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Pötter AR, Sauzet O, Borde T, Naghavi B, Razum O, Sehouli J, Somasundaram R, Stein H, David M. Influence of appropriate emergency department utilization and verbal communication on physicians' (dis)satisfaction with doctor-patient interactions with special consideration of migrational backgrounds. Wien Med Wochenschr 2024; 174:140-148. [PMID: 35849244 PMCID: PMC9294758 DOI: 10.1007/s10354-022-00948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 10/30/2022]
Abstract
In recent years, utilization of emergency departments (EDs) has increased continuously, both in Germany and internationally. Inappropriate use of EDs is believed to be partly responsible for this trend. The topic of doctor-patient interaction (DPI) has received little attention in research. However, successful DPI is not only important for adherence and treatment success, but also for the satisfaction of medical staff. This non-interventionl cross-sectional study attempts to identify factors influencing physicians' satisfaction with DPIs, with a particular focus on the appropriate utilization of EDs and verbal communication. We carried out tripartite data collection in three EDs of major referral hospitals in Berlin between July 2017 and July 2018. Migration experience, communication and language problems, level of education, and a large gap between physicians' and patients' perceived urgency regarding the utilization of EDs influence the quality of the doctor-patient relationships and interactions.
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Affiliation(s)
- Anna Rahel Pötter
- Campus Virchow Clinic, Clinic for Gynecology with Center for Oncological Surgery, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Odile Sauzet
- School of Public Health, Dept. of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- Alice Salomon University of Applied Sciences, Berlin, Germany
| | - Baharan Naghavi
- Charité Comprehensive Cancer Center, Charité University Medicine Berlin, Berlin, Germany
| | - Oliver Razum
- School of Public Health, Dept. of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Jalid Sehouli
- Campus Virchow Clinic, Clinic for Gynecology with Center for Oncological Surgery, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Hendrike Stein
- Department of Emergency Medicine, Vivantes Clinic Berlin-Neukölln, Berlin, Germany
| | - Matthias David
- Campus Virchow Clinic, Clinic for Gynecology with Center for Oncological Surgery, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Weber V, Hübner A, Pflock S, Schamberger L, Somasundaram R, Boehm L, Bauer W, Diehl-Wiesenecker E. Advance directives in the emergency department-a systematic review of the status quo. BMC Health Serv Res 2024; 24:426. [PMID: 38570808 PMCID: PMC10993583 DOI: 10.1186/s12913-024-10819-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g. as advance directives, can guide clinicians in making end-of-life decisions that respect the patient's wishes and autonomy. However, patient centered decisions are hindered by limited availability of DPWs in emergency settings. OBJECTIVE This systematic review aims to congregate present data on recorded rates for DPW existence and availability in the emergency department (ED) as well as contributing factors for these rates. METHODS We searched MEDLINE, Google Scholar, Embase and Web of Science databases in September 2023. Publications providing primary quantitative data on DPW in the ED were assessed. Publications referring only to a subset of ED patients (other than geriatric) and investigating DPW issued after admission were excluded. RESULTS A total of 22 studies from 1996 to 2021 were included in the analysis. Most were from the US (n = 12), followed by Australia (n = 4), Canada (n = 2), South Korea, Germany, the United Kingdom and Switzerland (n = 1 each). In the general adult population presenting to the ED, 19.9-27.8% of patients reported having some form of DPW, but only in 6.8% or less it was available on presentation. In the geriatric population, DPW rates (2.6-79%) as well as their availability (1.1-48.8%) varied widely. The following variables were identified as positive predictors of having DPW, among others: higher age, poorer overall health, as well as sociodemographic factors, such as female gender, having children, being in a relationship, higher level of education or a recent previous presentation to hospital. CONCLUSIONS Existence and availability of a recorded DPW among ED patients was low in general and even in geriatric populations mostly well below 50%. While we were able to gather data on prevalence and predictors, this was limited by heterogeneous data. We believe further research is needed to explore the quality of DPW and measures to increase both rates of existence and availability of DPW in the ED.
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Affiliation(s)
- Vincent Weber
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aurelia Hübner
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Pflock
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lukas Schamberger
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lennert Boehm
- Emergency Department, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Wolfgang Bauer
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva Diehl-Wiesenecker
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Espejo T, Terhalle L, Malinovska A, Riedel HB, Arntz L, Hafner L, Delport-Lehnen K, Zuppinger J, Geigy N, Leuppi J, Somasundaram R, Bingisser R, Nickel CH. Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study. Acad Emerg Med 2024. [PMID: 38532263 DOI: 10.1111/acem.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Emergency department (ED) presentations after a ground-level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high-sensitivity cardiac troponin (hs-cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), as well as the diagnostic accuracy of hs-cTnT and hs-cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF. METHODS This was a prospective, international, multicenter, cohort study with a follow-up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs-cTnT and hs-cTnI levels were determined from thawed samples for every patient. RESULTS In total, 558 patients were included. Median (IQR) age was 83 (77-89) years, and 67.7% were female. Elevated hs-cTnT levels were found in 384 (68.8%) patients, and elevated hs-cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the gold standard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs-cTnT and hs-cTnI levels compared with survivors (hs-cTnT 40 [23-85] ng/L in nonsurvivors and 20 [13-33] ng/L in survivors; hs-cTnI 25 [14-54] ng/L in nonsurvivors and 8 [4-16] ng/L in survivors; p < 0.001 for both). CONCLUSIONS A majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs-cTnT levels and 86 (15.4%) elevated hs-cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs-cTnT and hs-cTnI were both found to have prognostic properties for mortality prediction up to 1 year.
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Affiliation(s)
- Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Terhalle
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra Malinovska
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Arntz
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Livia Hafner
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Joanna Zuppinger
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Nicolas Geigy
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jörg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Piedmont S, Goldhahn L, Swart E, Robra BP, Fleischmann-Struzek C, Somasundaram R, Bauer W. Sepsis incidence, suspicion, prediction and mortality in emergency medical services: a cohort study related to the current international sepsis guideline. Infection 2024:10.1007/s15010-024-02181-5. [PMID: 38372959 DOI: 10.1007/s15010-024-02181-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. METHODS Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics' and emergency physicians' EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools' intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. RESULTS Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. CONCLUSION Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.
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Affiliation(s)
- Silke Piedmont
- Charité - Universitätsmedizin Berlin, Zentrale Notaufnahme Campus Benjamin Franklin, Berlin, Germany.
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany.
| | - Ludwig Goldhahn
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Bernt-Peter Robra
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | | | - Rajan Somasundaram
- Charité - Universitätsmedizin Berlin, Zentrale Notaufnahme Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Bauer
- Charité - Universitätsmedizin Berlin, Zentrale Notaufnahme Campus Benjamin Franklin, Berlin, Germany
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Gerischer L, Mainert M, Wohmann N, Kubisch I, Stölzel U, Stauch T, von Wegerer S, Braun F, Weiler-Normann C, Blaschke S, Frank J, Somasundaram R, Diehl-Wiesenecker E. German Porphyria Registry (PoReGer)-Background and Setup. Healthcare (Basel) 2024; 12:111. [PMID: 38201016 PMCID: PMC10779132 DOI: 10.3390/healthcare12010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Porphyrias, as most rare diseases, are characterized by complexity and scarcity of knowledge. A national registry in one of the largest European populations that prospectively collects longitudinal clinical and laboratory data are an important and effective tool to close this gap. The German Porphyria Registry (PoReGer) was founded by four centers with longstanding expertise in the field of porphyrias and rare diseases (Charité-Universitätsmedizin Berlin, Porphyria Center Saxony Chemnitz, University Medical Center Hamburg-Eppendorf, University Medical Center Göttingen) and the German reference laboratory for porphyria, and is supported by the largest German porphyria patient organization. A specified data matrix for three subgroups (acute, chronic blistering cutaneous, acute non-blistering cutaneous) includes data on demographics, specific porphyria-related symptoms, clinical course, general medical history, necessary follow-up assessments (including laboratory and imaging results), symptomatic and disease-modifying therapies, and side-effects. Additionally, the registry includes patient-reported outcome measures on quality of life, depression, and fatigue. PoReGer aims to broaden and deepen the understanding on all porphyria-related subjects. We expect these data to significantly improve the management and care of porphyria patients. Additionally, the data can be used for educational purposes to increase awareness, for the planning of healthcare services, and for machine learning algorithms for early detection of porphyrias.
