1
|
Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. HNO 2024:10.1007/s00106-024-01454-7. [PMID: 38578463 DOI: 10.1007/s00106-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
Collapse
Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
2
|
Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. Nervenarzt 2024; 95:342-352. [PMID: 38277047 PMCID: PMC11014872 DOI: 10.1007/s00115-023-01598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
Collapse
Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
3
|
Winkler S, Herbst B, Kafchitsas K, Wohlmuth P, Hoffstetter P, Rueth MJ. Pre-operative Assessment of Shoulder Pathologies on MRI by a Radiologist and an Orthopaedic Surgeon. Malays Orthop J 2024; 18:42-50. [PMID: 38638663 PMCID: PMC11023335 DOI: 10.5704/moj.2403.006] [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: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery. Materials and methods Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon. Results The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement. Conclusion This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.
Collapse
Affiliation(s)
- S Winkler
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - B Herbst
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - K Kafchitsas
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - P Wohlmuth
- Department of Research, ASKLEPIOS Proresearch, Hamburg, Germany
| | - P Hoffstetter
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | - M J Rueth
- Department Sports Clinic, Sportklinik Fichtelgebirge, Markredwitz, Germany
| |
Collapse
|
4
|
Litwin SE, Komtebedde J, Seidler T, Borlaug BA, Winkler S, Solomon SD, Eicher JC, Mazimba S, Khawash R, Sverdlov AL, Hummel SL, Bugger H, Boenner F, Hoendermis E, Cikes M, Demers C, Silva G, van Empel V, Starling RC, Penicka M, Cutlip DE, Leon MB, Kitzman DW, van Veldhuisen DJ, Shah SJ. Obesity in heart failure with preserved ejection fraction: Insights from the REDUCE LAP-HF II trial. Eur J Heart Fail 2024; 26:177-189. [PMID: 37989800 DOI: 10.1002/ejhf.3092] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/23/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF. METHODS AND RESULTS The REDUCE LAP-HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. Overall, 60.9% of patients had BMI ≥30 kg/m2 . As the severity of obesity increased, symptoms (Kansas City Cardiomyopathy Questionnaire score) and 6-min walk distance worsened. More severe obesity was associated with lower natriuretic peptide levels despite more cardiac remodelling, higher cardiac filling pressures, and higher cardiac output. Lower cut points for E/e' were needed to identify elevated PCWP in more obese patients. Strain measurements in all four chambers were maintained as BMI increased. Pulmonary vascular resistance at rest and exercise decreased with higher BMI. Obesity was associated with more first and recurrent heart failure events. However, there was no significant interaction between obesity and treatment effects of the atrial shunt. CONCLUSIONS Increasing severity of obesity was associated with greater cardiac remodelling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent heart failure events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy.
Collapse
Affiliation(s)
- Sheldon E Litwin
- Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | | | | | | | | | | | - Sula Mazimba
- University of Virginia, Charlottesville, VA, USA
| | | | - Aaron L Sverdlov
- John Hunter Hospital, Newcastle, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Scott L Hummel
- University of Michigan and VA Ann Arbor, Ann Arbor, MI, USA
| | | | - Florian Boenner
- Division of Cardiology, Pulmonology, and Vascular Medicine Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Elke Hoendermis
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maja Cikes
- Department of Cardiovascular Diseases, University Hospital Center, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | | | | | | | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, NY, USA
| | - Dalane W Kitzman
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dirk J van Veldhuisen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Deckwart O, Koehler K, Lezius S, Prescher S, Koehler F, Winkler S. Effects of remote patient management on self-care behaviour in heart failure patients: results from the randomized TIM-HF2 trial. Eur J Cardiovasc Nurs 2023; 22:786-794. [PMID: 36752782 DOI: 10.1093/eurjcn/zvad019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
AIMS Remote patient management (RPM) in heart failure (HF) patients has beneficial clinical effects. This analysis investigates the effects of RPM used in the Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial on HF-specific self-care. METHODS AND RESULTS From 2013 to 2017, 1538 HF outpatients (age 70.3 ± 10.5 years, 70% men, 52%/47% NYHA II/III, 65% LVEF ≤45%) with a recent HF hospitalization were included to the study and randomized to usual care (UC) plus RPM (n = 796) or UC only (n = 775), with a 12-month follow-up. Self-reported self-care behaviour at baseline and at end of study was assessed with the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9), obtaining 1321 patients with valid baseline and follow-up questionnaires for the analysis. EHFScBS-9 sum scores increased in the RPM group (n = 667) from 78.7 ± 17 to 84.5 ± 14 and in the UC group (n = 654) from 79.0 ± 17 to 80.0 ± 16 from baseline to 12 months [difference in means (MD) 4.58 (3.02, 6.14); P < 0.001] with highest improvement [8.66 (3.52; 13.81)] in patients living alone and having an inadequate (<70) baseline EHFScBS-9. There were differences between both groups in item 'I weight myself every day' [MD -1.13 (-1.24, -1.02); P < 0.001] and item 'I take my medication as prescribed' [MD -0.06 (-0.10, -0.01); P = 0.014]. No correlation was found between the EHFScBS-9 score and the efficacy of RPM on the TIM-HF2 primary endpoint of percentage of days lost due to unplanned cardiovascular hospitalization or death of any cause. CONCLUSIONS RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen. REGISTRATION ClinicalTrials.gov: NCT01878630.
Collapse
Affiliation(s)
- Oliver Deckwart
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Centre for Cardiovascular Telemedicine, 10117 Berlin, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Nurse Practice Development Department, Goethe University, University Hospital, 60318 Frankfurt, Germany
| | - Kerstin Koehler
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Centre for Cardiovascular Telemedicine, 10117 Berlin, Germany
| | - Susanne Lezius
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, 20246 Hamburg, Germany
| | - Sandra Prescher
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Centre for Cardiovascular Telemedicine, 10117 Berlin, Germany
| | - Friedrich Koehler
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Centre for Cardiovascular Telemedicine, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Sebastian Winkler
- Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Centre for Cardiovascular Telemedicine, 10117 Berlin, Germany
- Department of Internal Medicine, BG Klinikum Unfallkrankenhaus Berlin GmbH, Warener Str. 7, 12683 Berlin, Germany
| |
Collapse
|
6
|
Bavendiek U, Großhennig A, Schwab J, Berliner D, Liu X, Maier L, Gaspar T, Rieth A, Philipp S, Hambrecht R, Westenfeld R, Münzel T, Winkler S, Hülsmann M, Westermann D, Zdravkovic M, Lichtinghagen R, von der Leyen H, Zimmermann S, Veltmann C, Böhm M, Störk S, Koch A, Bauersachs J. Simple and safe digitoxin dosing in heart failure based on data from the DIGIT-HF trial. Clin Res Cardiol 2023:10.1007/s00392-023-02199-z. [PMID: 37087503 PMCID: PMC10359203 DOI: 10.1007/s00392-023-02199-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The present study aimed to develop a simple dosing score when starting the cardiac glycoside digitoxin in heart failure with reduced ejection fraction (HFrEF) employing first data from the randomized, double-blinded DIGIT-HF trial. METHODS AND RESULTS In DIGIT-HF, digitoxin was started with a dose of 0.07 mg once daily (o.d.) in all patients. For score derivation, 317 patients were analyzed who had been randomized to digitoxin. In these patients, after scheduled determination of serum levels at study week 6, the digitoxin dose had remained unchanged or had been reduced to 0.05 mg o.d. (97% of patients) to achieve serum concentrations within a predefined range (10.5-23.6 nmol/l). In logistic regression analyses, sex, age, body mass index (BMI), and estimated glomerular filtration rate (eGFR) were associated with need for dose reduction and, therefore, selected for further developing the dosing score. Optimal cut-points were derived from ROC curve analyses. Finally, female sex, age ≥ 75 years, eGFR < 50 ml/min/1.73 m2, and BMI < 27 kg/m2 each were assigned one point for the digitoxin dosing score. A score of ≥ 1 indicated the need for dose reduction with sensitivity/specificity of 81.6%/49.7%, respectively. Accuracy was confirmed in a validation data set including 64 patients randomized to digitoxin yielding sensitivity/specificity of 87.5%/37.5%, respectively. CONCLUSION In patients with HFrEF, treatment with digitoxin should be started at 0.05 mg o.d. in subjects with either female sex, eGFR < 50 ml/min/1.73m2, BMI < 27 kg/m2, or age ≥ 75 years. In any other patient, digitoxin may be safely started at 0.07 mg o.d.
Collapse
Affiliation(s)
- Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Anika Großhennig
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Johannes Schwab
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Xiaofei Liu
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Lars Maier
- Department for Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Gaspar
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Dresden, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Sebastian Philipp
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Elbeklinikum Stade, Stade, Germany
| | - Rainer Hambrecht
- Department of Internal Medicine II, Cardiology, Angiology and Intensive Care Medicine, Klinkum Links Der Weser, Bremen, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Thomas Münzel
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Winkler
- Department of Internal Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Martin Hülsmann
- Universitätsklinik Für Innere Medizin II, Abteilung Kardiologie, Medizinische Universität Wien, Vienna, Austria
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marja Zdravkovic
- University Hospital Medical Center Bezanujska Kosa, Belgrade, Serbia
| | - Ralf Lichtinghagen
- Institute for Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Silke Zimmermann
- Center for Clinical Trials, Hannover Medical School, Hannover, Germany
| | | | - Michael Böhm
- Klinik Für Innere Medizin III, Universitätsklinikum Des Saarlandes, Saarland University, Homburg a. d. Saar, Germany
| | - Stefan Störk
- Department Clincical Reserch & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Armin Koch
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| |
Collapse
|
7
|
Prescher S, Winkler S, Riehle L, Hiddemann M, Moeller V, Collins C, Deckwart O, Spethmann S. Patient reported experience and adherence to remote patient management in chronic heart failure patients: a posthoc analysis of the TIM-HF2 trial. Eur J Cardiovasc Nurs 2022; 22:245-253. [PMID: 36062451 DOI: 10.1093/eurjcn/zvac080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022]
Abstract
AIMS Remote Patient Management (RPM) enables early detection and prevention of deterioration in heart failure (HF) patients by measuring vital parameters. The analysis objective is to assess patient reported experience with RPM, adherence to daily measurements, and outline affecting factors both. METHODS & RESULTS TIM-HF2 was conducted in 2013-2018 with 1,538 HF patients with a 12-months follow-up. Under guidance of HF nurses patients had to measure daily weight, blood pressure, ECG, and self-rated health status. At the end of the study, patients received a program survey to analyse patient perceptions and satisfaction with telemedicine care and study organisation. Adherence was distinguished between measurement of at least one (incomplete adherence - IA) and all vital parameters (complete adherence - CA) and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data and group differences were analysed descriptively (mean ± SD) and by ANOVA and T-Test.Survey response rate was 79.7%. Patients were satisfied with the program and device usability. CA was 89.1 ± 14.1%, consistently high over the study course and independent of severity of disease (LVEF, NTproBNP, NYHA). Lower IA was found with patients <70 years and prior to unplanned cardiovascular (CV) hospitalisations (difference by -5.2 ± 20.5%) and after unplanned CV hospitalisations compared to the entire study period (lower by -12.8 ± 24.7%). Patients from rural areas were found to have higher CA than patients from urban regions. CONCLUSIONS With user-friendly devices, pre-interventional patient training, regular patient contact and close cooperation between primary physicians and Telemedical Centre (TMC), a long-lasting high adherence and satisfaction could be achieved. A change in adherence might detect health deterioration and indicate the need to intensify RPM. REGISTRATION ClinicalTrials.gov (NCT01878630) and Deutsches Register Klinischer Studien (DRKS00010239).
