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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.
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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
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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.
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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
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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.
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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
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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.
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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
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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.
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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
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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
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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
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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.
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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
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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.
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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
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Maurer B, Nivarthi H, Wingelhofer B, Pham HTT, Schlederer M, Suske T, Grausenburger R, Schiefer AI, Prchal-Murphy M, Chen D, Winkler S, Merkel O, Kornauth C, Hofbauer M, Hochgatterer B, Hoermann G, Hoelbl-Kovacic A, Prochazkova J, Lobello C, Cumaraswamy AA, Latzka J, Kitzwögerer M, Chott A, Janikova A, Pospíšilova Š, Loizou JI, Kubicek S, Valent P, Kolbe T, Grebien F, Kenner L, Gunning PT, Kralovics R, Herling M, Müller M, Rülicke T, Sexl V, Moriggl R. High activation of STAT5A drives peripheral T-cell lymphoma and leukemia. Haematologica 2020; 105:435-447. [PMID: 31123029 PMCID: PMC7012494 DOI: 10.3324/haematol.2019.216986] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 01/18/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022] Open
Abstract
Recurrent gain-of-function mutations in the transcription factors STAT5A and much more in STAT5B were found in hematopoietic malignancies with the highest proportion in mature T- and natural killer-cell neoplasms (peripheral T-cell lymphoma, PTCL). No targeted therapy exists for these heterogeneous and often aggressive diseases. Given the shortage of models for PTCL, we mimicked graded STAT5A or STAT5B activity by expressing hyperactive Stat5a or STAT5B variants at low or high levels in the hematopoietic system of transgenic mice. Only mice with high activity levels developed a lethal disease resembling human PTCL. Neoplasia displayed massive expansion of CD8+ T cells and destructive organ infiltration. T cells were cytokine-hypersensitive with activated memory CD8+ T-lymphocyte characteristics. Histopathology and mRNA expression profiles revealed close correlation with distinct subtypes of PTCL. Pronounced STAT5 expression and activity in samples from patients with different subsets underline the relevance of JAK/STAT as a therapeutic target. JAK inhibitors or a selective STAT5 SH2 domain inhibitor induced cell death and ruxolitinib blocked T-cell neoplasia in vivo. We conclude that enhanced STAT5A or STAT5B action both drive PTCL development, defining both STAT5 molecules as targets for therapeutic intervention.
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Affiliation(s)
- Barbara Maurer
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria.,Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Harini Nivarthi
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Bettina Wingelhofer
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ha Thi Thanh Pham
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michaela Schlederer
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Tobias Suske
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Reinhard Grausenburger
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ana-Iris Schiefer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Michaela Prchal-Murphy
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Doris Chen
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Susanne Winkler
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria
| | - Olaf Merkel
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Christoph Kornauth
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | | | | | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrea Hoelbl-Kovacic
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Jana Prochazkova
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Cosimo Lobello
- Central European Institute of Technology (CEITEC), Center of Molecular Medicine, Masaryk University, Brno, Czech Republic
| | - Abbarna A Cumaraswamy
- Department of Chemistry, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Johanna Latzka
- Karl Landsteiner Institute of Dermatological Research, St. Poelten, Austria and Department of Dermatology and Venereology, Karl Landsteiner University for Health Sciences, St. Poelten, Austria
| | - Melitta Kitzwögerer
- Department of Clinical Pathology, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Andreas Chott
- Institute of Pathology and Microbiology, Wilheminenspital, Vienna, Austria
| | - Andrea Janikova
- Department of Internal Medicine - Hematology and Oncology, Faculty of Medicine Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Šárka Pospíšilova
- Central European Institute of Technology (CEITEC), Center of Molecular Medicine, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, Faculty of Medicine Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Joanna I Loizou
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Thomas Kolbe
- Biomodels Austria, University of Veterinary Medicine Vienna, Vienna, Austria.,IFA-Tulln, University of Natural Resources and Applied Life Sciences, Tulln, Austria
| | - Florian Grebien
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Institute of Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Lukas Kenner
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria.,Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Patrick T Gunning
- Central European Institute of Technology (CEITEC), Center of Molecular Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Mathias Müller
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Thomas Rülicke
- Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Veronika Sexl
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria .,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria.,Medical University of Vienna, Vienna, Austria
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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]
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13
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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]
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Ta AD, Hsu LY, Conn HM, Winkler S, Greve AM, Shanbhag SM, Chen MY, Patricia Bandettini W, Arai AE. Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis. J Cardiovasc Magn Reson 2018; 20:16. [PMID: 29514708 PMCID: PMC5842542 DOI: 10.1186/s12968-018-0436-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion. METHODS Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50% diameter stenosis or computed tomographic coronary angiography (CTA) < 30% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level. RESULTS In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level. CONCLUSION Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.