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Affiliation(s)
- Lea Gerischer
- Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Neuroscience Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Mona Mainert
- Department of Emergency Medicine and Porphyria Clinic, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Nils Wohmann
- Department of Internal Medicine II, Saxony Porphyria Center, Klinikum Chemnitz, gGmbH, 09116 Chemnitz, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II, Saxony Porphyria Center, Klinikum Chemnitz, gGmbH, 09116 Chemnitz, Germany
| | - Ulrich Stölzel
- Department of Internal Medicine II, Saxony Porphyria Center, Klinikum Chemnitz, gGmbH, 09116 Chemnitz, Germany
| | - Thomas Stauch
- Porphyria Laboratory IPNET, MVZ Labor PD Dr. Med. Volkmann GbR, 76131 Karlsruhe, Germany
| | | | - Fabian Braun
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christina Weiler-Normann
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine and Porphyria Clinic, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Eva Diehl-Wiesenecker
- Department of Emergency Medicine and Porphyria Clinic, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
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6
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Voit F, Erber J, Feuerherd M, Fries H, Bitterlich N, Diehl-Wiesenecker E, Gladis S, Lieb J, Protzer U, Schneider J, Geisler F, Somasundaram R, Schmid RM, Bauer W, Spinner CD. Rapid point-of-care detection of SARS-CoV-2 infection in exhaled breath using ion mobility spectrometry: a pilot study. Eur J Med Res 2023; 28:318. [PMID: 37660038 PMCID: PMC10474630 DOI: 10.1186/s40001-023-01284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/12/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND An effective testing strategy is essential for pandemic control of the novel Coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Breath gas analysis can expand the available toolbox for diagnostic tests by using a rapid, cost-beneficial, high-throughput point-of-care test. We conducted a bi-center clinical pilot study in Germany to evaluate breath gas analysis using multi-capillary column ion mobility spectrometry (MCC-IMS) to detect SARS-CoV-2 infection. METHODS Between September 23, 2020, and June 11, 2021, breath gas measurements were performed on 380 patients (SARS-CoV-2 real-time polymerase chain reaction (PCR) positive: 186; PCR negative: 194) presenting to the emergency department (ED) with respiratory symptoms. RESULTS Breath gas analysis using MCC-IMS identified 110 peaks; 54 showed statistically significant differences in peak intensity between the SARS-CoV-2 PCR-negative and PCR-positive groups. A decision tree analysis classification resulted in a sensitivity of 83% and specificity of 86%, but limited robustness to dataset changes. Modest values for the sensitivity (74%) and specificity (52%) were obtained using linear discriminant analysis. A systematic search for peaks led to a sensitivity of 77% and specificity of 67%; however, validation by transferability to other data is questionable. CONCLUSIONS Despite identifying several peaks by MCC-IMS with significant differences in peak intensity between PCR-negative and PCR-positive samples, finding a classification system that allows reliable differentiation between the two groups proved to be difficult. However, with some modifications to the setup, breath gas analysis using MCC-IMS may be a useful diagnostic toolbox for SARS-CoV-2 infection. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov on September 21, 2020 (NCT04556318; Study-ID: HC-N-H-2004).
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Affiliation(s)
- Florian Voit
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - J Erber
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Feuerherd
- Institute of Virology, Helmholtz Center Munich, TUM, School of Medicine, Munich, Germany
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - H Fries
- B. Braun Melsungen AG, Melsungen, Germany
| | - N Bitterlich
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden, Germany
| | - E Diehl-Wiesenecker
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - S Gladis
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - J Lieb
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - U Protzer
- Institute of Virology, Helmholtz Center Munich, TUM, School of Medicine, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - J Schneider
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - F Geisler
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - R Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - R M Schmid
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - W Bauer
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - C D Spinner
- Department of Internal Medicine II, University Hospital Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
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Diehl-Wiesenecker E, Blaschke S, Wohmann N, Kubisch I, Stauch T, Mainert M, Helm F, von Wegerer S, Pittrow D, Frank J, Stölzel U, Somasundaram R. Detect Acute Porphyrias in Emergency Departments (DePorED) - a pilot study. Orphanet J Rare Dis 2023; 18:146. [PMID: 37308920 DOI: 10.1186/s13023-023-02768-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Acute porphyrias (APs) are a group of rare metabolic diseases related to a disturbed heme biosynthesis. Symptoms may first occur as life threatening attacks, comprising abdominal pain and/or variable neuro-psychiatric symptoms, thus leading to presentation in emergency departments (ED) first. Due to the low prevalence, diagnosis of AP is often missed, even after readmission to the ED. Therefore, strategies are needed to consider APs in ED patients with unexplained abdominal pain, especially since early and adequate treatment will avoid an unfavorable clinical course. Aim of this prospective study was to investigate the prevalence of APs in ED patients and thus, addressing feasibility of screening for rare diseases, such as APs in the real life setting. METHODS From September 2019 to March 2021, patients presenting to the ED of three German tertiary care hospitals with moderate to severe prolonged abdominal pain (Visual Analog Scale, VAS > 4 out of 10 points) not otherwise explained were screened and prospectively enrolled. In addition to standard of care (SOC) diagnostics a blood and urine sample for plasma fluorescence scan and biochemical porphyrin analysis were sent to a certified German porphyria laboratory. RESULTS Overall, of 653 screened patients, 68 patients (36 females; mean age 36 years) were included for biochemical porphyrin analysis. No patient with AP was detected. The most frequent discharge diagnoses included "abdominal and digestive symptoms" (n = 22, 32%), "gastrooesophageal diseases" (n = 18, 27%), "infectious bowel disease" (n = 6, 9%) and "biliopancreatic diseases" (n = 6, 9%). Although not primarily addressed, we observed an increase in knowledge of the ED staffs at all study sites regarding our screening algorithm and thus, awareness for APs. CONCLUSIONS To the best of our knowledge, we performed the first prospective screening project for APs in the ED. Although we detected no patient with AP in this study, we demonstrated the feasibility of a multicenter screening process for APs by building up a well-working infrastructure comprising laboratory testing as well as data management. This enables the set-up of a larger scale revised follow-up study with a central focus on structured education, thus, possibly acting as blueprint for other rare diseases.
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Affiliation(s)
- Eva Diehl-Wiesenecker
- Department of Emergency Medicine and Porphyria Clinic, Charité University Medicine Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Nils Wohmann
- Department of Internal Medicine II and Saxony Porphyria Center, Klinikum Chemnitz, Chemnitz, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II and Saxony Porphyria Center, Klinikum Chemnitz, Chemnitz, Germany
| | | | - Mona Mainert
- Department of Emergency Medicine and Porphyria Clinic, Charité University Medicine Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Franziska Helm
- Department of Internal Medicine II and Saxony Porphyria Center, Klinikum Chemnitz, Chemnitz, Germany
| | - Sabine von Wegerer
- Department of Emergency Medicine and Porphyria Clinic, Charité University Medicine Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Berliner Leberring e.V, Berlin, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Technical University of Dresden (TUD), Dresden, Germany
- Innovation Center Real World Evidence, GWT-TUD, Dresden, Germany
| | - Jorge Frank
- Department of Dermatology, Venerology and Allergology, University Medical Center, Göttingen, Germany
| | - Ulrich Stölzel
- Department of Internal Medicine II and Saxony Porphyria Center, Klinikum Chemnitz, Chemnitz, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine and Porphyria Clinic, Charité University Medicine Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Bauer W, Galtung N, von Wunsch-Rolshoven Teruel I, Dickescheid J, Reinhart K, Somasundaram R. Screening auf Sepsis in der Notfallmedizin – qSOFA ist uns nicht genug. Notf Rett Med 2023. [DOI: 10.1007/s10049-022-01078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Zusammenfassung
Hintergrund
Die Sepsis ist eine häufige und lebensbedrohliche Komplikation einer akuten Infektion. In der Notfallmedizin hat sich zum Screening auf Sepsis der Quick Sequential-Organ-Failure-Assessment(qSOFA)-Score etabliert. Bereits mit der Einführung des Scores wurde dessen schwache Sensitivität kritisiert. Nun fordern aktuelle Leitlinien, den qSOFA-Score nicht mehr zum Screening auf Sepsis einzusetzen. Als eine Alternative wird der National Early Warning Score 2 (NEWS2) vorgeschlagen.
Ziel der Arbeit
In einer Subanalyse einer Kohorte von notfallmedizinischen Patient*innen soll die diagnostische Aussagekraft des qSOFA-Scores und des NEWS2 zur Erkennung einer Sepsis verglichen werden. Zusätzlich soll gezeigt werden, inwieweit mithilfe von abweichenden Vitalparametern bereits eine Risikoerhöhung für eine Sepsis ableitbar ist.
Methodik
Mittels AUROC (Area Under Receiver Operating Characteristics) und Odds Ratios wurden die Scores bzw. die Vitalparameter auf ihre Fähigkeit untersucht, septische Patient*innen zu erkennen.
Ergebnisse
Von 312 eingeschlossenen Patient*innen wurde bei 17,9 % eine Sepsis diagnostiziert. Der qSOFA-Score erkannte eine Sepsis mit einer AUROC von 0,77 (NEWS2 0,81). Für qSOFA fand sich eine Sensitivität von 57 % (Spezifität 83 %), für NEWS2 96 % (Spezifität 45 %). Die Analyse der einzelnen Vitalparameter zeigte, dass unter Patient*innen mit einer akuten Infektion eine Vigilanzminderung als deutliches Warnsignal für eine Sepsis zu werten ist.
Diskussion
In der Notfallmedizin sollte qSOFA nicht als alleiniges Tool für das Screening auf Sepsis verwendet werden. Bei Verdacht auf eine akute Infektion sollten grundsätzlich sämtliche Vitalparameter erfasst werden, um das Vorliegen einer akuten Organschädigung und somit einen septischen Krankheitsverlauf frühzeitig zu erkennen.
Graphic abstract
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9
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Gisch UA, Ahlers E, Lee D, Heuser-Collier I, Somasundaram R. A program for volunteers accompanying older patients with cognitive dysfunction to improve the quality of emergency department care: A pilot study. Geriatr Nurs 2022; 48:94-102. [PMID: 36155315 DOI: 10.1016/j.gerinurse.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022]
Abstract
Admission to an emergency department (ED) is challenging for older patients with cognitive dysfunction (PWCD). Targeted patient-oriented approaches to improve the care for PWCD are needed. The aim of this pilot study was to design and evaluate a program for volunteers to support PWCD in the ED. Volunteers (N = 9) first received a training and during the following six months (N = 90 shifts), they accompanied PWCD (N = 112) during their stay. Results showed that the training increased volunteers' knowledge and expertise, but not shift-related self-efficacy. The most frequent strategies applied were conversations, holding hands and touching, and providing food and drinks. After six months, volunteers reported a great sense of meaningfulness and felt that they were highly appreciated by the patients. ED nurses' sceptical attitudes towards the program decreased. The program is beneficial for PWCD, appears to be meaningful for volunteers and is appreciated by ED nurses.