Collapse
Affiliation(s)
- Sandra Prescher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Winkler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charitéplatz 1, 10117 Berlin, Germany.,Unfallkrankenhaus Berlin, Medical Department of Internal Medicine, Warener Str. 7, 12683 Berlin, Germany
| | - Leonhard Riehle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Meike Hiddemann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Volker Moeller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Claudia Collins
- University of York, York, Heslington, York YO10 5DD, United Kingdom
| | - Oliver Deckwart
- University of Leipzig Medical Center, Academy for Vocational Qualification, Liebigstr. 18, 04103 Leipzig, Germany
| | - Sebastian Spethmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Medical Department, Division of Cardiology and Angiology, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
8
|
Naik MG, Budde K, Koehler K, Vettorazzi E, Pigorsch M, Arkossy O, Stuard S, Duettmann W, Koehler F, Winkler S. Remote Patient Management May Reduce All-Cause Mortality in Patients With Heart-Failure and Renal Impairment. Front Med (Lausanne) 2022; 9:917466. [PMID: 35899216 PMCID: PMC9309436 DOI: 10.3389/fmed.2022.917466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 01/17/2023] Open
Abstract
BackgroundRemote patient management (RPM) in heart failure (HF) patients has been investigated in several prospective randomized trials. The Telemedical Interventional Management in Heart Failure II (TIM-HF2)-trial showed reduced all-cause mortality and hospitalizations in heart failure (HF) patients using remote patient management (RPM) vs. usual care (UC). We report the trial's results for prespecified eGFR-subgroups.MethodsTIM-HF2 was a prospective, randomized, controlled, parallel-group, unmasked (with randomization concealment), multicenter trial. A total of 1,538 patients with stable HF were enrolled in Germany from 2013 to 2017 and randomized to RPM (+UC) or UC. Using CKD-EPI-formula at baseline, prespecified subgroups were defined. In RPM, patients transmitted their vital parameters daily. The telemedical center reviewed and co-operated with the patient's General Practitioner (GP) and cardiologist. In UC, patients were treated by their GPs or cardiologist applying the current guidelines for HF management and treatment. The primary endpoint was the percentage of days lost due to unplanned cardiovascular hospitalizations or death, secondary outcomes included hospitalizations, all-cause, and cardiovascular mortality.ResultsOur sub analysis showed no difference between RPM and UC in both eGFR-subgroups for the primary endpoint (<60 ml/min/1.73 m2: 40.9% vs. 43.6%, p = 0.1, ≥60 ml/min/1.73 m2 26.5 vs. 29.3%, p = 0.36). In patients with eGFR < 60 ml/min/1.73 m2, 1-year-survival was higher in RPM than UC (89.4 vs. 84.6%, p = 0.02) with an incident rate ratio (IRR) 0.67 (p = 0.03). In the recurrent event analysis, HF hospitalizations and all-cause death were lower in RPM than UC in both eGFR-subgroups (<60 ml/min/1.73 m2: IRR 0.70, p = 0.02; ≥60 ml/min/1.73 m2: IRR 0.64, p = 0.04). In a cox regression analysis, age, NT-pro BNP, eGFR, and BMI were associated with all-cause mortality.ConclusionRPM may reduce all-cause mortality and HF hospitalizations in patients with HF and eGFR < 60 ml/min/1.73 m2. HF hospitalizations and all-cause death were lower in RPM in both eGFR-subgroups in the recurrent event analysis. Further studies are needed to investigate and confirm this finding.
Collapse
Affiliation(s)
- Marcel G. Naik
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
- *Correspondence: Marcel G. Naik
| | - Klemens Budde
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
| | - Kerstin Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Eik Vettorazzi
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Otto Arkossy
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Wiebke Duettmann
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
| | - Friedrich Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
| | - Sebastian Winkler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
- Unfallkrankenhaus Berlin, Department of Internal Medicine, Berlin, Germany
| |
Collapse
|
9
|
Prescher S, Spethmann S, Winkler S, Riehle L, Hiddemann M, Moeller V, Deckwart O. Patient reported experience and adherence to remote patient management in chronic heart failure patients: a posthoc analysis of the TIM-HF2 trial. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research
Background
Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1).
Purpose
The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects.
Methods
TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion criteria were HF in NYHA class II or III with either LVEF ≤45% or, if LVEF >45%, patients had been treated with oral diuretics; and HF hospitalisation within the last 12 months. Patients with major depression were excluded. Patients were randomly assigned (1:1) to RPM or UC. RPM-Patients had to measure daily weight, blood pressure, ECG and self-rated health status. Data were sent automatically to the telemedical centre (TMC). In case of conspicuous findings, the TMC contacted the patient or GP for therapy adjustment. At the study end, RPM-patients were asked to evaluate the program through a 9-question survey. Adherence was distinguished between measurement of at least one (incomplete adherence- IA) and all vital parameters (complete adherence- CA) and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data were analysed descriptively (mean ± standard deviation). Differences between groups were analysed by ANOVA and T-Test.
Results
The survey was answered by n=564 patients (response rate: 79.7%). The patients were satisfied with the program and device usability. CA was 89.1±14.1% and consistently high over the study course (table 1). Reasons for dropouts (n=37) were e.g. frustration with the devices and physical inability to complete the measurement protocol.
Patients <70 years and living in rural areas had lower IA rates. The mean adherence was independent of severe of disease (LVEF, NTproBNP, NYHA). Patients (n=244) had significantly lower IA the week prior to an unplanned CV hospitalisation (difference by -5.2±20.5%) compared to the entire study period. IA was significantly lower by -12.8±24.7% in the week after an unplanned CV hospitalisation compared to the entire study period.
Conclusions
In a setting with user-friendly devices, pre-interventional patient training, regular TMC-patient contact and close cooperation between primary physicians and TMC a long-lasting and high adherence and satisfaction regarding RPM could be achieved. A change in adherence might detect deterioration in health status and indicate the need to intensify telemedical care.
Collapse
Affiliation(s)
- S Prescher
- Charite Universitatsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine , Berlin , Germany
| | - S Spethmann
- Charite Universitatsmedizin Berlin, Medical Department, Division of Cardiology and Angiology , Berlin , Germany
| | - S Winkler
- Unfallkrankenhaus Berlin, Department of Internal Medicine , Berlin , Germany
| | - L Riehle
- Charite Universitatsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine , Berlin , Germany
| | - M Hiddemann
- Charite Universitatsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine , Berlin , Germany
| | - V Moeller
- Charite Universitatsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine , Berlin , Germany
| | - O Deckwart
- University Hospital Leipzig, Academy of Vocational Qualification , Leipzig , Germany
| |
Collapse
|
10
|
Deckwart O, Koehler K, Lezius S, Prescher S, Koehler F, Winkler S. Effects of remote patient management on self-care behaviour in heart failure patients: results from the TIM-HF2 trial. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research
Background
Remote patient management (RPM) in heart failure (HF) patients is a rapidly developing field of digital cardiology with beneficial clinical effects. RPM might affect HF specific self-care behaviour, which represents an important patient-reported outcome.
Purpose
To investigate the effects of RPM used in the Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial on HF-specific self-care as a prespecified secondary endpoint analysis.
Methods and Results
HF patients who were recently hospitalized and do not suffer from major depression were randomized to either RPM plus Usual Care (UC) or UC only, with a 12-month follow-up. Self-reported self-care behaviour at baseline and study-end were assessed by mean differences of the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9). 1,538 HF patients (mean age 70.3±10.5 years, 70% men, 52% NYHA class II and 47% NYHA class III, 65% LVEF ≤45%) were included, obtaining 1,321 patients with valid baseline and follow-up questionnaires.
Self-care behaviour sum scores increased in the RPM group (n=667) from 78.7±17 to 84.5±14 and in the UC group (n=654) from 79.0±17 to 80.0±16 from baseline to 12 months (mean difference 4.58 95% CI 3.02, 6.14; p<0.001). The subgroup of patients living alone and having an inadequate (<70) baseline self-care behaviour score showed the highest improvement (8.66[3.52; 13.81]). There were significant changes between both groups in item "I weight myself every day" (MD -1.13; 95% CI -1.24, -1.02; p<0.001), and item "I take my medication as prescribed" (MD -0.06; 95% CI -0.10, -0.01; p=0.014). No relation was found between the self-care behaviour score and the efficacy of RPM on the primary and main secondary endpoints of the TIM-HF2 study.
Conclusions
RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen. Clinical endpoints were not affected by the level of self-care behaviour.