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Affiliation(s)
- Allison D. Ta
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
- Duke University School of Medicine, Durham, North Carolina USA
| | - Li-Yueh Hsu
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Hannah M. Conn
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Susanne Winkler
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
- Medical University of Vienna, Vienna, Austria
| | - Anders M. Greve
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Sujata M. Shanbhag
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Marcus Y. Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - W. Patricia Bandettini
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Andrew E. Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
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Hsu LY, Jacobs M, Benovoy M, Ta AD, Conn HM, Winkler S, Greve AM, Chen MY, Shanbhag SM, Bandettini WP, Arai AE. Diagnostic Performance of Fully Automated Pixel-Wise Quantitative Myocardial Perfusion Imaging by Cardiovascular Magnetic Resonance. JACC Cardiovasc Imaging 2018; 11:697-707. [PMID: 29454767 PMCID: PMC8760891 DOI: 10.1016/j.jcmg.2018.01.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The authors developed a fully automated framework to quantify myocardial blood flow (MBF) from contrast-enhanced cardiac magnetic resonance (CMR) perfusion imaging and evaluated its diagnostic performance in patients. BACKGROUND Fully quantitative CMR perfusion pixel maps were previously validated with microsphere MBF measurements and showed potential in clinical applications, but the methods required laborious manual processes and were excessively time-consuming. METHODS CMR perfusion imaging was performed on 80 patients with known or suspected coronary artery disease (CAD) and 17 healthy volunteers. Significant CAD was defined by quantitative coronary angiography (QCA) as ≥70% stenosis. Nonsignificant CAD was defined by: 1) QCA as <70% stenosis; or 2) coronary computed tomography angiography as <30% stenosis and a calcium score of 0 in all vessels. Automatically generated MBF maps were compared with manual quantification on healthy volunteers. Diagnostic performance of the automated MBF pixel maps was analyzed on patients using absolute MBF, myocardial perfusion reserve (MPR), and relative measurements of MBF and MPR. RESULTS The correlation between automated and manual quantification was excellent (r = 0.96). Stress MBF and MPR in the ischemic zone were lower than those in the remote myocardium in patients with significant CAD (both p < 0.001). Stress MBF and MPR in the remote zone of the patients were lower than those in the normal volunteers (both p < 0.001). All quantitative metrics had good area under the curve (0.864 to 0.926), sensitivity (82.9% to 91.4%), and specificity (75.6% to 91.1%) on per-patient analysis. On a per-vessel analysis of the quantitative metrics, area under the curve (0.837 to 0.864), sensitivity (75.0% to 82.7%), and specificity (71.8% to 80.9%) were good. CONCLUSIONS Fully quantitative CMR MBF pixel maps can be generated automatically, and the results agree well with manual quantification. These methods can discriminate regional perfusion variations and have high diagnostic performance for detecting significant CAD. (Technical Development of Cardiovascular Magnetic Resonance Imaging; NCT00027170)
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Affiliation(s)
- Li-Yueh Hsu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Matthew Jacobs
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mitchel Benovoy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Allison D Ta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah M Conn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Susanne Winkler
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Anders M Greve
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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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]
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17
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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.
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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
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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.
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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
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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
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20
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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.
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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
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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.
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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
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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]
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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
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24
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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
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25
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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
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26
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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
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27
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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
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28
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Maurer B, Nivarthi H, Prchal-Murphy M, Wingelhofer B, Chen D, Winkler S, Prochazkova J, Schlederer M, Pham H, Loizou JI, Kenner L, Sexl V, Kolbe T, Kralovics R, Müller M, Rülicke T, Moriggl R. ID: 65. Cytokine 2015. [DOI: 10.1016/j.cyto.2015.08.095] [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: 11/28/2022]
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29
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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.