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Affiliation(s)
- Ulrike A Gisch
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Eike Ahlers
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Johanniter-Krankenhaus Treuenbrietzen, Department of Psychiatry and Psychotherapy, Johanniterstraße 1, 14929 Treuenbrietzen, Germany.
| | - Denise Lee
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Isabella Heuser-Collier
- Charité - Universitaetsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Rajan Somasundaram
- Charité - Universitaetsmedizin Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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10
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Pin M, Somasundaram R, Wrede C, Schwab F, Gastmeier P, Hansen S. Correction: Antimicrobial resistance control in the emergency department: a need for concrete improvement. Antimicrob Resist Infect Control 2022; 11:128. [PMID: 36316718 PMCID: PMC9623993 DOI: 10.1186/s13756-022-01168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Martin Pin
- Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Department of Emergency Medicine, Düsseldorf, Germany ,Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), German Association for Emergency Medicine, Berlin, Germany
| | - Rajan Somasundaram
- grid.6363.00000 0001 2218 4662Department of Emergency Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Wrede
- Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), German Association for Emergency Medicine, Berlin, Germany ,grid.491869.b0000 0000 8778 9382Department of Emergency Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Frank Schwab
- grid.6363.00000 0001 2218 4662Department of Emergency Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany ,National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- grid.6363.00000 0001 2218 4662Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin, Germany ,National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Sonja Hansen
- grid.6363.00000 0001 2218 4662Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin, Germany ,National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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Pin M, Somasundaram R, Wrede C, Schwab F, Gastmeier P, Hansen S. Antimicrobial resistance control in the emergency department: a need for concrete improvement. Antimicrob Resist Infect Control 2022; 11:94. [PMID: 35804401 PMCID: PMC9264623 DOI: 10.1186/s13756-022-01135-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/29/2022] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Rational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey. METHODS Aspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively. RESULTS 66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs' healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs' organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise ICP responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively). CONCLUSIONS Management of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs.
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Affiliation(s)
- Martin Pin
- Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Department of Emergency Medicine, Düsseldorf, Germany
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
| | - Rajan Somasundaram
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Wrede
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
- Helios Hospital Berlin-Buch, Department of Emergency Medicine, Berlin, Germany
| | - Frank Schwab
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Sonja Hansen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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Bauer W, Weber M, Diehl-Wiesenecker E, Galtung N, Prpic M, Somasundaram R, Tauber R, Schwenk JM, Micke P, Kappert K. Plasma Proteome Fingerprints Reveal Distinctiveness and Clinical Outcome of SARS-CoV-2 Infection. Viruses 2021; 13:v13122456. [PMID: 34960725 PMCID: PMC8706135 DOI: 10.3390/v13122456] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 01/01/2023] Open
Abstract
Background: We evaluated how plasma proteomic signatures in patients with suspected COVID-19 can unravel the pathophysiology, and determine kinetics and clinical outcome of the infection. Methods: Plasma samples from patients presenting to the emergency department (ED) with symptoms of COVID-19 were stratified into: (1) patients with suspected COVID-19 that was not confirmed (n = 44); (2) non-hospitalized patients with confirmed COVID-19 (n = 44); (3) hospitalized patients with confirmed COVID-19 (n = 53) with variable outcome; and (4) patients presenting to the ED with minor diseases unrelated to SARS-CoV-2 infection (n = 20). Besides standard of care diagnostics, 177 circulating proteins related to inflammation and cardiovascular disease were analyzed using proximity extension assay (PEA, Olink) technology. Results: Comparative proteome analysis revealed 14 distinct proteins as highly associated with SARS-CoV-2 infection and 12 proteins with subsequent hospitalization (p < 0.001). ADM, IL-6, MCP-3, TRAIL-R2, and PD-L1 were each predictive for death (AUROC curve 0.80–0.87). The consistent increase of these markers, from hospital admission to intensive care and fatality, supported the concept that these proteins are of major clinical relevance. Conclusions: We identified distinct plasma proteins linked to the presence and course of COVID-19. These plasma proteomic findings may translate to a protein fingerprint, helping to assist clinical management decisions.
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Affiliation(s)
- Wolfgang Bauer
- Department of Emergency Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (W.B.); (E.D.-W.); (N.G.); (R.S.)
| | - Marcus Weber
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195 Berlin, Germany;
| | - Eva Diehl-Wiesenecker
- Department of Emergency Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (W.B.); (E.D.-W.); (N.G.); (R.S.)
| | - Noa Galtung
- Department of Emergency Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (W.B.); (E.D.-W.); (N.G.); (R.S.)
| | - Monika Prpic
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.P.); (R.T.)
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany; (W.B.); (E.D.-W.); (N.G.); (R.S.)
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.P.); (R.T.)
- Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany
| | - Jochen M. Schwenk
- Science for Life Laboratory, KTH-Royal Institute of Technology, Tomtebodavägen 23, 17165 Solna, Sweden;
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds Väg 20, 75185 Uppsala, Sweden;
| | - Kai Kappert
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.P.); (R.T.)
- Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-569-001; Fax: +49-30-450-569-900
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Fukumoto T, Hristova D, Hua X, Jimbo H, Takemori C, Nishigori C, Wei Z, Somasundaram R, Fukunaga-Kalabis M, Herlyn M. 295 The role of NUMB in melanoma. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.301] [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: 11/24/2022]
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Bauer W, Kappert K, Galtung N, Lehmann D, Wacker J, Cheng HK, Liesenfeld O, Buturovic L, Luethy R, Sweeney TE, Tauber R, Somasundaram R. A Novel 29-Messenger RNA Host-Response Assay From Whole Blood Accurately Identifies Bacterial and Viral Infections in Patients Presenting to the Emergency Department With Suspected Infections: A Prospective Observational Study. Crit Care Med 2021; 49:1664-1673. [PMID: 34166284 PMCID: PMC8439671 DOI: 10.1097/ccm.0000000000005119] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The rapid diagnosis of acute infections and sepsis remains a serious challenge. As a result of limitations in current diagnostics, guidelines recommend early antimicrobials for suspected sepsis patients to improve outcomes at a cost to antimicrobial stewardship. We aimed to develop and prospectively validate a new, 29-messenger RNA blood-based host-response classifier Inflammatix Bacterial Viral Non-Infected version 2 (IMX-BVN-2) to determine the likelihood of bacterial and viral infections. DESIGN Prospective observational study. SETTING Emergency Department, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany. PATIENTS Three hundred twelve adult patients presenting to the emergency department with suspected acute infections or sepsis with at least one vital sign change. INTERVENTIONS None (observational study only). MEASUREMENTS AND MAIN RESULTS Gene expression levels from extracted whole blood RNA was quantified on a NanoString nCounter SPRINT (NanoString Technologies, Seattle, WA). Two predicted probability scores for the presence of bacterial and viral infection were calculated using the IMX-BVN-2 neural network classifier, which was trained on an independent development set. The IMX-BVN-2 bacterial score showed an area under the receiver operating curve for adjudicated bacterial versus ruled out bacterial infection of 0.90 (95% CI, 0.85-0.95) compared with 0.89 (95% CI, 0.84-0.94) for procalcitonin with procalcitonin being used in the adjudication. The IMX-BVN-2 viral score area under the receiver operating curve for adjudicated versus ruled out viral infection was 0.83 (95% CI, 0.77-0.89). CONCLUSIONS IMX-BVN-2 demonstrated accuracy for detecting both viral infections and bacterial infections. This shows the potential of host-response tests as a novel and practical approach for determining the causes of infections, which could improve patient outcomes while upholding antimicrobial stewardship.
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Affiliation(s)
- Wolfgang Bauer
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Kai Kappert
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany
| | - Noa Galtung
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Dana Lehmann
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | | | | | | | | | | | | | - Rudolf Tauber
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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Freise C, Lee H, Chronowski C, Chan D, Cziomer J, Rühl M, Dagdelen T, Lösekann M, Erben U, Catic A, Tegge W, Schuppan D, Somasundaram R, Sahin E. Alpha-single chains of collagen type VI inhibit the fibrogenic effects of triple helical collagen VI in hepatic stellate cells. PLoS One 2021; 16:e0254557. [PMID: 34473704 PMCID: PMC8412337 DOI: 10.1371/journal.pone.0254557] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
The interaction of extracellular matrix (ECM) components with hepatic stellate cells (HSCs) is thought to perpetuate fibrosis by stimulating signaling pathways that drive HSC activation, survival and proliferation. Consequently, disrupting the interaction between ECM and HSCs is considered a therapeutical avenue although respective targets and underlying mechanisms remain to be established. Here we have interrogated the interaction between type VI collagen (CVI) and HSCs based on the observation that CVI is 10-fold upregulated during fibrosis, closely associates with HSCs in vivo and promotes cell proliferation and cell survival in cancer cell lines. We exposed primary rat HSCs and a rat hepatic stellate cell line (CFSC) to soluble CVI and determined the rate of proliferation, apoptosis and fibrogenesis in the absence of any additional growth factors. We find that CVI in nanomolar concentrations prevents serum starvation-induced apoptosis. This potent anti-apoptotic effect is accompanied by induction of proliferation and acquisition of a pronounced pro-fibrogenic phenotype characterized by increased α-smooth muscle actin, TGF-β, collagen type I and TIMP-1 expression and diminished proteolytic MMP-13 expression. The CVI-HSC interaction can be disrupted with the monomeric α2(VI) and α3(VI) chains and abrogates the activating CVI effects. Further, functional relevant α3(VI)—derived 30 amino acid peptides lead to near-complete inhibition of the CVI effect. In conclusion, CVI serves as a potent mitogen and activating factor for HSCs. The antagonistic effects of the CVI monomeric chains and peptides point to linear peptide sequences that prevent activation of CVI receptors which may allow a targeted antifibrotic therapy.