Collapse
Affiliation(s)
- O Deckwart
- Charité - University Medicine Berlin, Centre for Cardiovascular Telemedicine , Berlin , Germany
| | - K Koehler
- Charité - University Medicine Berlin, Centre for Cardiovascular Telemedicine , Berlin , Germany
| | - S Lezius
- The University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology , Hamburg , Germany
| | - S Prescher
- Charité - University Medicine Berlin, Centre for Cardiovascular Telemedicine , Berlin , Germany
| | - F Koehler
- Charité - University Medicine Berlin, Centre for Cardiovascular Telemedicine , Berlin , Germany
| | - S Winkler
- Unfallkrankenhaus Berlin, Department of Internal Medicine , Berlin , Germany
| |
Collapse
|
11
|
Mandl P, Tobudic S, Haslacher H, Mrak D, Nothnagl T, Perkmann T, Radner H, Sautner J, Simader E, Winkler F, Burgmann H, Aletaha D, Winkler S, Blüml S. AB1135 RESPONSE TO SARS-COV-2 VACCINATION IN SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASE DEPENDS ON IMMUNOSUPPRESSIVE REGIMEN: A MATCHED, PROSPECTIVE COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundVaccination efficiency has been demonstrated to be reduced in patients with systemic autoimmune rheumatic disease (SARD) compared with the general population.ObjectivesTo assess the humoral response to mRNA vaccine in patients with (SARD) and the effect of immunosuppressive medication in a matched cohort study.MethodsPatients with SARD were enrolled and matched 1:1 for gender and age with healthy control subjects (HC). Differences in the humoral response to two doses of mRNA vaccine BNT162b2 in terms of seroconversion rate and SARS-COV-2 antibody titer between the two groups and impact of treatment within SARD patients was assessed using Fisher’s exact test, Student’s t-test, Mann-Whitney test and Kruskal-Wallis test, adjusting for multiple testing.ResultsWe enrolled 82 patients with SARD and 82 matched HC (Table 1). Among patients the seroconversion rate was significantly lower after the 1st dose (65% compared to 100% in HC, p<0.0001) but levelled up after the 2nd dose (94% vs. 100%). While the difference in seroconversion rate was independent of treatment regime (no disease modifying anti-rheumatic drug (DMARD), DMARD monotherapy, DMARD combination therapy), the seroconversion rate of SARD patients on mono- or combination DMARD therapy was also significantly lower as compared to those receiving no DMARD therapy (56% for monotherapy and 57% for combination therapy compared to 77% for no DMARD therapy, p=0.002 and p=0.004 respectively; Figure 1A). Seroconversion rate after the 2nd dose was significantly lower for patients on combination DMARD therapy compared to all other groups (81% compared to 95% for monotherapy, and 100% for both no DMARD therapy and HC respectively, all p<0.0001); also antibody titers after the 2nd dose were lower when comparing patients on combination DMARD therapy to all other groups (49 binding antibody units (BAU)/ml versus 1673 BAU/ml in HC, p<0.0001; 2500 BAU/ml in those on no DMARD therapy, p<0.0001; and 687 BAU/ml in those on DMARD monotherapy, p=0.0072; Figure 1B). Considering effects of individual compounds, mycophenolate mofetil in mono- or combination therapy led to lower antibody titers after the 2nd dose as compared to HC or patients receiving no DMARDs (2 BAU/ml versus 1673 BAU/ml and 2500 BAU/ml respectively, both p<0.0001).Figure 1.Seroconversion rate (A) and anti-SARS-Cov 2 S antibody levels (B) after the 1stand 2ndvaccination between the healthy control (HC) group and patients according to therapyTable 1.Study subject characteristicsSARD (n=82)HC (n=82)Age, mean (±SD)52.05 (±14.06)52.15 (±13.42)Female, n (%)65 (79%)65 (79%)Different disease entity, n (%):33 (40%) Systemic lupus erythematosus Systemic sclerosis13 (16%) Other connective tissue diseases*15 (18%) Vasculitides#17 (21%) Miscellaneous$4 (5%)Treatment groups, n (%):43 (52%) csDMARD or b/tsDMARD monotherapy csDMARD and/or b/tsDMARD combination therapy16 (20%) No therapy23 (28%)Treatment agents, n (%):13 (16%) Methotrexate Mycophenolate14 (17%) Hydroxychloroquine28 (34%) Azathioprine13 (10%) Belimumab3 (4%) Tocilizumab3 (4%) Tacrolimus2 (2%) Olumiant1 (1%)*dermato-/polymyositis (n=4), mixed connective tissue disease (n=2), primary Sjögren’s syndrome (n=6), undifferentiated connective tissue disease (n=3)#antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (n=3), Behcet’s disease (n=1), large-vessel vasculitis (n=3), polymyalgia rheumatica (n=10)$ adult-onset Still’s disease (n=1), immune deficiency (n=2), sarcoidosis (n=1)b/tsDMARD: biological/targeted synthetic disease modifying antirheumatic drug; csDMARD: conventional synthetic disease modifying antirheumatic drug; HC: healthy control; n: number; SARD: systemic autoimmune rheumatic disease; SD: standard deviation;ConclusionPatients with SARD showed a good response after the 2nd vaccination with the mRNA vaccine. However, the choice of immunosuppressive regimen has a marked effect on both seroconversion rate and overall antibody titer.AcknowledgementsWe thank Sylvia Taxer and Zoltan Vass for their support.Disclosure of InterestsPeter Mandl Speakers bureau: AbbVie, Janssen, Novartis, Consultant of: AbbVie, Janssen, Novartis, Grant/research support from: AbbVie, BMS, Lilly, Novartis, MSD, UCB, Selma Tobudic: None declared, Helmut Haslacher: None declared, Daniel Mrak: None declared, Thomas Nothnagl: None declared, Thomas Perkmann: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Judith Sautner Speakers bureau: Otsuka, Novartis, Consultant of: Lilly, Astro Pharma, UCB, Abbvie, Elisabeth Simader Grant/research support from: Pfizer, Bristol-Myers Squibb, Florian Winkler: None declared, Heinz Burgmann: None declared, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Consultant of: Abbvie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, Stefan Winkler: None declared, Stephan Blüml Speakers bureau: Novartis, Abbvie, Consultant of: Gilead, Merck, Novartis, Abbvie
Collapse
|
12
|
Tobudic S, Simader E, Deimel T, Mandl P, Haslacher H, Perkmann T, Schneider L, Nothnagl T, Lechner-Radner H, Winkler F, Burgmann H, Stiasny K, Novacek G, Reinisch W, Aletaha D, Winkler S, Blüml S. POS1243 ACCELERATED WANING OF PROTECTIVE IMMUNITY AFTER SARS-CoV-2 mRNA VACCINATION IN PATIENTS TREATED WITH BIOLOGICAL AND TARGETED SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLittle is known about the duration of humoral antibody levels after two SARS-CoV-2 mRNA vaccinations in patients with immunosuppression. During this ongoing global epidemic, it is of essential interest to gather information about the time of protection after initial immunization in the vulnerable patients receiving either conventional synthetic disease modifying antirheumatic drugs (csDMARD) or biological/ targeted drugs (b/tsDMARDs).ObjectivesIn this study we compared the antibody level development after vaccination and after six months in patients with inflammatory arthritis, inflammatory bowel disease (IBD) and healthy controls. Furthermore, we assessed factors affecting the quality and quantity of the humoral response.MethodsWe enrolled 85 healthy controls (HC), 75 patients with rheumatoid arthritis and spondyloarthritis and 41 patients suffering from IBD. Patients treated with B-cell depleting therapies were excluded from this study. Binding antibody units were measured after vaccination and 6 or more months. Neutralizing antibodies were measured after 6 months. Multivariate regression analyses analyzing factors associated with low titers after 6 months was performed.ResultsWe found that patients with inflammatory arthritis or IBD showed reduced anti-SARS-CoV-2 S titers compared to HC. When we stratified for therapies, we found that patients receiving conventional synthetic disease modifying antirheumatic dugs (csDMARDs) had comparable anti-SARS-CoV-2 S titers to HC. In contrast, patients receiving biological or targeted synthetic (b/tsDMARDs) showed reduced anti-SARS-CoV-2 Igs as well as neutralizing antibody titers compared with healthy controls (HC) or patients receiving conventional synthetic (cs)DMARDs. We further show that anti-SARS-CoV-2 titers declined more rapidly in patients receiving b/tsDMARDs compared to HC, leading to a 50 percent reduction in vaccination-associated protection time in patients receiving b/tsDMARDs when compared to those receiving csDMARDs or even HC. In multivariate regression analyses, we found that in addition to the type of treatment, also age as well as corticosteroid use were associated with reduced anti-SARS-CoV-2 S titers.ConclusionPatients under ongoing b/tsDMARDs therapy exposed an accelerated waning of anti-SARS-CoV-2 S titers and therefore decreased immunity and protection against severe Covid-19 infections over time. These results may lead to more personalized approaches for further vaccination strategies in this group of immunosuppressed patients.Figure 1.A, Analysis of anti-SARS-CoV-2 S titers 6 months after the second vaccination in patients with inflammatory arthritis, inflammatory bowel disease and HC (** p ≤ 0.01; *** p ≤ 0.005, **** p ≤ 0.001). B, Determination of neutralizing antibody activity in sera of HC and patients with inflammatory arthritis receiving the indicated therapies.Disclosure of InterestsSelma Tobudic: None declared, Elisabeth Simader Grant/research support from: Pfizer, Bristol-Myers Squibb, Thomas Deimel: None declared, Peter Mandl Speakers bureau: AbbVie, Janssen, Bristol-Myers Squibb, Merck Sharp & Dohme, Celgene, Novartis, Pfizer, Roche, Sanofi, UCB, Consultant of: Novartis, Celgene, Grant/research support from: Novartis, Celgene, Abbvie, Roche, Bristol-Myers Squibb, Helmuth Haslacher Grant/research support from: Glock Health, BlueSky Immunotherapies and Neutrolis;, Thomas Perkmann: None declared, Lisa Schneider: None declared, Thomas Nothnagl: None declared, Helga Lechner-Radner: None declared, Florian Winkler: None declared, Heinz Burgmann Speakers bureau: Shionogi, Pfizer, MSD, Paid instructor for: Valneva, MSD, Gilead, Consultant of: from MSD, Pfizer, Takeda, Gilead, Karin Stiasny Grant/research support from: Pfizer, Gottfried Novacek: None declared, Walter Reinisch: None declared, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, SanofiMerck, Pfizer, Roche, Sandoz, Stefan Winkler: None declared, Stephan Blüml Speakers bureau: Abbvie, personal fees from Novartis
Collapse
|
13
|
Winkler S, Winkler I, Figaschewski M, Tiede T, Nordheim A, Kohlbacher O. De novo identification of maximally deregulated subnetworks based on multi-omics data with DeRegNet. BMC Bioinformatics 2022; 23:139. [PMID: 35439941 PMCID: PMC9020058 DOI: 10.1186/s12859-022-04670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background With a growing amount of (multi-)omics data being available, the extraction of knowledge from these datasets is still a difficult problem. Classical enrichment-style analyses require predefined pathways or gene sets that are tested for significant deregulation to assess whether the pathway is functionally involved in the biological process under study. De novo identification of these pathways can reduce the bias inherent in predefined pathways or gene sets. At the same time, the definition and efficient identification of these pathways de novo from large biological networks is a challenging problem. Results We present a novel algorithm, DeRegNet, for the identification of maximally deregulated subnetworks on directed graphs based on deregulation scores derived from (multi-)omics data. DeRegNet can be interpreted as maximum likelihood estimation given a certain probabilistic model for de-novo subgraph identification. We use fractional integer programming to solve the resulting combinatorial optimization problem. We can show that the approach outperforms related algorithms on simulated data with known ground truths. On a publicly available liver cancer dataset we can show that DeRegNet can identify biologically meaningful subgraphs suitable for patient stratification. DeRegNet can also be used to find explicitly multi-omics subgraphs which we demonstrate by presenting subgraphs with consistent methylation-transcription patterns. DeRegNet is freely available as open-source software. Conclusion The proposed algorithmic framework and its available implementation can serve as a valuable heuristic hypothesis generation tool contextualizing omics data within biomolecular networks.