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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
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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
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31
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Miller CA, Hsu LY, Ta A, Conn H, Winkler S, Arai AE. Quantitative pixel-wise measurement of myocardial blood flow: the impact of surface coil-related field inhomogeneity and a comparison of methods for its correction. J Cardiovasc Magn Reson 2015; 17:11. [PMID: 25827156 PMCID: PMC4323126 DOI: 10.1186/s12968-015-0117-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/08/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Surface coil-related field inhomogeneity potentially confounds pixel-wise quantitative analysis of perfusion CMR images. This study assessed the effect of surface coil-related field inhomogeneity on the spatial variation of pixel-wise myocardial blood flow (MBF), and assessed its impact on the ability of MBF quantification to differentiate ischaemic from remote coronary territories. Two surface coil intensity correction (SCIC) techniques were evaluated: 1) a proton density-based technique (PD-SCIC) and; 2) a saturation recovery steady-state free precession-based technique (SSFP-SCIC). METHODS 26 subjects (18 with significant CAD and 8 healthy volunteers) underwent stress perfusion CMR using a motion-corrected, saturation recovery SSFP dual-sequence protocol. A proton density (PD)-weighted image was acquired at the beginning of the sequence. Surface coil-related field inhomogeneity was approximated using a third-order surface fit to the PD image or a pre-contrast saturation prepared SSFP image. The estimated intensity bias field was subsequently applied to the image series. Pixel-wise MBF was measured from mid-ventricular stress images using the two SCIC approaches and compared to measurements made without SCIC. RESULTS MBF heterogeneity in healthy volunteers was higher using SSFP-SCIC (24.8 ± 4.1%) compared to PD-SCIC (20.8 ± 3.0%; p = 0.009), however heterogeneity was significantly lower using either SCIC technique compared to analysis performed without SCIC (36.2 ± 6.3%). In CAD patients, the difference in MBF between remote and ischaemic territories was minimal when analysis was performed without SCIC (0.06 ± 0.91 mL/min/kg), and was substantially lower than with either PD-SCIC (0.50 ± 0.63 mL/min/kg; p = 0.013) or with SSFP-SCIC (0.63 ± 0.89 mL/min/kg; p = 0.005). In 6 patients, MBF quantified without SCIC was artifactually higher in the stenosed coronary territory compared to the remote territory. PD-SCIC and SSFP-SCIC had similar differences in MBF between remote and ischaemic territories (p = 0.145). CONCLUSIONS This study demonstrates that surface coil-related field inhomogeneity can confound pixel-wise MBF quantification. Whilst a PD-based SCIC led to a more homogenous correction than a saturation recovery SSFP-based technique, this did not result in an appreciable difference in the differentiation of ischaemic from remote coronary territories and thus either method could be applied.
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Affiliation(s)
- Christopher A Miller
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
| | - Li-Yueh Hsu
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
| | - Allison Ta
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
| | - Hannah Conn
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
| | - Susanne Winkler
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
| | - Andrew E Arai
- Department of Health and Human Services, Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061 USA
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32
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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.
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Affiliation(s)
- H-Robert Springorum
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Sjöwall C, Zapf J, von Löhneysen S, Magorivska I, Biermann M, Janko C, Winkler S, Bilyy R, Schett G, Herrmann M, Muñoz LE. Altered glycosylation of complexed native IgG molecules is associated with disease activity of systemic lupus erythematosus. Lupus 2014; 24:569-81. [PMID: 25389233 DOI: 10.1177/0961203314558861] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 07/16/2014] [Accepted: 10/03/2014] [Indexed: 12/18/2022]
Abstract
In addition to the redundancy of the receptors for the Fc portion of immunoglobulins, glycans result in potential ligands for a plethora of lectin receptors found in immune effector cells. Here we analysed the exposure of glycans containing fucosyl residues and the fucosylated tri-mannose N-type core by complexed native IgG in longitudinal serum samples of well-characterized patients with systemic lupus erythematosus. Consecutive serum samples of a cohort of 15 patients with systemic lupus erythematosus during periods of increased disease activity and remission were analysed. All patients fulfilled the 1982 American College of Rheumatology classification criteria. Sera of 15 sex- and age-matched normal healthy blood donors served as controls. The levels and type of glycosylation of complexed random IgG was measured with lectin enzyme-immunosorbent assays. After specifically gathering IgG complexes from sera, biotinylated lectins Aleuria aurantia lectin and Lens culinaris agglutinin were employed to detect IgG-associated fucosyl residues and the fucosylated tri-mannose N-glycan core, respectively. In sandwich-ELISAs, IgG-associated IgM, IgA, C1q, C3c and C-reactive protein (CRP) were detected as candidates for IgG immune complex constituents. We studied associations of the glycan of complexed IgG and disease activity according to the physician's global assessment of disease activity and the systemic lupus erythematosus disease activity index 2000 documented at the moment of blood taking. Our results showed significantly higher levels of Aleuria aurantia lectin and Lens culinaris agglutinin binding sites exposed on IgG complexes of patients with systemic lupus erythematosus than on those of normal healthy blood donors. Disease activity in systemic lupus erythematosus correlated with higher exposure of Aleuria aurantia lectin-reactive fucosyl residues by immobilized IgG complexes. Top levels of Aleuria aurantia lectin-reactivity were found in samples taken during the highest activity of systemic lupus erythematosus. Our results show that native circulating IgG complexes from active systemic lupus erythematosus patients expose fucosyl residues and their glycan core is accessible to soluble lectins. Two putative mechanisms may contribute to the increased exposure of these glycans: (1) the canonical N-glycosylation site of the IgG-CH2 domain; (2) an IgG binding non-IgG molecule, like complement or C-reactive protein. In both cases the complexed IgG may be alternatively targeted to lectin receptors of effector cells, e.g. dendritic cells.