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Affiliation(s)
- Christian Freise
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hyunho Lee
- Huffington Center On Aging, Baylor College of Medicine, Houston, Texas, United States of America
| | - Christopher Chronowski
- Huffington Center On Aging, Baylor College of Medicine, Houston, Texas, United States of America
| | - Doug Chan
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jessica Cziomer
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Rühl
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tarkan Dagdelen
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maik Lösekann
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Erben
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andre Catic
- Huffington Center On Aging, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Werner Tegge
- Department of Chemical Biology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Detlef Schuppan
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany
| | - Rajan Somasundaram
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ergun Sahin
- Huffington Center On Aging, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, United States of America
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Bauer W, Ulke J, Galtung N, Strasser-Marsik LC, Neuwinger N, Tauber R, Somasundaram R, Kappert K. Role of Cell Adhesion Molecules for Prognosis of Disease Development of Patients With and Without COVID-19 in the Emergency Department. J Infect Dis 2021; 223:1497-1499. [PMID: 33502532 PMCID: PMC7928779 DOI: 10.1093/infdis/jiab042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/24/2021] [Indexed: 01/18/2023] Open
Affiliation(s)
- Wolfgang Bauer
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jannis Ulke
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Noa Galtung
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Nick Neuwinger
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kai Kappert
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
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David M, Richter R, Naghavi B, Borde T, Razum O, Somasundaram R, Stein H, Sehouli J. [Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status]. Notf Rett Med 2021; 25:252-259. [PMID: 33649703 PMCID: PMC7904028 DOI: 10.1007/s10049-021-00851-7] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Fragestellung Welche prädiktiven Faktoren lassen sich für die Gruppe der sog. Mehrfachnutzer (MFN; 4 und mehr Inanspruchnahmen einer Notaufnahme [NA] in den letzten 12 Monaten) finden? Sind Personen mit Migrationshintergrund häufiger in die Gruppe der MFN einzuordnen? Methodik Konsekutive Patienten, die von Juli 2017 bis Juli 2018 drei Klinik-NA in Berlin aufsuchten. Mittels Fragebogen Erfassung von Erkrankungen, Gründen für den NA-Besuch und sozioökonomischen Faktoren. Die Unterschiede zwischen Migranten (1. Generation), ihren Nachkommen (2. Generation) und Nichtmigranten wurden mithilfe der logistischen Regression bewertet. Ergebnisse 2339 Patienten konnten in die Auswertung einbezogen werden (Rücklaufrate 56 %), davon hatten 901 einen Migrationshintergrund. Bei jungen Frauen (<30 Jahre), chronisch Kranken, Schwangeren, Patientinnen und Patienten mit starken Beschwerden und Personen mit (selbsteingeschätzter) mittlerer und schlechter „Gesundheitsqualität“ sowie solchen ohne ärztliche Zuweisung war die Chance für eine Mehrfachnutzung der NA größer. Schlussfolgerung MFN belasten das ohnehin zunehmende Patientenvolumen von NA. Sie stellen jedoch eine heterogene Patientengruppe dar, unter der Menschen mit Migrationshintergrund nicht häufiger vertreten sind. Weitere Untersuchungen sind erforderlich, um die Faktoren, die zu einer häufigen Inanspruchnahme führen, besser zu verstehen und wirksame Strategien zu entwickeln, um den komplexen Gesundheitsbedürfnissen von MFN gerecht zu werden.
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Affiliation(s)
- Matthias David
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Rolf Richter
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Baharan Naghavi
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Theda Borde
- Alice Salomon-Hochschule Berlin, Berlin, Deutschland
| | - Oliver Razum
- Fakultät für Gesundheitswissenschaften, AG 3: Epidemiologie und International Public Health, Universität Bielefeld, Bielefeld, Deutschland
| | - Rajan Somasundaram
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hendrike Stein
- Rettungsstelle, Vivantes Klinikum Berlin-Neukölln, Berlin, Deutschland
| | - Jalid Sehouli
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
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Möckel M, Corman VM, Stegemann MS, Hofmann J, Stein A, Jones TC, Gastmeier P, Seybold J, Offermann R, Bachmann U, Lindner T, Bauer W, Drosten C, Rosen A, Somasundaram R. SARS-CoV-2 antigen rapid immunoassay for diagnosis of COVID-19 in the emergency department. Biomarkers 2021; 26:213-220. [PMID: 33455451 PMCID: PMC7898296 DOI: 10.1080/1354750x.2021.1876769] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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] [Indexed: 12/31/2022]
Abstract
Background In the emergency department (ED) setting, rapid testing for SARS-CoV-2 is likely associated with advantages to patients and healthcare workers, for example, enabling early but rationale use of limited isolation resources. Most recently, several SARS-CoV-2 rapid point-of-care antigen tests (AGTEST) became available. There is a growing need for data regarding their clinical utility and performance in the diagnosis of SARS-CoV-2 infection in the real life setting EDs. Methods We implemented AGTEST (here: Roche/SD Biosensor) in all four adult and the one paediatric EDs at Charité – Universitätsmedizin Berlin in our diagnostic testing strategy. Test indication was limited to symptomatic suspected COVID-19 patients. Detailed written instructions on who to test were distributed and testing personnel were trained in proper specimen collection and handling. In each suspected COVID-19 patient, two sequential deep oro-nasopharyngeal swabs were obtained for viral tests. The first swab was collected for nucleic acid testing through SARS-CoV-2 real-time reverse transcriptase (rt)-PCR diagnostic panel (PCRTEST) in the central laboratory. The second swab was collected to perform the AGTEST. Analysis of routine data was prospectively planned and data were retrieved from the medical records after the inclusion period in the adult or paediatric ED. Diagnostic performance was calculated using the PCRTEST as reference standard. False negative and false positive AGTEST results were analysed individually and compared with viral concentrations derived from the calibrated PCRTEST. Results We included n = 483 patients including n = 202 from the paediatric ED. N = 10 patients had to be excluded due to missing data and finally n = 473 patients were analysed. In the adult cohort, the sensitivity of the AGTEST was 75.3 (95%CI: 65.8/83.4)% and the specificity was 100 (95%CI: 98.4/100)% with a SARS-CoV-2 prevalence of 32.8%; the positive predictive value was 100 (95%CI: 95.7/100)% and the negative predictive value 89.2 (95%CI: 84.5/93.9)%. In the paediatric cohort, the sensitivity was 72.0 (95%CI: 53.3/86.7)%, the specificity was 99.4 (95%CI:97.3/99.9)% with a prevalence of 12.4%; the positive predictive value was 94.7 (95%CI: 78.3/99.7)% and the negative predictive value was 96.2 (95%CI:92.7/98.3)%. Thus, n = 22 adult and n = 7 paediatric patients showed false negative AGTEST results and only one false positive AGTEST occurred, in the paediatric cohort. Calculated viral concentrations from the rt-PCR lay between 3.16 and 9.51 log10 RNA copies/mL buffer. All false negative patients in the adult ED cohort, who had confirmed symptom onset at least seven days earlier had less than 5 × 105 RNA copies/mL buffer. Conclusions We conclude that the use of AGTEST among symptomatic patients in the emergency setting is useful for the early identification of COVID-19, but patients who test negative require confirmation by PCRTEST and must stay isolated until this result becomes available. Adult patients with a false negative AGTEST and symptom onset at least one week earlier have typically a low SARS-CoV-2 RNA concentration and are likely no longer infectious.
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Affiliation(s)
- Martin Möckel
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Infection Research (DZIF), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam S Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Hofmann
- Institute of Virology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin - Charité Vivantes GmbH, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Stein
- Labor Berlin - Charité Vivantes GmbH, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Terry C Jones
- Institute of Virology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Gastmeier
- Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Seybold
- Medical Directorate, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Offermann
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Bachmann
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Lindner
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Bauer
- Department of Emergency and Acute Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Rosen
- Department of Pediatrics, Division of Pulmonology Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency and Acute Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Bauer W, Galtung N, Neuwinger N, Kaufner L, Langer E, Somasundaram R, Tauber R, Kappert K. A Matter of Caution: Coagulation Parameters in COVID-19 Do Not Differ from Patients with Ruled-Out SARS-CoV-2 Infection in the Emergency Department. TH Open 2021; 5:e43-e55. [PMID: 33564744 PMCID: PMC7867413 DOI: 10.1055/s-0040-1722612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 (coronavirus disease 2019) patients often show excessive activation of coagulation, associated with increased risk of thrombosis. However, the diagnostic value of coagulation at initial clinical evaluation is not clear. We present an in-depth analysis of coagulation in patients presenting to the emergency department (ED) with suspected COVID-19. N = 58 patients with clinically suspected COVID-19 in the ED were enrolled. N = 17 subsequently tested positive using SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) swabs, while in n = 41 COVID-19 was ruled-out. We analyzed both standard and extended coagulation parameters, including thromboplastin time (INR), activated partial thromboplastin time (aPTT), antithrombin, plasminogen, plasminogen activator inhibitor-1 (PAI-1), D-dimers, and fibrinogen at admission, as well as α2-antiplasmin, activated protein C -resistance, factor V, lupus anticoagulant, protein C, protein S, and von Willebrand diagnostics. These data, as well as mortality and further laboratory parameters, were compared across groups based on COVID-19 diagnosis and severity of disease. In patients with COVID-19, we detected frequent clotting abnormalities, including D-dimers. The comparison cohort in the ED, however, showed similarly altered coagulation. Furthermore, parameters previously shown to distinguish between severe and moderate COVID-19 courses, such as platelets, plasminogen, fibrinogen, aPTT, INR, and antithrombin, as well as multiple nonroutine coagulation analytes showed no significant differences between patients with and without COVID-19 when presenting to the ED. At admission to the ED the prevalence of coagulopathy in patients with COVID-19 is high, yet comparable to the non-COVID-19 cohort presenting with respiratory symptoms. Nevertheless, coagulopathy might worsen during disease progression with the need of subsequent risk stratification.