Collapse
Affiliation(s)
- Sebastian Winkler
- Applied Bioinformatics, Department of Computer Science, University of Tuebingen, Tübingen, Germany. .,International Max Planck Research School (IMPRS) "From Molecules to Organism", Tübingen, Germany.
| | - Ivana Winkler
- International Max Planck Research School (IMPRS) "From Molecules to Organism", Tübingen, Germany.,Interfaculty Institute for Cell Biology (IFIZ), University of Tuebingen, Tübingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mirjam Figaschewski
- Applied Bioinformatics, Department of Computer Science, University of Tuebingen, Tübingen, Germany
| | - Thorsten Tiede
- Applied Bioinformatics, Department of Computer Science, University of Tuebingen, Tübingen, Germany
| | - Alfred Nordheim
- Interfaculty Institute for Cell Biology (IFIZ), University of Tuebingen, Tübingen, Germany.,Leibniz Institute on Aging (FLI), Jena, Germany
| | - Oliver Kohlbacher
- Applied Bioinformatics, Department of Computer Science, University of Tuebingen, Tübingen, Germany.,Institute for Bioinformatics and Medical Informatics, University of Tuebingen, Tübingen, Germany.,Translational Bioinformatics, University Hospital Tuebingen, Tübingen, Germany
| |
Collapse
|
14
|
Shah SJ, Borlaug BA, Chung ES, Cutlip DE, Debonnaire P, Fail PS, Gao Q, Hasenfuß G, Kahwash R, Kaye DM, Litwin SE, Lurz P, Massaro JM, Mohan RC, Ricciardi MJ, Solomon SD, Sverdlov AL, Swarup V, van Veldhuisen DJ, Winkler S, Leon MB. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial. Lancet 2022; 399:1130-1140. [PMID: 35120593 DOI: 10.1016/s0140-6736(22)00016-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Placement of an interatrial shunt device reduces pulmonary capillary wedge pressure during exercise in patients with heart failure and preserved or mildly reduced ejection fraction. We aimed to investigate whether an interatrial shunt can reduce heart failure events or improve health status in these patients. METHODS In this randomised, international, blinded, sham-controlled trial performed at 89 health-care centres, we included patients (aged ≥40 years) with symptomatic heart failure, an ejection fraction of at least 40%, and pulmonary capillary wedge pressure during exercise of at least 25 mm Hg while exceeding right atrial pressure by at least 5 mm Hg. Patients were randomly assigned (1:1) to receive either a shunt device or sham procedure. Patients and outcome assessors were masked to randomisation. The primary endpoint was a hierarchical composite of cardiovascular death or non-fatal ischemic stroke at 12 months, rate of total heart failure events up to 24 months, and change in Kansas City Cardiomyopathy Questionnaire overall summary score at 12 months. Pre-specified subgroup analyses were conducted for the heart failure event endpoint. Analysis of the primary endpoint, all other efficacy endpoints, and safety endpoints was conducted in the modified intention-to-treat population, defined as all patients randomly allocated to receive treatment, excluding those found to be ineligible after randomisation and therefore not treated. This study is registered with ClinicalTrials.gov, NCT03088033. FINDINGS Between May 25, 2017, and July 24, 2020, 1072 participants were enrolled, of whom 626 were randomly assigned to either the atrial shunt device (n=314) or sham procedure (n=312). There were no differences between groups in the primary composite endpoint (win ratio 1·0 [95% CI 0·8-1·2]; p=0·85) or in the individual components of the primary endpoint. The prespecified subgroups demonstrating a differential effect of atrial shunt device treatment on heart failure events were pulmonary artery systolic pressure at 20W of exercise (pinteraction=0·002 [>70 mm Hg associated with worse outcomes]), right atrial volume index (pinteraction=0·012 [≥29·7 mL/m2, worse outcomes]), and sex (pinteraction=0·02 [men, worse outcomes]). There were no differences in the composite safety endpoint between the two groups (n=116 [38%] for shunt device vs n=97 [31%] for sham procedure; p=0·11). INTERPRETATION Placement of an atrial shunt device did not reduce the total rate of heart failure events or improve health status in the overall population of patients with heart failure and ejection fraction of greater than or equal to 40%. FUNDING Corvia Medical.
Collapse
Affiliation(s)
- Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Eugene S Chung
- The Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | | | | | - Peter S Fail
- Cardiovascular Institute of the South, Houma, LA, USA
| | - Qi Gao
- Baim Clinical Research Institute, Boston, MA, USA
| | - Gerd Hasenfuß
- Heart Center, University Medical Center, Göttingen, Germany
| | | | | | - Sheldon E Litwin
- Medical University of South Carolina and Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | | | | | | | | | - Aaron L Sverdlov
- John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | | | - Dirk J van Veldhuisen
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York City, NY, USA
| |
Collapse
|
15
|
Roland W, Marschik C, Kommenda M, Haghofer A, Dorl S, Winkler S. Predicting the Non-Linear Conveying Behavior in Single-Screw Extrusion: A Comparison of Various Data-Based Modeling Approaches used with CFD Simulations. INT POLYM PROC 2021. [DOI: 10.1515/ipp-2020-4094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The traditional approach to modeling the polymer melt flow in single-screw extruders is based on analytical and numerical analyses. Due to increasing computational power, data-driven modeling has grown significantly in popularity in recent years. In this study, we compared and evaluated databased modeling approaches (i. e., gradient-boosted trees, artificial neural networks, and symbolic regression models based on genetic programming) in terms of their ability to predict – within a hybrid modeling framework – the three-dimensional non-linear throughput-pressure relationship of metering channels in single-screw extruders. By applying the theory of similarity to the governing flow equations, we identified the characteristic dimensionless influencing parameters, which we then varied to create a large dataset covering a wide range of possible applications. For each single design point we conducted numerical simulations and obtained the dimensionless flow rate. The large dataset was divided into three independent sets for training, interpolation, and extrapolation, the first being used to generate and the remaining two to evaluate the models. Further, we added two features derived from expert knowledge to the models and analyzed their influence on predictive power. In addition to prediction accuracy and interpolation and extrapolation capabilities, we evaluated model complexity, interpretability, and time required to learn the models. This study provides a rigorous analysis of various data-based modeling approaches applied to simulation data in extrusion.
Collapse
Affiliation(s)
- W. Roland
- Institute of Polymer Extrusion and Compounding, Johannes Kepler University Linz , Linz , Austria
- Pro2Future GmbH , Linz , Austria
| | - C. Marschik
- Institute of Polymer Extrusion and Compounding, Johannes Kepler University Linz , Linz , Austria
- CHASE GmbH , Linz , Austria
| | - M. Kommenda
- Josef Ressel Centre for Symbolic Regression, University of Applied Sciences Upper Austria , Hagenberg , Austria
- Heuristic and Evolutionary Algorithm Laboratory, University of Applied Sciences Upper Austria , Hagenberg , Austria
| | - A. Haghofer
- Bioinformatics Research Group, University of Applied Sciences Upper Austria , Hagenberg , Austria
| | - S. Dorl
- Bioinformatics Research Group, University of Applied Sciences Upper Austria , Hagenberg , Austria
| | - S. Winkler
- Heuristic and Evolutionary Algorithm Laboratory, University of Applied Sciences Upper Austria , Hagenberg , Austria
- Bioinformatics Research Group, University of Applied Sciences Upper Austria , Hagenberg , Austria
| |
Collapse
|
16
|
Griss J, Eichinger S, Winkler S, Weninger W, Petzelbauer P. A case of COVID-19 vaccination-associated forme fruste purpura fulminans. Br J Dermatol 2021; 186:e1. [PMID: 34585371 PMCID: PMC8652590 DOI: 10.1111/bjd.20744] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
We report the case of a female, 77 year old patient with multi-localized skin infarctions following vaccination with mRNA-1273 (Moderna). This phenomenon is to our knowledge otherwise only seen in infection-associated purpura fulminans - which was thoroughly ruled out in our patient. This report demonstrates that we need to be vigilant of a wider array of vascular phenomena related to Covid vaccinations.
Collapse
Affiliation(s)
- J Griss
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - S Eichinger
- Division of Hematology and Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - S Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - W Weninger
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - P Petzelbauer
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| |
Collapse
|
17
|
Winkler S, Koehler K, Prescher S, Koehler M, Kirwan BA, Tajsic M, Koehler F. Is 24/7 remote patient management in heart failure necessary? Results of the telemedical emergency service used in the TIM-HF and in the TIM-HF2 trials. ESC Heart Fail 2021; 8:3613-3620. [PMID: 34182596 PMCID: PMC8497196 DOI: 10.1002/ehf2.13413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Aims Telemedical emergency services for heart failure (HF) patients are usually provided during business hours. However, many emergencies occur outside of business hours. This study evaluates if a 24/7 telemedical emergency service is needed for the remote management of high‐risk HF patients. Methods and results The study included 1119 patients merged from the TIM‐HF and TIM‐HF2 trials [age 69 ± 11, 73% male, left ventricular ejection fraction 37% ± 13, 557 New York Heart Association (NYHA) II/562 NYHA III]. Patients received a 24/7 physician‐guided emergency service provided by the telemedical centre (TMC) in addition to remote management within business hours. During emergency calls, patient status, symptoms, electronic patient record, and instant telemonitoring data were evaluated by the TMC physician. Following diagnosis, patients were referred for hospital admission or instructed to stay at home. Apart from the TMC, patients could place a call to the public emergency service at any time. Seven hundred sixty‐eight emergency calls were placed over 1383 patient years (0.56 calls/patient year). Five hundred twenty‐six calls (69%) occurred outside business hours. There were 146 (19%) emergency calls for worsening HF, 297 (39%) other cardiovascular, and 325 (42%) non‐cardiac causes, with a similar pattern inside and outside business hours. Of the 1119 patients, 417 (37%) placed at least one emergency call. Patients with NYHA Class III, higher N‐terminal prohormone of brain natriuretic peptide (>1.400 pg/mL) levels, ischaemic aetiology of HF, implanted defibrillator, and impaired renal function had a higher probability of placing emergency calls. During study follow‐up, patients who made an emergency call had a higher all‐cause mortality (22% vs. 11%, P = 0.007 in TIM‐HF; 16% vs. 4%, P < 0.001 in TIM‐HF2) and more unplanned hospitalizations (324 vs. 162, P < 0.001 in TIM‐HF; 545 vs. 180, P < 0.001 in TIM‐HF2). Of the total 1,211 unplanned hospital admissions, 492 (41%) were initiated by a patient emergency call. Three hundred seventy‐nine calls (49%) were placed to the TMC, whereas 389 calls (51%) were made to the public emergency service. Three hundred twenty‐six (84%) of the calls to the public emergency service resulted in acute hospitalizations. The TMC initiated 202 (53%) hospital admissions; 177 (47%) patients were advised to stay at home. All patients that remained at home were alive during a prespecified safety period of 7 days post‐call. Diagnoses made by the TMC physician were confirmed in 83% of cases by the hospital. Conclusion A telemedical emergency service for high‐risk HF patients is safe and should operate 24/7 to reduce unplanned hospitalizations. Emergency calls could be considered as a marker for higher morbidity and mortality.