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Affiliation(s)
- C Sjöwall
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - J Zapf
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - S von Löhneysen
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - I Magorivska
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - M Biermann
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - C Janko
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany Department of Otorhinolaryngology, Head and Neck Surgery, Section for Experimental Oncology and Nanomedicine (SEON), University Hospital Erlangen, Germany
| | - S Winkler
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - R Bilyy
- Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - G Schett
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - M Herrmann
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
| | - L E Muñoz
- Department for Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Germany
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Hildebrand U, Lex J, Taraz K, Winkler S, Ockels W, Budzikiewicz H. Untersuchungen zum Redox-System Bis-(pyridin-2,6-dicarbothioato)-ferrat(II) /-ferrat(III) [1]. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1984-1123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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 structure of the blue pigment obtained from the culture medium of Pseudomonas putida upon addition of Fe++ and the nature of its redox reactions has been elucidated.
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Affiliation(s)
- U. Hildebrand
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
| | - J. Lex
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
| | - K. Taraz
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
| | - S. Winkler
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
| | - W. Ockels
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
| | - H. Budzikiewicz
- Institut für Organische Chemie der Universität zu Köln, Greinstraße 4, D-5000 Köln 41, West-Germany
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Munch F, Retel J, Jeuthe S, van Rossum B, Oh-Ici D, Berger F, Kuhne T, Oschkinat H, Messroghli D, Rodriguez Palomares J, Gutierrez Garcia Moreno L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Barrabes J, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Barison A, Del Torto A, Chiappino S, Del Franco A, Pugliese N, Aquaro G, Positano V, Passino C, Emdin M, Masci P, Fischer K, Guensch D, Shie N, Friedrich M, Captur G, Zemrak F, Muthurangu V, Chunming L, Petersen S, Kawel-Boehm N, Bassett P, Elliott P, Lima J, Bluemke D, Moon J, Pontone G, Bertella E, Loguercio M, Baggiano A, Mushtaq S, Aquaro G, Salerni S, Rossi C, Andreini D, Masci P, Ucar E, Baydes R, Ngah N, Kuo Y, Dabir D, Cummins C, Higgins D, Schaeffter T, Gaddum N, Chowienczyk P, Carr-White G, Marber M, Ucar S, Baydes R, Ngah N, Kuo Y, Dabir D, Cummins C, Higgins D, Schaeffter T, Gaddum N, Chowienczyk P, Carr-White G, Marber M, Reinstadler S, Klug G, Feistritzer H, Greber K, Mair J, Schocke M, Franz W, Metzler B, Moschetti K, Petersen S, Pilz G, Wasserfallen J, Lombardi M, Korosoglou G, Van Rossum A, Bruder O, Mahrholdt H, Schwitter J, Rodriguez Palomares J, Garcia Del Blanco B, Ferreira Gonzalez I, Otaegui I, Pineda V, Ruiz Salmeron R, San Roman A, Evangelista A, Fernandez Aviles F, Garcia Dorado D, Winkler S, Allison T, Conn H, Bandettini P, Shanbhag S, Kellman P, Hsu L, Arai A, Klug G, Reinstadler S, Feistritzer H, Pernter B, Mair J, Schocke M, Franz W, Metzler B, Pica S, Sado D, Maestrini V, Fontana M, White S, Treibel T, Anderson S, Piechnik S, Robson M, Lachmann R, Murphy E, Mehta A, Hughes D, Elliott P, Moon J, Ferreira V, Dall'Armellina E, Piechnik S, Karamitsos T, Francis J, Choudhury R, Banning A, Channon K, Kharbanda R, Forfar C, Ormerod O, Prendergast B, Kardos A, Newton J, Friedrich M, Robson M, Neubauer S, Barison A, Del Franco A, Vergaro G, Mirizzi G, Del Torto A, Chiappino S, Masci P, Passino C, Emdin M, Aquaro G, Florian A, Ludwig A, Rosch S, Sechtem U, Yilmaz A, Greulich S, Kitterer D, Latus J, Bentz K, Birkmeier S, Alscher M, Sechtem U, Braun N, Mahrholdt H, Barison A, Pugliese N, Masci P, Del Franco A, Vergaro G, Del Torto A, Passino C, Perfetto F, Emdin M, Aquaro G, Secchi F, Petrini M, Cannao P, Di Leo G, Sardanelli F, Lombardi M, Yoshihara H, Bastiaansen J, Berthonneche C, Comment A, Schwitter J, Gerber B, Noppe G, Marquet N, Buchlin P, Vanoverschelde J, Bertrand L, Horman S, Dorota P, Piotr W, Marek G, Almeida A, Cortez-Dias N, de Sousa J, Carpinteiro L, Magalhaes A, Silva G, Bernardes A, Pinto F, Nunes Diogo A. These abstracts have been selected for presentation in 4 sessions throughout the meeting. Please refer to the PROGRAM for more details. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Renkawitz T, Winkler S, Weber M, von Kunow F, Grifka J, Baier C. [Update on navigation in total knee arthroplasty. Where are we today and what lies in the future?]. Orthopade 2014; 43:448-54. [PMID: 24718607 DOI: 10.1007/s00132-013-2193-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The implantation of an artificial knee is one of the most common operative interventions in German hospitals. Navigation procedures have developed into an integral component of such interventions in the operating theatres of many clinics. METHODS For orthopedic surgeons who want to implement an as exact as possible reconstruction of the mechanical leg axis and require intraoperative control of the three dimensional positioning of components and/or the capsular ligament situation, navigation is a well-proven intraoperative tool. The immediate intraoperative control possibility of bone resection and capsular ligament soft tissue balancing means that navigation is a valuable instrument for the biomechanical fundamental understanding in training operations for further education of orthopedic surgeons in training. DEVELOPMENTS The greater precision obtained by the implementation of the procedure has not yet been conclusively reflected in an improved postoperative knee function or an increased durability of prostheses. New developments in navigated knee prostheses are pinless navigation and navigation kinematics. In pinless navigation the conventional reference marker system fixed in the femur and shin bones is replaced by a non-invasive reference system. With the aid of navigation kinematics it is possible to image the tibiofemoral and patellofemoral movement dynamics, intraoperatively. PERSPECTIVE The aim of the next generation navigation systems for computer-assisted knee prosthetics is implant positioning aligned to the individual anatomy of patients with high and stable range of movement for optimum patellar guidance and kinematics of the artificial joint.
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Affiliation(s)
- T Renkawitz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Prescher S, Deckwart O, Koehler K, Lücke S, Schieber M, Wellge B, Winkler S, Baumann G, Koehler F. [Will telemonitoring be adopted by patients with chronic heart failure?]. Dtsch Med Wochenschr 2014; 139:829-34. [PMID: 24722932 DOI: 10.1055/s-0034-1369849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Remote Patient Management for chronic heart failure (CHF) is gaining increasing importance in health care. Telemonitoring is defined as daily measuring of health parameters by the patient and their transmission to a telemedical centre. The adherence of this action by the patient can be considered as a measure for RPM adoption. METHODS The randomized controlled clinical trial TIM-HF (NCT 00543881) was conducted between 2008 and 2010 with 710 CHF patients with the primary endpoint total mortality for a mean follow-up of 21.5 ± 7.2 months. The non-prespecified analysis of adherence to daily measuring of ECG, blood pressure, weight and self-assessment was focused on sociodemographic and disease-related factors of the 354 RPM patients. RESULTS The mean adherence to telemonitoring was more than 80% (absolute adherence: 81.8 ± 22.8%, relative adherence: 88.9 ± 21.5%). From the beginning of treatment 6.5% of the patients (23/354) have shown an adherence below average. The high adherence of the majority of the patients was stable for the entire study duration and irrespective of age, sex, severity of the disease and the presence of mild to moderate depression. CONCLUSION A high adherence can be achieved by individual training of the patient regarding the handling of his disease, the use of telemedical devices and an easy-to-use telemonitoring system. The majority of the informed self-determined CHF patients NYHA class II/III are adopting telemonitoring and are adherent in the long term.
