were found in the group of vegetarians. An age-dependent increase of cVCAM-1 and cICAM-1 levels was found both in the group of vegetarians and control subjects. No significant differences were noted regarding the gender of the subjects included in the study. CONCLUSION Low cE-selectin levels of vegetarians may reflect the favorable cardiovascular risk profile of this group. Furthermore, the present data indicate that cVCAM-1 and cICAM-1 are age-dependent parameters independent of risk for atherosclerosis.
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Affiliation(s)
- K Purschwitz
- Institut für Laboratoriumsmedizin Klinische Chemie und Molekulare Diagnostik Universitätsklinikum Leipzig Liebigstrasse 27 04103 Leipzig, Germany
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28
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Bohuslavizki KH, Brenner W, Braunsdorf WE, Behnke A, Tinnemeyer S, Hugo HH, Jahn N, Wolf H, Sippel C, Clausen M, Mehdorn HM, Henze E. Somatostatin receptor scintigraphy in the differential diagnosis of meningioma. Nucl Med Commun 1996; 17:302-10. [PMID: 8786866 DOI: 10.1097/00006231-199604000-00157] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate somatostatin receptor scintigraphy (SRS) in patients with meningioma proven or suspected on magnetic resonance imaging (MRI). Prior to surgery, 47 patients were investigated up to 24 h following the injection of 200 MBq 111In-octreotide. Tracer uptake was compared with the histological presence of meningioma. Histology revealed 43 meningiomas, 3 neurinomas and 1 ependymoma. A true-positive SRS result was obtained in 36 patients, in 13 of whom a tumour volume of < 10 ml was noted. A false-negative SRS result was obtained in seven patients, all of whom had a tumour volume of < 10 ml. Whereas MRI alone was decisive in 38 of 47 patients, it could only provide a differential diagnosis in the remaining 9 patients. A positive SRS result confirmed meningioma in five of these patients, and a negative SRS result excluded meningioma in the other four. Therefore, cases of SRS-negative meningioma do exist. Nevertheless, significant clinical benefit can be obtained from functional imaging with 111In-octreotide in patients with an inconclusive MRI result, as large meningiomas can be excluded by scintigraphy alone, whereas meningiomas of any size may be confirmed in combination with specific MRI results.
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Affiliation(s)
- K H Bohuslavizki
- Clinic of Nuclear Medicine, Christian-Albrechts University, Kiel, Germany
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Bohuslavizki KH, Brenner W, Günther M, Eberhardt JU, Jahn N, Tinnemeyer S, Wolf H, Sippel C, Clausen M, Gatzemeier U, Henze E. Somatostatin receptor scintigraphy in the staging of small cell lung cancer. Nucl Med Commun 1996; 17:191-6. [PMID: 8692484 DOI: 10.1097/00006231-199603000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to evaluate somatostatin receptor scintigraphy (SRS) in the staging of patients with small cell lung cancer. Prior to chemotherapy, 20 patients were investigated up to 24 h following an injection of 200 MBq 111In-octreotide. Following chemotherapy and restaging, four patients were re-evaluated. Primary tumour was detected in 18 of 23 studies, which exhibited increasing target-to-back-ground ratios over time. Lymph node metastases and distant metastases were detected in 7 of 27 and 8 of 31 sites, respectively. Thus, the overall sensitivity for detecting metastases was less than 26%. SRS did not result in any upstaging of patients. We conclude that in patients with small cell lung cancer, functional imaging by SRS has no impact on clinical decision making.
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Affiliation(s)
- K H Bohuslavizki
- Clinic of Nuclear Medicine, Christian-Albrechts-Universität Kiel, Germany
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Eujen R, Jahn N, Thurmann U. Synthesis and properties of trifluoromethylated stannanes. The formation and NMR spectra of the difluoromethylstannanes (CF3)n(CF2H)mSn(CH3)4-n-m. J Organomet Chem 1994. [DOI: 10.1016/0022-328x(94)87049-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Jahn N, Lindemann M. [Various theories on heart function in the 19th and 20th century in "Pflügers Archiv"]. Z Arztl Fortbild (Jena) 1991; 85:895-6. [PMID: 1950017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- N Jahn
- Ambulante medizinische Betreuung III. Wohngebiet Berlin-Marzahn, Abteilung Allgemeinmedizin, Medizin, Humboldt-Universität zu Berlin
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33
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Rhim SL, Jahn N, Schnetter W, Geider K. Heterologous expression of a mutated toxin gene from Bacillus thuringiensis subsp. tenebrionis. FEMS Microbiol Lett 1990; 54:95-9. [PMID: 2323547 DOI: 10.1016/0378-1097(90)90264-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Using oligonucleotide probes we have isolated a DNA fragment encoding an insecticidal toxin of the coleopteran specific Bacillus thuringiensis subsp. tenebrionis. The gene was altered by site directed mutagenesis at its 5'-end and adapted for general cloning and expression purposes with a linker including a start codon and new restriction sites. The constructs were inserted into several vector plasmids and expressed in Escherichia coli. Expression E. coli was strongly enhanced by the lac-promoter. A fusion protein with phage MS2-polymerase was produced together with a 67 kDa protein also found for normal expression of the toxin gene. Synthesis of the latter protein indicated a second ribosome binding site at the 5'-terminus of the toxin encoding sequence. Toxin-containing proteins were identified by Western blot analysis. The positive cell extracts from E. coli had insecticidal activity on larvae of the Colorado potato beetle. The cloned gene is not homologous to a gene previously cloned by us whose gene products were also toxic to coleopteran larvae.
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Affiliation(s)
- S L Rhim
- Max-Planck-Institut für medizinische Forschung, Abteilung Molekulare Biologie, Heidelberg, F.R.G
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34
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Lindemann M, Jahn N, Richter J. [Public health education in Russia in the 18th century]. Z Gesamte Hyg 1987; 33:314-5. [PMID: 3307184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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