Collapse
Affiliation(s)
- Sebastian Winkler
- Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany.,Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Kerstin Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Sandra Prescher
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - Magdalena Koehler
- Ludwig-Maximilians Universität München, Munich, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, University Hospital 'Klinikum rechts der Isar', School of Medicine, Technical University Munich, Munich, Germany
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland; Faculty of Epidemiology and Public Health London School of Hygiene & Tropical Medicine, University College London, London, UK
| | - Milos Tajsic
- Emergency Department, Wilhelminenspital Wien, Vienna, Austria
| | - Friedrich Koehler
- Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
18
|
Krieger K, Winkler S, Lenz C. Successful high-resolution left atrial mapping and catheter ablation of a complex supraventricular tachycardia with transseptal passage through an atrial shunt device. Europace 2021; 23:1697. [PMID: 34061961 PMCID: PMC8576276 DOI: 10.1093/europace/euab046] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Konstantin Krieger
- Department of Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | - Sebastian Winkler
- Department of Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | | |
Collapse
|
19
|
Winkler S, Edelmann J, Schubert A. Characterization of a bonding method for titanium-glass sealing. SN Appl Sci 2020. [DOI: 10.1007/s42452-020-03871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractApplications for smart medical implants require hermetic and mechanically strong seals between functional and biocompatible materials. Hermetic seals between titanium Ti6Al4V and silica-based glass can be produced using a novel bonding method based on glass pressing at temperatures around the softening point. This paper presents investigation results for the tensile bond strength and the gas leak rate depending on the manufacturing process parameters. Notably, when using blasted surfaces, the tensile bond strengths reached 12 MPa and good adherence with very low leakage due to the removed oxide layer and surface structure. The interface is analyzed and characterized by applying SEM methods related to the different adhesion mechanisms.
Collapse
|
20
|
Reents W, Barth S, Griese DP, Winkler S, Babin-Ebell J, Kerber S, Diegeler A, Zacher M, Hamm K. Transfemoral versus transapical transcatheter aortic valve implantation: a single-centre experience. Eur J Cardiothorac Surg 2020; 55:744-750. [PMID: 30418538 DOI: 10.1093/ejcts/ezy363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Transapical transcatheter aortic valve implantation (TAVI) is associated with increased mortality as compared to the transfemoral (TF) access. Possible mechanisms include different patient risk profiles as well as an intrinsic injury caused by the access route itself. METHODS All consecutive patients scheduled for TAVI between January 2009 and June 2016 at a single centre were evaluated. A comparison of 30-day mortality and morbidity rates for patients undergoing TF or transapical (TA) TAVI was performed according to the criteria of the Valve Academic Research Consortium 2. RESULTS During the investigated period, 1130 patients (TF: n = 619, TA: n = 511) were scheduled for TAVI. TA patients had a higher operative risk profile (logistic EuroSCORE: 24% vs 17%; P < 0.001). Unadjusted 30-day mortality rate was higher in TA than in TF patients, albeit this difference was not significant [TA: 6.7%, TF: 4.8%; odds ratio (OR) 1.3 (0.8-2.3); P = 0.216]. The multivariate logistic regression analysis revealed the logistic EuroSCORE and institutional experience, but not the access mode as independent predictors of 30-day mortality. Major access-site complications occurred with a similar frequency in both groups [TA: 9.4%; TF: 9.2%; OR 1.02 (0.68-1.53); P = 0.915]. Unadjusted long-term mortality rate was higher after TA TAVI. After adjustment, the Cox regression analysis revealed similar long-term mortality rates after TF and TA TAVI [hazard ratio 1.1 (0.88-1.36)]. CONCLUSIONS The increased mortality of patients undergoing TA TAVI is associated with the patient risk profile and the institutional experience but not with the access mode itself.
Collapse
Affiliation(s)
- Wilko Reents
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Daniel P Griese
- Department of Cardiology, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Sebastian Winkler
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Jörg Babin-Ebell
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Anno Diegeler
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Michael Zacher
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Karsten Hamm
- Department of Cardiology, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| |
Collapse
|
21
|
Koehler F, Koehler K, Prescher S, Kirwan BA, Wegscheider K, Vettorazzi E, Lezius S, Winkler S, Moeller V, Fiss G, Schleder J, Koehler M, Zugck C, Störk S, Butter C, Prondzinsky R, Spethmann S, Angermann C, Stangl V, Halle M, von Haehling S, Dreger H, Stangl K, Deckwart O, Anker SD. Mortality and morbidity 1 year after stopping a remote patient management intervention: extended follow-up results from the telemedical interventional management in patients with heart failure II (TIM-HF2) randomised trial. The Lancet Digital Health 2020; 2:e16-e24. [DOI: 10.1016/s2589-7500(19)30195-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
|
22
|
Zhang L, Winkler S, Schlottmann FP, Kohlbacher O, Elias JE, Skotheim JM, Ewald JC. Multiple Layers of Phospho-Regulation Coordinate Metabolism and the Cell Cycle in Budding Yeast. Front Cell Dev Biol 2019; 7:338. [PMID: 31921850 PMCID: PMC6927922 DOI: 10.3389/fcell.2019.00338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/29/2019] [Indexed: 01/20/2023] Open
Abstract
The coordination of metabolism and growth with cell division is crucial for proliferation. While it has long been known that cell metabolism regulates the cell division cycle, it is becoming increasingly clear that the cell division cycle also regulates metabolism. In budding yeast, we previously showed that over half of all measured metabolites change concentration through the cell cycle indicating that metabolic fluxes are extensively regulated during cell cycle progression. However, how this regulation is achieved still remains poorly understood. Since both the cell cycle and metabolism are regulated to a large extent by protein phosphorylation, we here decided to measure the phosphoproteome through the budding yeast cell cycle. Specifically, we chose a cell cycle synchronization strategy that avoids stress and nutrient-related perturbations of metabolism, and we grew the yeast on ethanol minimal medium to force cells to utilize their full biosynthetic repertoire. Using a tandem-mass-tagging approach, we found over 200 sites on metabolic enzymes and transporters to be phospho-regulated. These sites were distributed among many pathways including carbohydrate catabolism, lipid metabolism, and amino acid synthesis and therefore likely contribute to changing metabolic fluxes through the cell cycle. Among all one thousand sites whose phosphorylation increases through the cell cycle, the CDK consensus motif and an arginine-directed motif were highly enriched. This arginine-directed R-R-x-S motif is associated with protein-kinase A, which regulates metabolism and promotes growth. Finally, we also found over one thousand sites that are dephosphorylated through the G1/S transition. We speculate that the phosphatase Glc7/PP1, known to regulate both the cell cycle and carbon metabolism, may play an important role because its regulatory subunits are phospho-regulated in our data. In summary, our results identify extensive cell cycle dependent phosphorylation and dephosphorylation of metabolic enzymes and suggest multiple mechanisms through which the cell division cycle regulates metabolic signaling pathways to temporally coordinate biosynthesis with distinct phases of the cell division cycle.
Collapse
Affiliation(s)
- Lichao Zhang
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA, United States
| | - Sebastian Winkler
- Applied Bioinformatics, Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Fabian P. Schlottmann
- Molecular Cell Biology, Interfaculty Institute of Cell Biology, University of Tübingen, Tübingen, Germany
| | - Oliver Kohlbacher
- Applied Bioinformatics, Department of Computer Science, University of Tübingen, Tübingen, Germany
- Institute for Translational Bioinformatics, University Hospital Tübingen, Tübingen, Germany
- Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
- Quantitative Biology Center, University of Tübingen, Tübingen, Germany
- Biomolecular Interactions, Max Planck Institute for Developmental Biology, Tübingen, Germany
| | - Josh E. Elias
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA, United States
| | - Jan M. Skotheim
- Department of Biology, Stanford University, Stanford, CA, United States
| | - Jennifer C. Ewald
- Molecular Cell Biology, Interfaculty Institute of Cell Biology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
23
|
Winkler S. Untersuchungen über den Einfluß von Keimung und Wachstum der Kartoffel sowie der mineralischen Düngung auf die Eigenschaften von Fruchtsaft und Stärke. STARCH-STARKE 2019. [DOI: 10.1002/star.19600120604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
24
|
|
25
|
Hirmer E, Kell R, Winkler S, Winkler K, Mutschelknaus L, Mörtl S, Atkinson M, Combs S, Schmid T, Anastasov N. PO-1087 The interaction between miR-221 overexpression and radiosensitivity in mamma carcinoma cell lines. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31507-5] [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: 10/26/2022]
|
26
|
Koehler F, Koehler K, Deckwart O, Prescher S, Wegscheider K, Kirwan BA, Winkler S, Vettorazzi E, Bruch L, Oeff M, Zugck C, Doerr G, Naegele H, Störk S, Butter C, Sechtem U, Angermann C, Gola G, Prondzinsky R, Edelmann F, Spethmann S, Schellong SM, Schulze PC, Bauersachs J, Wellge B, Schoebel C, Tajsic M, Dreger H, Anker SD, Stangl K. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018; 392:1047-1057. [PMID: 30153985 DOI: 10.1016/s0140-6736(18)31880-4] [Citation(s) in RCA: 381] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Remote patient management in patients with heart failure might help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failure decompensation. We aimed to investigate the efficacy of our remote patient management intervention on mortality and morbidity in a well defined heart failure population. METHODS The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial was a prospective, randomised, controlled, parallel-group, unmasked (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. The trial was done in Germany, and patients were recruited from hospitals and cardiology practices. Eligible patients had heart failure, were in New York Heart Association class II or III, had been admitted to hospital for heart failure within 12 months before randomisation, and had a left ventricular ejection fraction (LVEF) of 45% or lower (or if higher than 45%, oral diuretics were being prescribed). Patients with major depression were excluded. Patients were randomly assigned (1:1) using a secure web-based system to either remote patient management plus usual care or to usual care only and were followed up for a maximum of 393 days. The primary outcome was percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death, analysed in the full analysis set. Key secondary outcomes were all-cause and cardiovascular mortality. This study is registered with ClinicalTrials.gov, number NCT01878630, and has now been completed. FINDINGS Between Aug 13, 2013, and May 12, 2017, 1571 patients were randomly assigned to remote patient management (n=796) or usual care (n=775). Of these 1571 patients, 765 in the remote patient management group and 773 in the usual care group started their assigned care, and were included in the full analysis set. The percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause death was 4·88% (95% CI 4·55-5·23) in the remote patient management group and 6·64% (6·19-7·13) in the usual care group (ratio 0·80, 95% CI 0·65-1·00; p=0·0460). Patients assigned to remote patient management lost a mean of 17·8 days (95% CI 16·6-19·1) per year compared with 24·2 days (22·6-26·0) per year for patients assigned to usual care. The all-cause death rate was 7·86 (95% CI 6·14-10·10) per 100 person-years of follow-up in the remote patient management group compared with 11·34 (9·21-13·95) per 100 person-years of follow-up in the usual care group (hazard ratio [HR] 0·70, 95% CI 0·50-0·96; p=0·0280). Cardiovascular mortality was not significantly different between the two groups (HR 0·671, 95% CI 0·45-1·01; p=0·0560). INTERPRETATION The TIM-HF2 trial suggests that a structured remote patient management intervention, when used in a well defined heart failure population, could reduce the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality. FUNDING German Federal Ministry of Education and Research.