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Affiliation(s)
- S Prescher
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - O Deckwart
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - K Koehler
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - S Lücke
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - M Schieber
- Kardiologische Gemeinschaftspraxis Stuttgart-Feuerbach, Stuttgart
| | - B Wellge
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - S Winkler
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin/ Kardiologie, Berlin
| | - G Baumann
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
| | - F Koehler
- Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin
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Winkler S, Davies P, Janoschek J. High-temperature dilatometer with pyrometer measuring system and rate-controlled sintering capability. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/bf02546859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brückner S, Tautenhahn HM, Winkler S, Stock P, Jonas S, Dollinger M, Christ B. Isolation and hepatocyte differentiation of mesenchymal stem cells from porcine bone marrow--"surgical waste" as a novel MSC source. Transplant Proc 2014; 45:2056-8. [PMID: 23769107 DOI: 10.1016/j.transproceed.2013.01.101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/15/2013] [Accepted: 01/31/2013] [Indexed: 12/17/2022]
Abstract
Mesenchymal stem cells (MSC) isolated from bone marrow and differentiated into hepatocyte-like cells have increasingly gained attention for clinical cell therapy of liver diseases because of their high regenerative capacity. They are available from bone marrow aspirates of the os coxae after puncture of the crista iliaca or from bone marrow "surgical waste" gained from amputations or knee and hip operations. Thus, the aim of the study was to demonstrate whether these pBM-MSC (porcine bone marrow-derived mesenchymal stem cells) displayed mesenchymal features and hepatocyte differentiation potential. MSC were isolated either from crista iliaca punctures or after sampling and collagenase digestion of bone marrow from the os femoris. Mesenchymal features were assessed by flow cytometry for specific surface antigens and their ability to differentiate into at least 3 lineages. Functional properties, such as urea or glycogen synthesis and cytochrome P450 activity, as well as the cell morphology were examined during hepatocyte differentiation. pBM-MSC from both sources lacked the hematopoietic markers CD14 and CD45 but expressed the typical mesenchymal markers CD44, CD29, CD90, and CD105. Both cell types could differentiate into adipocyte, osteocyte, and hepatocyte lineages. After hepatocyte differentiation, CD105 expression decreased significantly and cells changed morphology from fibroblastoid into polygonal, displaying significantly increased glycogen storage, urea synthesis, and cytochrome activity. pBM-MSC from various sources were identical in respect to their mesenchymal features and their hepatocyte differentiation potential. Hence, long bones might be a particularly useful resource to isolate bone marrow mesenchymal stem cells for transplantation.
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Affiliation(s)
- S Brückner
- University Hospital Leipzig, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig, Germany
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Conn H, Hsu LY, Winkler S, Ta AD, Nguyen KL, Kellman P, Shanbhag SM, Chen MY, Bandettini WP, Arai AE. Interobserver reproducibility of fully quantitative pixel-wise analysis of clinical CMR perfusion imaging. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044910 DOI: 10.1186/1532-429x-16-s1-p350] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Winkelbauer A, Fuiko R, Krampe J, Winkler S. Crucial elements and technical implementation of intelligent monitoring networks. Water Sci Technol 2014; 70:1926-1933. [PMID: 25521126 DOI: 10.2166/wst.2014.415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Growing complexity of water monitoring instrumentation leads to specialized solutions in respect to sensor integration across several measurement device suppliers. Despite efforts of standardization for data interfaces and protocols, problems regarding the combination of several devices to gain the complete picture in terms of water quality remain. This assessment, especially accomplished from the perspective of a catchment area, requires a transition from sole use of data collectors toward an implementation of intelligent measurement networks. Several challenges and bottlenecks concerning distributed data collection are discussed starting with data acquisition up to the user-scope of utilizing data processing software. Finally, experiences using automated data inspection and export tools are discussed and a brief overview of expectable long-term data availability is given.