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Affiliation(s)
- Wolfgang Bauer
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Noa Galtung
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nick Neuwinger
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Elisabeth Langer
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rudolf Tauber
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Kai Kappert
- Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
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20
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Bauer W, Diehl-Wiesenecker E, Ulke J, Galtung N, Havelka A, Hegel JK, Tauber R, Somasundaram R, Kappert K. Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department. J Infect 2020; 82:84-123. [PMID: 33217473 PMCID: PMC7670934 DOI: 10.1016/j.jinf.2020.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Wolfgang Bauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany.
| | - Eva Diehl-Wiesenecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Jannis Ulke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany
| | - Noa Galtung
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Aleksandra Havelka
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Gentian Diagnostics AB, Stockholm, Sweden
| | - J Kolja Hegel
- Labor Berlin - Charité Vivantes Services GmbH, Berlin, Germany
| | - Rudolf Tauber
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Rajan Somasundaram
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Kai Kappert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
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21
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Kroll L, Böhning N, Müßigbrodt H, Stahl M, Halkin P, Liehr B, Grunow C, Kujumdshieva-Böhning B, Freise C, Hopfenmüller W, Friesdorf W, Jockers-Scherübl M, Somasundaram R. Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study. BMC Psychiatry 2020; 20:165. [PMID: 32295567 PMCID: PMC7161155 DOI: 10.1186/s12888-020-02573-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Agitation is common in geriatric patients with cognitive impairment, e.g. in persons with dementia (PWD), who are admitted to an emergency department (ED). It might be a first sign of upcoming delirium and is associated with a higher risk of an unfavorable clinical course. Hence, monitoring of vital signs and enhanced movement as indicators of upcoming agitation is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, a novel developed non-contact monitoring system (NCMSys) might represent an appropriate alternative. Aim of this feasibility study was to test the validity of a NCMSys and of the tent-like "Charité Dome" (ChD), aimed to shelter PWD from the busy ED environment. Furthermore, effects of the ChD on wellbeing and agitation of PWD were investigated. METHODS Both devices were attached to patient's bed. Tests on technical validity and safety issues of NCMSys and ChD were performed at the iDoc institute with six healthy volunteers. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. 19 patients were included, ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥ 55 years, a dementia diagnosis and a written consent (by patients or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. RESULTS Measurements of heart rate, changes in movement and sound emissions by the NCMSys were valid, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients' vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. CONCLUSIONS The results of this feasibility study encourage a future controlled clinical trial in geriatric ED patients, including PWD, to further evaluate if our concept of non-contact measurement of vital signs and movement combined with the "Charité Dome" helps to prevent upcoming agitation in this vulnerable patient group in the ED. TRIAL REGISTRATION ICTRP: "Charité-Dome-Study - DRKS00014737" (retrospectively registered).
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Affiliation(s)
- Lisa Kroll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Nikolaus Böhning
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Heidi Müßigbrodt
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Maria Stahl
- grid.6734.60000 0001 2292 8254Technical University of Berlin— Institute of Psychology and Ergonomics, Berlin, Germany
| | - Pavel Halkin
- iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany
| | - Birgit Liehr
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Christine Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | | | - Christian Freise
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Werner Hopfenmüller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Wolfgang Friesdorf
- HCMB – Institute for Health Care Systems Management Berlin eG, Berlin, Germany
| | - Maria Jockers-Scherübl
- Oberhavel Kliniken, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hennigsdorf, Germany
| | - Rajan Somasundaram
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Erdur H, Ernst S, Ahmadi M, Albers A, Marzinzik F, Somasundaram R, Audebert H, Weber J. Evidence for Seasonal Variation of Bell’s Palsy in Germany. Neuroepidemiology 2018; 51:128-130. [DOI: 10.1159/000492097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 11/19/2022] Open
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Ravindran Menon D, Hammerlindl H, Emran A, Torrano J, Hammerlindl S, Zhang G, Krause L, Somasundaram R, Sturm R, Haass N, Flaherty K, Herlyn M, Schaider H. 1237 Escape form adaptive drug tolerance through OGT and TET1 mediated H3K4me3 remodeling in MAPKi-resistant melanoma. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1252] [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: 10/17/2022]
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Perego M, Maurer M, Wang JX, Shaffer S, Müller AC, Parapatics K, Li L, Hristova D, Shin S, Keeney F, Liu S, Xu X, Raj A, Jensen JK, Bennett KL, Wagner SN, Somasundaram R, Herlyn M. A slow-cycling subpopulation of melanoma cells with highly invasive properties. Oncogene 2018; 37:302-312. [PMID: 28925403 PMCID: PMC5799768 DOI: 10.1038/onc.2017.341] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/02/2017] [Accepted: 08/12/2017] [Indexed: 12/16/2022]
Abstract
Melanoma is a heterogeneous tumor with different subpopulations showing different proliferation rates. Slow-cycling cells were previously identified in melanoma, but not fully biologically characterized. Using the label-retention method, we identified a subpopulation of slow-cycling cells, defined as label-retaining cells (LRC), with strong invasive properties. We demonstrate through live imaging that LRC are leaving the primary tumor mass at a very early stage and disseminate to peripheral organs. Through global proteome analyses, we identified the secreted protein SerpinE2/protease nexin-1 as causative for the highly invasive potential of LRC in melanomas.
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Affiliation(s)
- M Perego
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - M Maurer
- Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - J X Wang
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - S Shaffer
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - A C Müller
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - K Parapatics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - L Li
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - D Hristova
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - S Shin
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - F Keeney
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - S Liu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - X Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - A Raj
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - J K Jensen
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - K L Bennett
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - S N Wagner
- Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - R Somasundaram
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - M Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
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26
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Frick J, Möckel M, Muller R, Searle J, Somasundaram R, Slagman A. Suitability of current definitions of ambulatory care sensitive conditions for research in emergency department patients: a secondary health data analysis. BMJ Open 2017; 7:e016109. [PMID: 29061605 PMCID: PMC5665266 DOI: 10.1136/bmjopen-2017-016109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the suitability of existing definitions of ambulatory care sensitive conditions (ACSC) in the setting of an emergency department (ED) by assessing ACSC prevalence in patients admitted to hospital after their ED stay. The secondary aim was to identify ACSC suitable for specific application in the ED setting. DESIGN Observational clinical study with secondary health data. SETTING Two EDs of the Charité-Universitätsmedizin Berlin. PARTICIPANTS All medical ED patients of the 'The Charité Emergency Medicine Study' (CHARITEM) study, who were admitted as inpatients during the 1-year study period (n=13 536). OUTCOME MEASURES Prevalence of ACSC. RESULTS Prevalence of ACSC in the study population differed significantly depending on the respective ACSC set used. Prevalence ranged between 19.1% (95% CI 18.4% to 19.8%; n=2586) using the definition by Albrecht et al and 36.6% (95% CI 35.8% to 37.5%; n=4960) using the definition of Naumann et al. (p<0.001). Overall ACSC prevalence (ie, when using all diagnoses used in any of the assessed ACSC-definitions) was 48.1% (95% CI 47.2% to 48.9%; n=6505). Some frequently observed diagnoses such as 'convulsion and epilepsy' (prevalence: 3.4%, 95% CI 3.1% to 3.7%; n=455), 'diseases of the urinary system' (prevalence: 1.4%; 95% CI 1.2% to 1.6%; n=191) or 'atrial fibrillation and flutter' (prevalence: 1.0%, 95% CI 0.8% to 1.2%, n=134) are not included in all of the current ACSC definitions. CONCLUSIONS The results highlight the need for an optimised, ED-specific ACSC definition. Particular ACSC diagnoses (such as 'convulsion and epilepsy' or 'diseases of the urinary system' and others) seem to be of special relevance in an ED population but are not included in all available ACSC definitions. Further research towards the development of a suitable and specific ACSC definition for research in the ED setting seems warranted. TRIAL REGISTRATION German Clinical Trials Register Deutsches Register für Klinische Studien: DRKS-ID: DRKS00000261.
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Affiliation(s)
- Johann Frick
- Department of Emergency and Acute Medicine, Campus Virchow Klinikum, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Campus Virchow Klinikum, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Reinhold Muller
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Julia Searle
- Department of Emergency and Acute Medicine, Campus Virchow Klinikum, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rajan Somasundaram
- Department of Emergency and Acute Medicine, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Slagman
- Department of Emergency and Acute Medicine, Campus Virchow Klinikum, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Muche M, Meyer U, Siegmund B, Somasundaram R, Epple HJ. Sustained Off-Treatment Response After Discontinuation of Long-Term Nucleos(t)ide Analogue Treatment in HBeAg-Seronegative Hepatitis B: A Case Series. Top Antivir Med 2017; 25:114-117. [PMID: 28820727 PMCID: PMC5935213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/13/2017] [Indexed: 06/07/2023]
Abstract
International guidelines recommend lifelong nucleos(t)ide analogue (NA) treatment in individuals with chronic hepatitis B (CHB) infection who are hepatitis B e antigen (HBeAg) seronegative, because hepatitis B surface antigen (HBsAg) seroconversion is rarely achieved. However, after terminating therapy, sustained responses and HBsAg loss have been observed. Clinical characteristics identifying persons with favorable outcomes after discontinuing NA therapy have not yet been defined. This case series describes outcomes of 6 individuals with HBeAg-seronegative CHB infection without cirrhosis and low plasma levels of HBsAg who discontinued long-term NA treatment. All individuals had a virologic relapse and 4 of 6 had a biochemical relapse; but 5 of 6 later developed a sustained virologic and biochemical response and a marked reduction of quantitative HBsAg (qHBsAg). Two of the 6 individuals experienced HBsAg loss. Only 1 patient was retreated, and none showed signs of hepatic decompensation. NA treatment can be safely stopped in selected HBeAg-seronegative patients. Sustained offtreatment responses seem to be frequently preceded by a virologic and biochemical flare. Loss of HBsAg possibly reflects restoration of antiviral immunity during prolonged NA treatment. Predictive factors, such as qHBsAg, may be valuable in selecting patients who could benefit from NA discontinuation.