Collapse
Affiliation(s)
- Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Kerstin Koehler
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Deckwart
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Prescher
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bridget-Anne Kirwan
- Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sebastian Winkler
- Clinic for Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Leonhard Bruch
- Clinic for Internal Medicine and Cardiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Michael Oeff
- Telemedicine Centre, Department of Cardiology, Municipal Hospital Brandenburg/Havel and Brandenburg Medical School, Brandenburg/Havel, Germany
| | | | - Gesine Doerr
- Clinic for Internal Medicine, St Josefs-Krankenhaus Potsdam, Potsdam, Germany
| | - Herbert Naegele
- Department for Heart Insufficiency and Device Therapy, Albertinen Cardiovascular Centre, Hamburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center (CHFC) Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | - Christian Butter
- Immanuel Hospital Bernau, Brandenburg Heart Center, Department of Cardiology and Medical School Brandenburg Theodor Fontane, Bernau, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center (CHFC) Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | | | - Roland Prondzinsky
- Department of Internal Medicine I, Carl-von-Basedow-Klinikum Merseburg, Merseburg, Germany
| | - Frank Edelmann
- Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Sebastian Spethmann
- Federal Armed Forces Hospital Berlin, Division of Cardiology, Department of Internal Medicine, Berlin, Germany
| | | | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Johann Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - Brunhilde Wellge
- Centre for Cardiovascular Telemedicine, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schoebel
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Milos Tajsic
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; University Medical Center Göttingen, Department of Cardiology and Pneumology, Göttingen, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| |
Collapse
|
27
|
Koehler F, Koehler K, Deckwart O, Prescher S, Wegscheider K, Winkler S, Vettorazzi E, Polze A, Stangl K, Hartmann O, Marx A, Neuhaus P, Scherf M, Kirwan BA, Anker SD. Telemedical Interventional Management in Heart Failure II (TIM-HF2), a randomised, controlled trial investigating the impact of telemedicine on unplanned cardiovascular hospitalisations and mortality in heart failure patients: study design and description of the intervention. Eur J Heart Fail 2018; 20:1485-1493. [PMID: 30230666 DOI: 10.1002/ejhf.1300] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 07/11/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms, all of which necessitate close follow-up by health care providers. Lack of disease monitoring may result in increased mortality and more frequent hospital readmissions for decompensated HF. Remote patient management (RPM) in this patient population may help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a manifestation of HF decompensation. OBJECTIVE The objective of the present article is to describe the design of a new trial investigating the impact of RPM on unplanned cardiovascular hospitalisations and mortality in HF patients. METHODS The TIM-HF2 trial is designed as a prospective, randomised, controlled, parallel group, open (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. Eligible patients with HF are randomised (1:1) to either RPM + usual care or to usual care only and are followed for 12 months. The primary outcome is the percentage of days lost due to unplanned cardiovascular hospitalisations or all-cause death. The main secondary outcomes are all-cause and cardiovascular mortality. CONCLUSION The TIM-HF2 trial will provide important prospective data on the potential beneficial effect of telemedical monitoring and RPM on unplanned cardiovascular hospitalisations and mortality in HF patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01878630.
Collapse
Affiliation(s)
- Friedrich Koehler
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Kerstin Koehler
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Oliver Deckwart
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Sandra Prescher
- Charité - Universitätsmedizin Berlin, Centre for Cardiovascular Telemedicine, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Sebastian Winkler
- Unfallkrankenhaus Berlin, Clinic for Internal Medicine, Berlin, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Andreas Polze
- Hasso Plattner Institute gGmbH, Digital Engineering Faculty, University Potsdam, Potsdam, Germany
| | - Karl Stangl
- Charité - Universitätsmedizin Berlin, Department of Cardiology and Angiology Campus Mitte, Berlin, Germany
| | | | | | - Petra Neuhaus
- University of Leipzig, Faculty of Medicine, Clinical Trial Centre Leipzig - KKS, Leipzig, Germany
| | - Michael Scherf
- GETEMED Medizin- und Informationstechnik AG, Teltow, Germany
| | - Bridget-Anne Kirwan
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Public Health, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin- Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité - Universitätsmedizin Berlin, Germany
| |
Collapse
|
28
|
Wagner F, Brendel J, Dingeldey E, Winkler S, Grifka J, Matussek J. [Disease-specific Knowledge in Conservative Treatment of Adolescent Idiopathic Scoliosis]. Z Orthop Unfall 2018; 156:385-392. [PMID: 29415311 DOI: 10.1055/s-0043-125091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The typical onset of adolescent idiopathic scoliosis falls in a sensitive stage of life. Nevertheless, conservative brace treatment requires a high degree of compliance. Disease-specific knowledge influences therapy outcome in many diseases and potentially improves patient compliance and quality of life. We analysed disease-specific knowledge and quality of life of patients with adolescent idiopathic scoliosis. METHODS Scoliosis patients (n = 67) undergoing conservative brace treatment were asked to answer a questionnaire with items about scoliosis-specific knowledge. This was anonymous and prior to regular interviews and examinations. The scoliosis-research-society-22 r score was determined in order to assess quality of life. RESULTS The major sources of information for the patients were the attending physicians and the world wide web. The majority stated that they understood the nature of scoliosis, although their answers to more detailed questions revealed a major lack of knowledge. A significant gap in provision of information was found, especially in the field of therapy regimen and treatment goals. The expected duration of the therapy was unclear to most patients. Nevertheless, higher quality of life correlated with high compliance and patients who regarded alleviation of the disturbing appearance of their trunk as a main treatment aim also experienced a lower quality of life in the section of self image. CONCLUSIONS Our study revealed a significant lack of disease-specific knowledge in patients with idiopathic scoliosis. Facilitation of knowledge might improve quality of life and therapy outcome in the future. As the attending physicians are the main source of information, it is up to us to improve this situation.
Collapse
Affiliation(s)
- Ferdinand Wagner
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
- Kinderchirurgische Klinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München
- Institute of Health and Biomedical Innovation, Queensland University of Technology Faculty of Science and Engineering, Brisbane, Australia
| | - Julia Brendel
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
| | - Esther Dingeldey
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
| | - Sebastian Winkler
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
| | - Joachim Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
| | - Jan Matussek
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach
| |
Collapse
|
29
|
Prescher S, Schoebel C, Koehler K, Deckwart O, Wellge B, Honold M, Hartmann O, Winkler S, Koehler F. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure: A pre-specified sub-study of the TIM-HF-Trial. Eur J Prev Cardiol 2018; 23:21-26. [PMID: 27892422 DOI: 10.1177/2047487316671438] [Citation(s) in RCA: 16] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The six-minute walk test (6MWT) is an established functional test assessing exercise capacity and is used to predict clinical prognosis in patients with chronic heart failure (HF). Tele-accelerometry is a novel approach to activity monitoring using telemedical data transfer and allows a Tele-6MWT to be performed in an outpatient setting. It offers patients the option of performing simple serial follow-up tests in their own home. AIMS The aim of this study was to investigate the prognostic value of serial Tele-6MWTs using tele-accelerometry in patients with HF. DESIGN/METHODS In this proof-of-concept study, 155 patients with HF completed the Tele-6MWT in an outdoor setting once per month over a period of 0.25-21 months. We analysed the differences in the number of steps over time to predict hospitalization as a result of HF or death. RESULTS Patients with at least one event (n = 31) recorded a lower number of steps and a shorter distance in Tele-6MWT at baseline compared with patients who remained event-free (n = 124) (540.1 ± 78.4 steps vs. 601.8 ± 76.7 steps, P < 0.001 respectively; 353.2 ± 82.4 m vs. 418.8 ± 95.6 m, P < 0.001). Patients (n = 19) who performed more than one Tele-6MWT prior to a clinical event showed no significant difference in the number of steps, regardless of whether the baseline test was compared with the last Tele-6MWT before the event or with the last two tests before the event. CONCLUSION Tele-6MWT has a high predictive value with respect to hospitalization as a result of HF or death from any cause and the results were comparable with the prognostic impact of a conventional 6MWT. Therefore Tele-6MWT may be used as alternative test method in the home environment. However, there is no added prognostic value of repeating Tele-6MWTs on a monthly basis.
Collapse
Affiliation(s)
- Sandra Prescher
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Christoph Schoebel
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Kerstin Koehler
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Oliver Deckwart
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Brunhilde Wellge
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | | | - Oliver Hartmann
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany.,Dr Oliver Hartmann Statistical Consulting, Frankfurt/Main, Germany
| | - Sebastian Winkler
- Department of Internal Medicine/Cardiology, Unfallkrankenhaus Berlin, Germany
| | - Friedrich Koehler
- Charité-Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| |
Collapse
|
30
|
Abstract
AbstractRecent advancements in implant technology include increasing application of electronic systems in the human body. Hermetic encapsulation of electronic components is necessary, specific implant functions and body environments must be considered. Additional functions such as wireless communication systems require specialized technical solutions for the encapsulation.In this paper 3 different implant strategies based on the material groups silicone, ceramics and titanium alloys are evaluated. With the background of a specific application the requirements for the encapsulation are defined and include the implementation of electrical feedthroughs, wireless communication and wireless energy transfer as well as biomedical specifications such as hermetic sealing, mechanical stability and biocompatibility. The encapsulations are manufactured and qualified experimentally.
Collapse
Affiliation(s)
- Sebastian Winkler
- Fraunhofer Institute for Machine Tools and Forming Technology, Reichenhainer Straße 88, 09126 Chemnitz, Germany
| | - Jan Edelmann
- Fraunhofer Institute for Machine Tools and Forming Technology, Reichenhainer Straße 88, 09126 Chemnitz, Germany
| | - Christine Welsch
- Fraunhofer Institute for Biomedical Engineering IBMT, Ensheimer Strasse 48, 66386 St. Ingbert, Germany
| | - Roman Ruff
- Fraunhofer Institute for Biomedical Engineering IBMT, Ensheimer Strasse 48, 66386 St. Ingbert, Germany
| |
Collapse
|
31
|
Al-Kawlani B, Prieto DM, Fritzsche A, Winkler S, Markert U. Effects of chemotherapeutic agents on miR-132 expression in human ovarian granulosa cells. J Reprod Immunol 2017. [DOI: 10.1016/j.jri.2017.07.019] [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: 11/29/2022]
|
32
|
Albrecht V, Zweiniger C, Surendranath V, Lang K, Schöfl G, Dahl A, Winkler S, Lange V, Böhme I, Schmidt AH. Dual redundant sequencing strategy: Full-length gene characterisation of 1056 novel and confirmatory HLA alleles. HLA 2017; 90:79-87. [PMID: 28547825 PMCID: PMC6084308 DOI: 10.1111/tan.13057] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 04/19/2017] [Accepted: 05/01/2017] [Indexed: 01/26/2023]
Abstract
The high‐throughput department of DKMS Life Science Lab encounters novel human leukocyte antigen (HLA) alleles on a daily basis. To characterise these alleles, we have developed a system to sequence the whole gene from 5′‐ to 3′‐UTR for the HLA loci A, B, C, DQB1 and DPB1 for submission to the European Molecular Biology Laboratory – European Nucleotide Archive (EMBL‐ENA) and the IPD‐IMGT/HLA Database. Our workflow is based on a dual redundant sequencing strategy. Using shotgun sequencing on an Illumina MiSeq instrument and single molecule real‐time (SMRT) sequencing on a PacBio RS II instrument, we are able to achieve highly accurate HLA full‐length consensus sequences. Remaining conflicts are resolved using the R package DR2S (Dual Redundant Reference Sequencing). Given the relatively high throughput of this strategy, we have developed the semi‐automated web service TypeLoader, to aid in the submission of sequences to the EMBL‐ENA and the IPD‐IMGT/HLA Database. In the IPD‐IMGT/HLA Database release 3.24.0 (April 2016; prior to the submission of the sequences described here), only 5.2% of all known HLA alleles have been fully characterised together with intronic and UTR sequences. So far, we have applied our strategy to characterise and submit 1056 HLA alleles, thereby more than doubling the number of fully characterised alleles. Given the increasing application of next generation sequencing (NGS) for full gene characterisation in clinical practice, extending the HLA database concomitantly is highly desirable. Therefore, we propose this dual redundant sequencing strategy as a workflow for submission of novel full‐length alleles and characterisation of sequences that are as yet incomplete. This would help to mitigate the predominance of partially known alleles in the database.
Collapse
Affiliation(s)
| | | | | | - K Lang
- DKMS Life Science Lab, Dresden, Germany
| | - G Schöfl
- DKMS Life Science Lab, Dresden, Germany
| | - A Dahl
- Deep Sequencing Group, CRTD - Center for Regenerative Therapies Dresden, Dresden, Germany
| | - S Winkler
- DNA Sequencing, Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany
| | - V Lange
- DKMS Life Science Lab, Dresden, Germany
| | - I Böhme
- DKMS Life Science Lab, Dresden, Germany
| | - A H Schmidt
- DKMS Life Science Lab, Dresden, Germany.,DKMS, Tübingen, Germany
| |
Collapse
|
33
|
Abstract
Caspase-1 is an integral regulator of the innate immune system. Its core functions are the processing and secretion of the proinflammatory cytokines interleukin 1β (IL-1 beta) and IL-18 and the initiation of proinflammatory cell death, which is referred to as pyroptosis. Activation of caspase-1 plays a pivotal role during immune defense mechanisms against infections by the innate immune system. Dysregulated activation of caspase-1 has been recognized to be involved in the pathophysiology of a constantly increasing number of inflammatory diseases. This article gives an overview of the regulation and function of caspase-1 and its involvement in monogenic, polygenic and/or polyetiological rheumatic diseases.
Collapse
Affiliation(s)
- S Winkler
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C M Hedrich
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - A Rösen-Wolff
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| |
Collapse
|
34
|
Winkler S, Müller K, Brückner S, Hempel M, Schoon HA, Christ B. Mesenchymale Stammzellen vermindern die durch Diethylnitrosamin induzierte Entstehung prä-neoplastischer Foci in der Mausleber. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Winkler
- Universität Leipzig, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Angewandte Molekulare Hepatologie, Leipzig, Deutschland
| | - K Müller
- Universität Leipzig, Institut für Veterinär-Pathologie, Leipzig, Deutschland
| | - S Brückner
- Universität Leipzig, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Angewandte Molekulare Hepatologie, Leipzig, Deutschland
| | - M Hempel
- Universität Leipzig, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Angewandte Molekulare Hepatologie, Leipzig, Deutschland
| | - HA Schoon
- Universität Leipzig, Institut für Veterinär-Pathologie, Leipzig, Deutschland
| | - B Christ
- Universität Leipzig, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Angewandte Molekulare Hepatologie, Leipzig, Deutschland
| |
Collapse
|
35
|
Craiovan B, Woerner M, Winkler S, Springorum HR, Grifka J, Renkawitz T, Keshmiri A. Decreased femoral periprosthetic bone mineral density: a comparative study using DXA in patients after cementless total hip arthroplasty with osteonecrosis of the femoral head versus primary osteoarthritis. Arch Orthop Trauma Surg 2016; 136:709-13. [PMID: 26891850 DOI: 10.1007/s00402-016-2423-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trabecular properties in osteonecrosis of the femoral head (ONFH) are altered for bone volume and structure in the femoral head and proximal femoral canal. We analysed the periprosthetic bone mineral density (BMD) as a correlate to bony ingrowth in patients with ONFH who received a cementless THA. MATERIALS AND METHODS We performed a matched-pair analysis of 100 patients with ONFH (n = 50) and primary osteoarthritis (n = 50) who received the same, unilateral cementless THA. We compared the periprosthetic BMD 5 years after surgery by means of dual energy X-ray absorptiometry (DXA) analysing the seven femoral regions of interest (ROIs) according to Gruen. RESULTS Within the ONFH group, significantly lower BMD values were found in the ROI 1 and 7 (p < 0.05). No statistically significant difference was found for ROIs 2-6. CONCLUSIONS An altered periprosthetic bone stock in the proximal femur in patients with prior ONFH might be a possible risk factor for premature loosening of the femoral stem in THA. Surgeons need to consider coating and fixation philosophy of cementless implants when choosing the right stem for patients with ONFH.
Collapse
Affiliation(s)
- Benjamin Craiovan
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Michael Woerner
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Sebastian Winkler
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Hans-Robert Springorum
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
36
|
Wilken F, Banke IJ, Hauschild M, Winkler S, Schott K, Rudert M, Eisenhart-Rothe RV. [Endoprosthetic tumor replacement : Reconstruction of the extensor mechanism and complications]. Orthopade 2016; 45:439-45. [PMID: 27115678 DOI: 10.1007/s00132-016-3255-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The reconstruction of the extensor mechanism around the knee is an essential part of tumorresection and tumor arthroplasty in orthopaedic oncology for functional rehabilitation of quality of life and daily activities. OBJECTIVES Operative procedures, treatment options and management of complications with reconstruction of the extensor mechanism after tumor resection around the knee depend on the type of arthroplasty. MATERIALS AND METHODS Description of the different treatment option for extensor deficiency divided into infra- and suprapatellar modalities. RESULTS The operative procedure is always an individual decision depending on the size of the tumor and its localisation. The extensor mechanism is reconstructed with autogenic, allogenic or synthetic material in combination with tumor arthroplasty. CONCLUSIONS Extensor reconstruction (supra-/infrapatellar) is an essential part of tumor resection and tumor arthroplasty around the knee. Often, low functional results and high levels of complications (arthrofibrosis, rerupture extensor mechanism, periprosthetic joint infection) are seen in these highly demanding cases in orthopaedic oncology.
Collapse
Affiliation(s)
- F Wilken
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - I J Banke
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Hauschild
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S Winkler
- Klinik für Orthopädie, König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - K Schott
- Klinik für Orthopädie, König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - M Rudert
- Klinik für Orthopädie, König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| |
Collapse
|
37
|
Abstract
The need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient's hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.
Collapse
Affiliation(s)
- H-R Springorum
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - S Winkler
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Maderbacher
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Universitätsklinik Regensburg im Asklepiosklinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
38
|
Winkler S, Springorum HR, Vaitl T, Handel M, Barta S, Kehl V, Craiovan B, Grifka J. Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac. Int Orthop 2016; 40:673-80. [PMID: 26728611 DOI: 10.1007/s00264-015-3077-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigated whether etoricoxib (COX-II blocker) has a superior efficacy of preventing heterotopic ossification (HO) after total hip arthroplasty (THA) compared to diclofenac (non-selective NSAID). METHODS One hundred patients were included (50 in each group) in this single centre, prospective, double-blinded, randomized, controlled trial. Etoricoxib (90 mg) was administered once and diclofenac (75 mg) twice per day for a perioperative period of nine days. The incidence of HO was evaluated on radiographs of the pelvis six months after surgery. RESULTS Eighty nine of 100 (89 %) patients could be analysed. The overall HO incidence was 37.8 %. There was no significant difference between both study groups. Twelve patients (27.3 %) of the DIC group and 13 patients (28.9 %) of the ETO group showed Brooker grade I ossifications. Five patients (11.4 %) of the DIC and four patients of the ETO (8.9 %) group showed grade II HO formations. No class III or IV HO formations occured in both groups. Ad hoc analysis detected a negative correlation between HO incidence and limited abduction and internal rotation of the hip. CONCLUSIONS Etoricoxib and diclofenac are equally effective for oral HO prophylaxis after primary cementless THA when given for nine peri-operative days to ensure a full recovery and high patient satisfaction.