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Geissler A, Somasundaram R, Leidel BA, Wrede CE. Reasons for emergency department visits – Results of a patient survey. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.068] [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: 11/13/2022] Open
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Abstract
OBJECTIVES The number of patients visiting emergency departments (ED) is steadily increasing. The cause for this rise in Germany is unclear and less examined. This study aimed to assess the reasons of walk-in patients to visit EDs by using a direct survey. METHODS During a period of 4 weeks, 2 010 walk-in patients were anonymously surveyed in 2 major Berlin hospitals using a standardized questionnaire. Descriptive statistics were used for data analysis. RESULTS More than 90% of patients assessed themselves as an emergency and three-quarters of patients reported pain. The majority of patients (57%) tried to contact statutory health insurance (SHI) office-based physicians in advance and 59% of patients said they would make use of ambulatory emergency facilities if they were available and well established. However, 55% of patients were unaware of the emergency service of the association of SHI physicians. CONCLUSION The results indicate that centralized ambulatory emergency facilities should be available 24/7 at hospitals with EDs. Therefore, future planning of emergency services should integrate providers of ambulatory and inpatient sector. International experience suggests that different instruments aiming at better coordination of care, such as integrated call centers, extended ambulatory services and facilities for less urgent cases located in or nearby hospitals with EDs should also be implemented in Germany.
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Affiliation(s)
- R Somasundaram
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Interdisziplinäre Rettungsstelle und Aufnahmestation, Berlin
| | - A Geissler
- Technische Universität Berlin, Fachgebiet Management im Gesundheitswesen, Berlin
| | - B A Leidel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Interdisziplinäre Rettungsstelle und Aufnahmestation, Berlin
| | - C E Wrede
- HELIOS Klinikum Berlin-Buch, Interdisziplinäres Notfallzentrum, Berlin
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Kulla M, Kraus S, Walcher F, Somasundaram R, Wrede CE, Lampl L, Helm M. [Patients with Acute, Non-Traumatic Abdominal Pain in German Emergency Departments: A Prospective Monocentric Observation Study]. Zentralbl Chir 2016; 141:666-676. [PMID: 27135864 DOI: 10.1055/s-0042-102536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Up to 11 % of patients in an Emergency Department (ED) present with non-traumatic acute abdominal pain. Based on this presenting symptom, this study aimed to analyse how residents (surgery, internal medicine, anaesthesiology and other fields) working in an ED during their second and third year of education treat these patients. Material and Methods: We performed a prospective, monocentric observation study in an ED in accordance with the STROBE recommendations, following the recommendations from the Ethics Committee of the University of Ulm (application no. 335/12) and the Declaration of Helsinki. The hospital's data protection officer approved the study. During a 12-month period (Dec. 2012 to Dec. 2013), a random sample of patients with non-traumatic abdominal pain was obtained in the ED of a major German acute care hospital by an independent observer, who was not part of the ED team. In addition to demographic data, the study focused on analysing processes and patient care (including medical history taking and physical examinations). In addition, subgroups were defined (clinical background of the treating physician, severity pursuant to the Manchester Triage Score [MTS]). Results: 143 patients met the inclusion criteria. The clinical background of the physician had no influence on the reviewed processes such as medical history taking, initial examinations, the request of consultative examinations or diagnostic procedures. Patients triaged as "urgent" were treated significantly earlier than patients triaged as "non-urgent" (time to first physician contact 26 ± 24 vs. 46 ± 34 min, p < 0.001). However, the overall time spent in the ED was equal (210 ± 79 vs. 220 ± 114 min, p = 0.555). Yet the initially estimated urgency was correlated with the need for hospitalisation (share: 57 %). Conclusion: The overall compliance with standards of care was high. The clinical background (surgery, internal medicine, anaesthesiology, other fields) of the physician in charge of initial treatment had no influence on the reviewed processes.
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Affiliation(s)
- M Kulla
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Deutschland
| | - S Kraus
- Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Deutschland
| | - F Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - R Somasundaram
- Interdisziplinäre Rettungsstelle und Aufnahmestation, Charité - Universitätsmedizin Berlin - Campus Benjamin Franklin, Deutschland
| | - C E Wrede
- Interdisziplinäres Notfallzentrum mit Rettungsstelle, Helios Klinikum Berlin-Buch, Deutschland
| | - L Lampl
- Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Deutschland
| | - M Helm
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Deutschland
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Somasundaram R, Wrede C. Notfallversorgung von Patienten mit alkoholbedingten Erkrankungen. Notf Rett Med 2016. [DOI: 10.1007/s10049-015-0126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Slagman A, Searle J, Vollert JO, Storchmann H, Büschenfelde DMZ, von Recum J, Vlasny D, Ale-Abaei A, Koch M, Müller C, Müller R, Somasundaram R, Möckel M. Sex differences of troponin test performance in chest pain patients. Int J Cardiol 2015; 187:246-51. [DOI: 10.1016/j.ijcard.2015.03.261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 03/04/2015] [Accepted: 03/19/2015] [Indexed: 11/16/2022]
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Freise C, Heldwein S, Erben U, Hoyer J, Köhler R, Jöhrens K, Patsenker E, Ruehl M, Seehofer D, Stickel F, Somasundaram R. K⁺-channel inhibition reduces portal perfusion pressure in fibrotic rats and fibrosis associated characteristics of hepatic stellate cells. Liver Int 2015; 35:1244-52. [PMID: 25212242 DOI: 10.1111/liv.12681] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/03/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS In liver fibrosis, activated hepatic stellate cells (HSC) secrete excess extracellular matrix, thus, represent key targets for antifibrotic treatment strategies. Intermediate-conductance Ca(2) (+) -activated K(+) -channels (KCa3.1) are expressed in non-excitable tissues affecting proliferation, migration and vascular resistance rendering KCa3.1 potential targets in liver fibrosis. So far, no information about KCa3.1 expression and their role in HSC exists. Aim was to quantify the KCa3.1 expression in HSC depending on HSC activation and investigation of antifibrotic properties of the specific KCa3.1 inhibitor TRAM-34 in vitro and in vivo. METHODS KCa3.1 expression and functionality were studied in TGF-β1-activated HSC by quantitative real time PCR, western-blot and patch-clamp analysis respectively. Effects of TRAM-34 on HSC proliferation, cell cycle and fibrosis-related gene expression were assessed by [(3) H]-thymidine incorporation, FACS-analysis and RT-PCR respectively. In vivo, vascular resistance and KCa3.1 gene and protein expression were determined in bile duct ligated rats by in situ liver perfusion, Taqman PCR and immunohistochemistry respectively. RESULTS Fibrotic tissues and TGF-β1-activated HSC exhibited higher KCa3.1-expressions than normal tissue and untreated cells. KCa3.1 inhibition with TRAM-34 reduced HSC proliferation by induction of cell cycle arrest and reduced TGF-β1-induced gene expression of collagen I, alpha-smooth muscle actin and TGF-β1 itself. Furthermore, TRAM-34 blocked TGF-β1-induced activation of TGF-β signalling in HSC. In vivo, TRAM-34 reduced the thromboxane agonist-induced portal perfusion pressure. CONCLUSION Inhibition of KCa3.1 with TRAM-34 downregulates fibrosis-associated gene expression in vitro, and reduces portal perfusion pressure in vivo. Thus, KCa3.1 may represent novel targets for the treatment of liver fibrosis.
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Affiliation(s)
- Christian Freise
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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Somasundaram R, Rangeeth BN, Moses J, Sivakumar S. Comparison of the source of introduction to cariogenic food substance and caries prevalence in children. J Clin Diagn Res 2015; 8:ZC138-40. [PMID: 25584307 DOI: 10.7860/jcdr/2014/8967.5216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 08/30/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dental caries being a multi-factorial disease depends on lot of factors. Since awareness and exposure seems to have increased, in the present scenario it is difficult to assume that one particular source would increase the occurrence of dental caries. Children are exposed to different media sources and spend most of their free time watching them. They are attracted by messages of advertisers' and susceptible to stylish advertisements of foods often harmful to oral and general health. AIM To compare the effects of three different sources of introduction to cariogenic food substance among school children and their role in caries prevalence. MATERIALS AND METHODS A total of 300 school children were selected for the study and a questionnaire was prepared keeping in mind the various sources introducing cariogenic foods to children namely television advertisement, magazines/news paper, posters/banners. Following which oral examination will be done to determine the number of carious lesions in the subjects. The data will be acquired, computed and statistically analysed to compare the correlation between these sources and caries prevalence. RESULTS Children who watched television advertisements and asked for food items and soft drinks were found to have more caries and DMFT/dmft index. CONCLUSION A total ban on advertisements would not be practically possible. A more realistic approach would be to limit the number of advertisements that feature potentially cariogenic and unhealthy food products, and also ensure that they ideally carry statutory warnings.