Collapse
Affiliation(s)
- Sebastian Winkler
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Hans-Robert Springorum
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Vaitl
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Martin Handel
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Sabine Barta
- Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Technische Universität, Munich, Germany
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
39
|
Winkler S, Hempel M, Schmidt L, Ditze M, Böhmer F, Müller J, Kaufmann R, Christ B. Identifizierung angiogener Faktoren nach Applikation von Hep3B mit mesenchymalen Stammzellen in der immundefizienten Maus. Z Gastroenterol 2015. [DOI: 10.1055/s-0035-1568080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Luksch H, Schlipfenbacher V, Köhler S, Münch F, Winkler S, Schulze F, Roesler J, Rösen-Wolff A. Expression of Caspase-1 variants induced ER stress. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597323 DOI: 10.1186/1546-0096-13-s1-p17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
41
|
Schulze F, Hengst E, Winkler S, Rösen-Wolff A. A transgenic in vitro cell model for the analysis of proinflammatory effects of naturally occurring genetic variants of caspase-1. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597410 DOI: 10.1186/1546-0096-13-s1-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
42
|
Rabe S, Heymann MC, Stein R, Kapplusch F, Russ S, Schulze F, Winkler S, Staroske W, Rösen-Wolff A, Hofmann SR. Influence of the naturally occurring human CASP1 variant L265S on subcellular distribution and pyroptosis. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597328 DOI: 10.1186/1546-0096-13-s1-o61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
43
|
Grinstein L, Luksch H, Robertson AAB, Cooper MA, Winkler S, Rösen-Wolff A. An optimized whole blood assay measuring expression and activity of NLRP3-, NLRC4 and AIM2-inflammasomes. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596943 DOI: 10.1186/1546-0096-13-s1-o51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
44
|
Reinke S, Gocht A, Luksch H, Rösen-Wolff A, Winkler S. Enzymatically inactive caspase-1 mediates a proinflammatory phenotype in mice. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597411 DOI: 10.1186/1546-0096-13-s1-o53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
45
|
Winkler S, Wagner F, Weber M, Matussek J, Craiovan B, Heers G, Springorum HR, Grifka J, Renkawitz T. Current therapeutic strategies of heterotopic ossification--a survey amongst orthopaedic and trauma departments in Germany. BMC Musculoskelet Disord 2015; 16:313. [PMID: 26494270 PMCID: PMC4619196 DOI: 10.1186/s12891-015-0764-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022] Open
Abstract
Background Heterotopic ossification (HO) is a complication after tissue trauma, fracture and surgery (i.e. total hip arthroplasty). Prophylaxis is the most effective therapy. If HO formations become symptomatic and limit patients’ quality of life, revision surgery is indicated and is usually combined with a perioperative oral prophylaxis (NSAIDs) and/or irradiation. However, a long-term use of NSAIDs can induce gastro-intestinal or cardiac side-effects and possible bony non-unions during fracture healing. Subject of this study was to assess the current status of HO prophylaxis after injuries or fractures and to evaluate current indications and strategies for excision of symptomatic HO. Methods Between 2013 and 2014, a questionnaire was sent to 119 orthopaedic and trauma surgery departments in Germany. Participation was voluntary and all acquired data was given anonymously. Results The cumulative feedback rate was 71 %. Trauma and orthopaedic surgery departments in Germany recommend oral HO prophylaxis after acetabulum and femoral neck fractures, elbow dislocation, and fracture or dislocation of the radial head. Pain upon movement and an increasing loss of range of motion in the affected joint are considered to be clear indications for HO surgery. A partial removal of ROM-limiting HO formations was also considered important. The vast majority of all departments include perioperative oral HO prophylaxis and/or irradiation if surgical HO removal is planned. The choice and duration of NSAIDs is highly variable. Conclusion HO is of clinical significance in current traumatology and orthopaedics. Certain fractures and injuries are prone to HO, and prophylactic measures should be taken. The respondents in this survey assessed current therapeutic strategies for HO formations similarly. These concepts are in line with the literature. However, the duration of perioperative oral HO prophylaxis varied greatly among the specialist centres. This is significant as a long-term use of NSAIDs fosters a potential risk for the patients’ safety and could influence the clinical outcome. National and international guidelines need to be developed to further reduce HO rates and improve patients’ safety in trauma and orthopaedic surgery.
Collapse
Affiliation(s)
- Sebastian Winkler
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Ferdinand Wagner
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Jan Matussek
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Guido Heers
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Hans Robert Springorum
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| |
Collapse
|
46
|
Winkler S, Niedermair T, Füchtmeier B, Grifka J, Grässel S, Anders S, Heers G, Wagner F. The impact of hypoxia on mesenchymal progenitor cells of human skeletal tissue in the pathogenesis of heterotopic ossification. International Orthopaedics (SICOT) 2015; 39:2495-501. [DOI: 10.1007/s00264-015-2995-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/10/2015] [Indexed: 12/20/2022]
|
47
|
Winkler S, Hempel M, Brückner S, Mallek F, Weise A, Liehr T, Tautenhahn HM, Bartels M, Christ B. Mouse white adipose tissue-derived mesenchymal stem cells gain pericentral and periportal hepatocyte features after differentiation in vitro, which are preserved in vivo after hepatic transplantation. Acta Physiol (Oxf) 2015; 215:89-104. [PMID: 26235702 DOI: 10.1111/apha.12560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/06/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
AIM Mesenchymal stem cells may differentiate into hepatocyte-like cells in vitro and in vivo. Therefore, they are considered a novel cell resource for the treatment of various liver diseases. Here, the aim was to demonstrate that mesenchymal stem cells may adopt both perivenous and periportal hepatocyte-specific functions in vitro and in vivo. METHODS Adipose tissue-derived mesenchymal stem cells were isolated from immunodeficient C57BL/6 (B6.129S6-Rag2(tm1Fwa) Prf1(tm1Clrk) ) mice and differentiated into the hepatocytic phenotype by applying a simple protocol. Their physiological and metabolic functions were analysed in vitro and after hepatic transplantation in vivo. RESULTS Mesenchymal stem cells changed their morphology from a fibroblastoid into shapes of osteocytes, chondrocytes, adipocytes and hepatocytes. Typical for mesenchymal stem cells, hematopoietic marker genes were not expressed. CD90, which is not expressed on mature hepatocytes, decreased significantly after hepatocytic differentiation. Markers indicative for liver development like hepatic nuclear factor 4 alpha, or for perivenous hepatocyte specification like cytochrome P450 subtype 3a11, and CD26 were significantly elevated. Periportal hepatocyte-specific markers like carbamoylphosphate synthetase 1, the entry enzyme of the urea cycle, were up-regulated. Consequently, cytochrome P450 enzyme activity and urea synthesis increased significantly to values comparable to cultured primary hepatocytes. Both perivenous and periportal qualities were preserved after hepatic transplantation and integration into the host parenchyma. CONCLUSIONS Adult mesenchymal stem cells from adipose tissue differentiated into hepatocyte-like cells featuring both periportal and perivenous functions. Hence, they are promising candidates for the treatment of region-specific liver cell damage and may support organ regeneration in acute and chronic liver diseases.
Collapse
Affiliation(s)
- S. Winkler
- Applied Molecular Hepatology Laboratory; Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
| | - M. Hempel
- Applied Molecular Hepatology Laboratory; Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
| | - S. Brückner
- Applied Molecular Hepatology Laboratory; Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
| | - F. Mallek
- Jena University Hospital; Institute of Human Genetics; Friedrich Schiller University; Jena Germany
| | - A. Weise
- Jena University Hospital; Institute of Human Genetics; Friedrich Schiller University; Jena Germany
| | - T. Liehr
- Jena University Hospital; Institute of Human Genetics; Friedrich Schiller University; Jena Germany
| | - H.-M. Tautenhahn
- Applied Molecular Hepatology Laboratory; Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
- Translational Centre for Regenerative Medicine (TRM); University of Leipzig; Leipzig Germany
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
| | - M. Bartels
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
| | - B. Christ
- Applied Molecular Hepatology Laboratory; Department of Visceral, Transplantation, Thoracic and Vascular Surgery; University Hospital of Leipzig; Leipzig Germany
- Translational Centre for Regenerative Medicine (TRM); University of Leipzig; Leipzig Germany
| |
Collapse
|
48
|
Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T. The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop 2015; 39:2323-33. [PMID: 25920600 DOI: 10.1007/s00264-015-2777-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Different target areas within the concept of combined cup and stem anteversion have been published for total hip arthroplasty (THA). We asked whether component positioning according to eight standard combined anteversion rules is associated with (1) more physiological gait patterns, (2) higher improvement of gait variables and (3) better clinical outcome after THA. METHODS In a prospective clinical study, 60 patients received cementless THA through an anterolateral MIS approach in a lateral decubitus position. Six weeks postoperatively, implant position was analysed using 3D-CT by an independent external institute. Preoperatively, six and 12 months postoperatively range of motion, normalized walking speed and hip flexion symmetry index were measured using 3D motion-capture gait analysis. Patient-related outcome measures (HHS, HOOS, EQ-5D) were obtained by an observer blinded to 3D-CT results. Eight combined anteversion definitions and Lewinnek's "safe zone" were evaluated regarding their impact on gait patterns and clinical outcome. RESULTS Combined cup and stem anteversion according to standard combined anteversion definitions as well as cup placement within Lewinnek's "safe zone" did not influence range of motion, normalized walking speed and/or hip flexion symmetry index six and 12 months after THA. Similarly, increase of gait parameters within the first year after THA was comparable between all eight combined anteversion rules. Clinical outcome measures like HHS, HOOS and EQ-5D did not show any benefit for either of the combined anteversion definitions. CONCLUSIONS Standard combined cup and stem anteversion rules do not improve postoperative outcome as measured by gait analysis and clinical scores within one year after THA.
Collapse
Affiliation(s)
- Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Tim Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.,Regensburg Centre of Biomedical Engineering, Ostbayerische Technische Hochschule Regensburg, 93053, Regensburg, Germany
| | - Michael Woerner
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Michael Worlicek
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Sebastian Winkler
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
49
|
Pecks U, Rath W, Winkler S, Maass N, Contini C, Winkler K. Erweitertes Serum-Lipid-Profiling bei IUGR und Präeklampsie. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
50
|
Springorum HR, Winkler S, Maderbacher G, Götz J, Heers G, Grifka J, Preissler P. [Wrist arthroscopy : challenging procedure of modern hand surgery]. Orthopade 2014; 44:89-102. [PMID: 25527300 DOI: 10.1007/s00132-014-3059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.
Collapse
Affiliation(s)
- H-Robert Springorum
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
| | | | | | | | | | | | | |
Collapse
|