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Affiliation(s)
- R Somasundaram
- Post Graduate Student, Department of Pedodontics and Preventive Dentistry, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Reserch Institute University , Chennai, India
| | - B N Rangeeth
- Reader, Department of Pedodontics and Preventive Dentistry, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Reserch Institute University , Chennai, India
| | - Joyson Moses
- Professor & Head of Department, Department of Pedodontics and Preventive Dentistry, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Reserch Institute University , Chennai, India
| | - S Sivakumar
- Reader, Department of Pedodontics and Preventive Dentistry, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Reserch Institute University , Chennai, India
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Ravindran Menon D, Das S, Krepler C, Vultur A, Rinner B, Schauer S, Kashofer K, Wagner K, Zhang G, Bonyadi Rad E, Haass NK, Soyer HP, Gabrielli B, Somasundaram R, Hoefler G, Herlyn M, Schaider H. A stress-induced early innate response causes multidrug tolerance in melanoma. Oncogene 2014; 34:4448-59. [PMID: 25417704 DOI: 10.1038/onc.2014.372] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/07/2014] [Accepted: 10/03/2014] [Indexed: 02/07/2023]
Abstract
Acquired drug resistance constitutes a major challenge for effective cancer therapies with melanoma being no exception. The dynamics leading to permanent resistance are poorly understood but are important to design better treatments. Here we show that drug exposure, hypoxia or nutrient starvation leads to an early innate cell response in melanoma cells resulting in multidrug resistance, termed induced drug-tolerant cells (IDTCs). Transition into the IDTC state seems to be an inherent stress reaction for survival toward unfavorable environmental conditions or drug exposure. The response comprises chromatin remodeling, activation of signaling cascades and markers implicated in cancer stemness with higher angiogenic potential and tumorigenicity. These changes are characterized by a common increase in CD271 expression concomitantly with loss of differentiation markers such as melan-A and tyrosinase, enhanced aldehyde dehydrogenase (ALDH) activity and upregulation of histone demethylases. Accordingly, IDTCs show a loss of H3K4me3, H3K27me3 and gain of H3K9me3 suggesting activation and repression of differential genes. Drug holidays at the IDTC state allow for reversion into parental cells re-sensitizing them to the drug they were primarily exposed to. However, upon continuous drug exposure IDTCs eventually transform into permanent and irreversible drug-resistant cells. Knockdown of CD271 or KDM5B decreases transition into the IDTC state substantially but does not prevent it. Targeting IDTCs would be crucial for sustainable disease management and prevention of acquired drug resistance.
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Affiliation(s)
- D Ravindran Menon
- Cancer Biology Unit, Department of Dermatology, Medical University of Graz, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria.,Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - S Das
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - C Krepler
- The Wistar Institute, Philadelphia, PA, USA
| | - A Vultur
- The Wistar Institute, Philadelphia, PA, USA
| | - B Rinner
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - S Schauer
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - K Kashofer
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - K Wagner
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - G Zhang
- The Wistar Institute, Philadelphia, PA, USA
| | - E Bonyadi Rad
- Cancer Biology Unit, Department of Dermatology, Medical University of Graz, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria
| | - N K Haass
- The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - H P Soyer
- Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - B Gabrielli
- The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | | | - G Hoefler
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - M Herlyn
- The Wistar Institute, Philadelphia, PA, USA
| | - H Schaider
- Cancer Biology Unit, Department of Dermatology, Medical University of Graz, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria.,Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
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Menon D, Das S, Krepler C, Vultur A, Rinner B, Schauer S, Kashofer K, Wagner K, Zhang G, Rad EB, Soyer H, Gabrielli B, Somasundaram R, Hoefler G, Herlyn M, Schaider H. 93 A stress induced early innate response causes multi-drug tolerance in melanoma. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70219-9] [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]
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Baid-Agrawal S, Pascual M, Moradpour D, Somasundaram R, Muche M. Hepatitis C virus infection and kidney transplantation in 2014: what's new? Am J Transplant 2014; 14:2206-20. [PMID: 25091274 DOI: 10.1111/ajt.12835] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 01/25/2023]
Abstract
Chronic hepatitis C virus (HCV) infection remains an important health problem, which is associated with deleterious consequences in kidney transplant recipients. Besides hepatic complications, several extrahepatic complications contribute to reduced patient and allograft survival in HCV-infected kidney recipients. However, HCV infection should not be considered as a contraindication for kidney transplantation because patient survival is better with transplantation than on dialysis. Treatment of HCV infection is currently interferon-alpha (IFN-α) based, which has been associated with higher renal allograft rejection rates. Therefore, antiviral treatment before transplantation is preferable. As in the nontransplant setting, IFN-free treatment regimens, because of their greater efficacy and reduced toxicity, currently represent promising and attractive therapeutic options after kidney transplantation as well. However, clinical trials will be required to closely evaluate these regimens in kidney recipients. There is also a need for prospective controlled studies to determine the optimal immunosuppressive regimens after transplantation in HCV-infected recipients. Combined kidney and liver transplantation is required in patients with advanced liver cirrhosis. However, in patients with cleared HCV infection and early cirrhosis without portal hypertension, kidney transplantation alone may be considered. There is some agreement about the use of HCV-positive donors in HCV-infected recipients, although data regarding posttransplant survival rates are controversial.
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Affiliation(s)
- S Baid-Agrawal
- Department of Nephrology and Medical Intensive Care, Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Berlin, Germany
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Reiter R, Freise C, Jöhrens K, Kamphues C, Seehofer D, Stockmann M, Somasundaram R, Asbach P, Braun J, Samani A, Sack I. Wideband MRE and static mechanical indentation of human liver specimen: Sensitivity of viscoelastic constants to the alteration of tissue structure in hepatic fibrosis. J Biomech 2014; 47:1665-74. [DOI: 10.1016/j.jbiomech.2014.02.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/04/2014] [Accepted: 02/25/2014] [Indexed: 01/30/2023]
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Muche M, Somasundaram R. Akute Hepatitis, Leberversagen, akut dekompensierte Leberzirrhose. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1842-y] [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: 10/25/2022]
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Hirsch S, Guo J, Reiter R, Schott E, Büning C, Somasundaram R, Braun J, Sack I, Kroencke TJ. Towards compression-sensitive magnetic resonance elastography of the liver: Sensitivity of harmonic volumetric strain to portal hypertension. J Magn Reson Imaging 2013; 39:298-306. [DOI: 10.1002/jmri.24165] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/13/2013] [Indexed: 12/27/2022] Open
Affiliation(s)
- Sebastian Hirsch
- Department of Radiology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Jing Guo
- Department of Radiology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Rolf Reiter
- Department of Radiology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Eckart Schott
- Department of Hepatology and Gastroenterology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Carsten Büning
- Department of Hepatology and Gastroenterology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Rajan Somasundaram
- Department of Gastroenterology, Rheumathology and Infectiology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Jürgen Braun
- Institute of Medical Informatics; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Ingolf Sack
- Department of Radiology; Charité, Universitätsmedizin Berlin; Berlin Germany
| | - Thomas J. Kroencke
- Department of Radiology; Charité, Universitätsmedizin Berlin; Berlin Germany
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Freise C, Trowitzsch-Kienast W, Erben U, Seehofer D, Kim KY, Zeitz M, Ruehl M, Somasundaram R. (+)-Episesamin inhibits adipogenesis and exerts anti-inflammatory effects in 3T3-L1 (pre)adipocytes by sustained Wnt signaling, down-regulation of PPARγ and induction of iNOS. J Nutr Biochem 2013; 24:550-5. [DOI: 10.1016/j.jnutbio.2012.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/30/2012] [Accepted: 02/10/2012] [Indexed: 01/26/2023]
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Heimesaat MM, Heilmann K, Kühl AA, Erben U, Rühl M, Fischer A, Farndale RW, Bereswill S, Göbel UB, Zeitz M, Somasundaram R, Freise C. The synthetic hydroxyproline-containing collagen analogue (Gly-Pro-Hyp)10 ameliorates acute DSS colitis. Eur J Microbiol Immunol (Bp) 2012; 2:192-200. [PMID: 24688765 DOI: 10.1556/eujmi.2.2012.3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/17/2012] [Indexed: 01/13/2023] Open
Abstract
In experimental models of and humans with intestinal inflammation, increased levels of the matrix-degrading gelatinases MMP-2 and -9 in inflamed tissues can be detected. The synthetic collagen analogue (Gly-Pro-Hyp)10, (GPO)10, has been identified as a relevant binding structure for proMMP-2/-9 and promotes enzymatic activity of proMMP-2. Since targeted MMP strategies might offer promising anti-inflammatory treatment options, we for the first time studied in vivo actions exerted by (GPO)10 applying an acute dextrane sulfate sodium (DSS) induced colitis model. Seven-day intraperitoneal (GPO)10 treatment ameliorated clinical symptoms and histopathological colonic changes as compared to placebo controls with severe colitis. (GPO)10-treated mice displayed a diminished influx of neutrophils, and T- and B-lymphocytes into their colonic mucosa whereas numbers of regulatory T-cells and regenerative cells were higher as compared to placebo controls. Furthermore, IL-6 secretion was down-regulated in ex vivo colonic biopsies derived from (GPO)10-treated mice whereas higher concentrations of the anti-inflammatory cytokine IL-10 in extra-intestinal compartments such as MLN and spleen could be detected. Strikingly, influx of inflammatory cells into lungs was abolished following (GPO)10 application. We therefore propose (GPO)10 as a promising effective and safe treatment option of intestinal and extra-intestinal inflammatory conditions in humans.
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Freise C, Ruehl M, Erben U, Farndale RW, Somasundaram R, Heimesaat MM. The synthetic hydroxyproline-containing collagen analogue (Gly-Pro-Hyp)10 promotes enzymatic activity of matrixmetalloproteinase-2 in vitro. Eur J Microbiol Immunol (Bp) 2012; 2:186-91. [PMID: 24688764 DOI: 10.1556/eujmi.2.2012.3.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/17/2012] [Indexed: 11/19/2022] Open
Abstract
Diseases such as liver fibrosis and intestinal inflammation are characterized by accumulated components of the extracellular matrix (ECM). Given that fibrillar collagen structures were shown to serve as storage site for inactive proforms of matrixmetalloproteinases (MMPs), modulating this MMP-collagen interaction might offer a rational interventional (therapeutic) approach to enhance degradation of accumulated ECM. The synthetic triple helical collagen analogue (Gly-Pro-Hyp)10 - (GPO)10 - was shown to trigger release and enzymatic activation of collagen sequestered proMMP-2. In the presented study, we, for the first time, investigated how MMP-(GPO)10 interaction impacts cellular responses in vitro. We found that recombinant proMMP-2 induced proliferation of hepatic stellate cells (HSC), which was enhanced after addition of (GPO)10 reaching comparable levels following incubation with fully activated MMP-2. In addition, (GPO)10 induced HSC migration similar to the platelet-derived growth factor subunit-B. Further, the MMP-2-dependent invasion of HT1080 fibrosarcoma cells through an ECM membrane was enhanced after addition of (GPO)10. Since cellular proliferation and migration concomitant with matrix degradation is stimulated, we conclude that the MMP-(GPO)10 interaction also functions in a physiological environment. Thus, a potential therapeutic effect of (GPO)10 should be further tested in animal models for MMP-associated diseases such as colitis or fibrosis.
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Somasundaram R, Deuring JJ, van der Woude CJ, Peppelenbosch MP, Fuhler GM. Linking risk conferring mutations in NCF4 to functional consequences in Crohn's disease. Gut 2012; 61:1097; author reply 1097-8. [PMID: 22027479 DOI: 10.1136/gutjnl-2011-301344] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Eurich D, Boas-Knoop S, Yahyazadeh A, Neuhaus R, Somasundaram R, Ruehl M, Puhl G, Neuhaus P, Neumann UP, Bahra M. Role of mannose-binding lectin-2 polymorphism in the development of acute cellular rejection after transplantation for hepatitis C virus-induced liver disease. Transpl Infect Dis 2012; 14:488-95. [PMID: 22650645 DOI: 10.1111/j.1399-3062.2012.00747.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/26/2011] [Accepted: 01/21/2012] [Indexed: 01/13/2023]
Abstract
UNLABELLED The development of liver and graft disease is suspected to be affected by genetic diversity. Mannose-binding lectin-2 (MBL-2) is an important immunomodulatory factor that is involved in complement activation. The aim of our study was to elucidate the role of MBL-2 genotypes after liver transplantation (LT) for hepatitis C virus (HCV)-induced liver disease regarding the incidence of acute cellular rejection (ACR), graft inflammation, fibrosis development, and antiviral treatment response. METHODS A group of 149 patients who underwent LT for HCV-induced liver disease were genotyped for MBL-2 (rs7096206; G/C) by TaqMan genotyping assay. We evaluated 518 post-LT protocol biopsies and at least 98 urgent liver biopsies regarding graft fibrosis stages, inflammation grades, and evidence for rejection within MBL-2 genotype groups. RESULT No association of MBL-2 polymorphisms was observed regarding inflammation, fibrosis, and antiviral treatment outcome. However, the C allele of the MBL-2 gene (P = 0.001) and gender compatibility (P = 0.012) were factors significantly associated with the incidence of ACR. CONCLUSION MBL-2 polymorphisms and gender are involved in the development of ACR after LT. CC genotype and gender match may be regarded as risk factors for ACR in HCV-positive graft recipients. Further studies are needed to confirm and verify this observation in non-HCV groups as well.
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Affiliation(s)
- D Eurich
- Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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Eurich D, Boas-Knoop S, Bahra M, Neuhaus R, Somasundaram R, Neuhaus P, Neumann U, Seehofer D. Role of IL28B polymorphism in the development of hepatitis C virus-induced hepatocellular carcinoma, graft fibrosis, and posttransplant antiviral therapy. Transplantation 2012; 93:644-9. [PMID: 22411462 DOI: 10.1097/tp.0b013e318244f774] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 12/14/2022]
Abstract
BACKGROUND The development of liver graft disease is partially determined by individual genetic background. Interleukin 28B (IL28B) is strongly suspected to be involved in susceptibility for hepatitis C virus (HCV) infection, inflammation, and antiviral treatment response before and after liver transplantation (LT). Currently, the role of IL28B polymorphism (rs12979860) in the development of hepatocellular carcinoma (HCC) is unclear, and only limited data are available on the course of HCV recurrence. METHODS One hundred sixty-seven HCV-positive patients after LT were genotyped for IL28B (C→T; rs12979860). Sixty-one patients with histologically confirmed HCC in the explanted liver were compared with 106 patients without HCC regarding IL28B genotypes. Among patients with HCC, IL28B genotypes were correlated with tumor histology and pretransplant α-fetoprotein (AFP) levels. Furthermore, the role of IL28B polymorphism was evaluated regarding interferon-based treatment success and fibrosis progression after LT. RESULTS The prevalence of HCC in explanted livers was significantly higher among patients with TT genotype, suggesting a protective role of the C allele in HCC development (P=0.041). Median AFP level was closely to significance higher in the presence of T allele (P=0.052). Significant differences in IL28B genotype distribution were detected between AFP-negative and AFP-positive HCCs (<15 μg/L vs. >15 μg/L; P=0.008). Although no impact could be observed regarding acute cellular rejection (P=0.940), T allele was significantly associated with antiviral therapy failure (P=0.028) and faster development of advanced fibrosis (P=0.017) after LT. CONCLUSION IL28B polymorphism seems to be involved in the development of HCV-induced HCC and in the course of HCV recurrence after LT. T allele may be regarded as a genetic risk factor for HCV-related carcinogenesis, posttransplant fibrosis progression, and antiviral therapy failure.
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Affiliation(s)
- Dennis Eurich
- Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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Seehofer D, Nebrig M, Denecke T, Kroencke T, Weichert W, Stockmann M, Somasundaram R, Schott E, Puhl G, Neuhaus P. Impact of neoadjuvant transarterial chemoembolization on tumor recurrence and patient survival after liver transplantation for hepatocellular carcinoma: a retrospective analysis. Clin Transplant 2012; 26:764-74. [PMID: 22432589 DOI: 10.1111/j.1399-0012.2012.01609.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
Transarterial chemoembolization (TACE) has gained wide acceptance as a bridge to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Aim of this analysis was to compare long-term results with and without neoadjuvant TACE and to identify subgroups, which particularly benefit from TACE. Patients with HCC transplanted at our center were retrospectively analyzed. The following were excluded to increase consistency: incidental-HCC, Child-C, living-related-LT, other HCC-specific-treatment. Of 336 patients, 177 were subject of this analysis, 71 received TACE and 106 no HCC therapy. Patients with and without TACE showed similar five-yr survival (73/67%) and recurrence rates (23/29%). Progression on the waiting list was associated with a higher recurrence rate in the TACE (50 vs.12%) and the non-TACE group (40 vs. 22%). HCC recurrence was reduced in patients inside Milan (0.053) and UCSF (0.037) criteria by neoadjuvant TACE but not outside UCSF (0.99). Also a trend towards an improved survival was seen within these criteria. Our large single center experience suggests that TACE lowers the HCC recurrence rate in patients inside the Milan and UCSF criteria. Moreover, the response to TACE is a good indicator of low recurrence rates. The effect of TACE might be more pronounced in patients with longer waiting time than in this cohort (mean, 4.6 months).
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Affiliation(s)
- Daniel Seehofer
- Department of General-, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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Trowitzsch-Kienast W, Rühl M, Kim KY, Emmerling F, Erbenb U, Somasundaram R, Freise C. Absolute configuration of antifibrotic (+)-episesamin isolated from Lindera obtusiloba BLUME. ACTA ACUST UNITED AC 2012; 66:460-4. [PMID: 22191210 DOI: 10.1515/znc-2011-9-1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fractionation of a 70% ethanolic extract from twigs of Lindera obtusiloba BLUME (Japanese spicebush, Tohaku) yielded five fractions of different polarity. The antifibrotic activity within the chloroform phase was best assessed by an in vitro bioassay using rat hepatic stellate cell (HSC) proliferation and their autocrine transforming growth factor beta (TGF-beta) expression as sensitive fibrosis-associated read out. Chromatography of the chloroform extract on Sephadex LH-20 or liquid-liquid extractions yielded a crystalline compound as an active principle, which was identified from NMR and ESI-MS analyses, its melting point, and its optical rotation as (7S,7'R,8R,8'R)-3,4:3',4'-bis(methylenedioxy)-7,9':7',9-diepoxy-lignane [(+)-episesamin]. X-Ray diffraction confirmed the structure and provided, for the first time, directly its absolute configuration. (+)-Episesamin blocked proliferation and the profibrotic autocrine TGF-beta expression HSC without significant cytotoxicity.
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Eurich D, Boas-Knoop S, Morawietz L, Neuhaus R, Somasundaram R, Ruehl M, Neumann UP, Neuhaus P, Bahra M, Seehofer D. Association of mannose-binding lectin-2 gene polymorphism with the development of hepatitis C-induced hepatocellular carcinoma. Liver Int 2011; 31:1006-12. [PMID: 21733090 DOI: 10.1111/j.1478-3231.2011.02522.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Development of end-stage liver and graft disease is suspected to be partially determined by the individual genetic background. Mannose-binding lectin (MBL) is an important immunomodulatory factor, which is supposed to be involved in complement activation and oncogenesis. Genetic polymorphisms of MBL-2 alter MBL functionality. The aim of our study was to determine the prevalence of MBL-2 polymorphism (rs7096206) in hepatitis C virus (HCV)-induced hepatocellular carcinoma (HCC) based on histological analysis of explanted livers in patients undergoing liver transplantation (LT). METHODS One hundred and seventy-seven patients, who underwent LT for HCV-induced liver disease, were genotyped for MBL-2 by TaqMan genotyping assay. Sixty-two patients with histologically confirmed HCC were compared with 115 patients without HCC. MBL-2 genotypes were corelated with the growth patern, tumour size and pretransplant α-fetoprotein (AFP) level of HCC patients. RESULTS The prevalence of GG/GC genotypes was significantly higher among HCC patients compared with tumour-free explanted livers (P = 0.004; odds ratio 2.5; 1.3-4.8). GG/GC genotype group was significantly associated with the size of HCC (P = 0.022), higher pretransplant AFP level (P = 0.010) and bilobar tumour growth (P = 0.038). Furthermore, CC genotype was found to be significantly more frequent in AFP-negative HCCs (P = 0.002). CONCLUSION Mannose-binding lectin-2 polymorphism seems to be involved in the development of pretransplant HCV-induced HCC and should be further investigated as potential risk factor for HCV-associated carcinogenesis.
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Affiliation(s)
- Dennis Eurich
- General, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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