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Affiliation(s)
- A Winkelbauer
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - R Fuiko
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - J Krampe
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - S Winkler
- HACH LANGE GMBH, Hütteldorfer Straße 299/Top 6, A-1140 Wien, Austria
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Ta AD, Hsu LY, Miller CA, Conn H, Winkler S, Kellman P, Nguyen KL, Shanbhag SM. Impact of errors in determining the start of myocardial enhancement during quantitative first pass perfusion cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044143 DOI: 10.1186/1532-429x-16-s1-p367] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ta AD, Hsu LY, Miller CA, Greve AM, Conn H, Winkler S, Kellman P, Nguyen KL, Shanbhag SM, Chen MY, Bandettini WP, Arai AE. Feasibility and preliminary diagnostic results of pixel-wise quantification of regadenoson first pass cardiac magnetic resonance perfusion imaging. J Cardiovasc Magn Reson 2014. [PMCID: PMC4042605 DOI: 10.1186/1532-429x-16-s1-p214] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Miller CA, Hsu LY, Ta AD, Conn H, Winkler S, Arai AE. Quantitative pixel-wise measurement of myocardial blood flow: a comparison of methods to correct for surface coil-related field inhomogeneity. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043519 DOI: 10.1186/1532-429x-16-s1-p364] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bandettini WP, Hsu LY, Conn H, Winkler S, Greve AM, Kellman P, Booker OJ, Vasu S, Shanbhag SM, Chen MY, Arai AE. In the absence of obstructive coronary artery disease, patients with class II and III obesity have decreased myocardial perfusion reserve. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044326 DOI: 10.1186/1532-429x-16-s1-p256] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lidzba K, Konietzko A, Schwilling E, Krägeloh-Mann I, Winkler S. Processing of non-canonical word-order: a case-series on lesion-induced reorganized language and age-effects in typical development. Brain Lang 2013; 127:377-387. [PMID: 24267487 DOI: 10.1016/j.bandl.2013.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/07/2013] [Accepted: 10/19/2013] [Indexed: 06/02/2023]
Abstract
Complex grammatical structures are mastered late in language acquisition. We studied age-effects on performance in object topicalization in 48 typically developing German-speaking participants (aged 8-30years) and in five patients (children and adolescents) with lesion-induced atypical language representation. Production was tested by a sentence repetition task, comprehension by an acting out task. Three topicalized conditions with differing disambiguation (agreement, case, and case plus agreement) were contrasted with canonical control sentences. Children's (aged 8-13years) performance was significantly below that of adolescents and adults in all topicalized conditions. All participants made most mistakes in the agreement condition. Patients showed remarkable difficulties as compared with age-appropriate control groups in all topicalization conditions and across age-groups. Despite the small sample size, the consistency of these difficulties might hint to the importance of an intact typical neural language substrate for processing complex grammatical structures even in very early brain lesions.
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Affiliation(s)
- Karen Lidzba
- University of Tübingen, Collaborative Research Center 833, Nauklerstr. 35, 72074 Tübingen, Germany; University Children's Hospital, Dept. Pediatric Neurology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
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Lidzba K, Winkler S, Krägeloh-Mann I. The neural and linguistic basis of language development. Brain Lang 2013; 127:343-344. [PMID: 24148145 DOI: 10.1016/j.bandl.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
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Hu X, Ackermann H, Martin JA, Erb M, Winkler S, Reiterer SM. Language aptitude for pronunciation in advanced second language (L2) learners: behavioural predictors and neural substrates. Brain Lang 2013; 127:366-376. [PMID: 23273501 DOI: 10.1016/j.bandl.2012.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/22/2012] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
Individual differences in second language (L2) aptitude have been assumed to depend upon a variety of cognitive and personality factors. Especially, the cognitive factor phonological working memory has been conceptualised as language learning device. However, strong associations between phonological working memory and L2 aptitude have been previously found in early-stage learners only, not in advanced learners. The current study aimed at investigating the behavioural and neurobiological predictors of advanced L2 learning. Our behavioural results showed that phonetic coding ability and empathy, but not phonological working memory, predict L2 pronunciation aptitude in advanced learners. Second, functional neuroimaging revealed this behavioural trait to be correlated with hemodynamic responses of the cerebral network of speech motor control and auditory-perceptual areas. We suggest that the acquisition of L2 pronunciation aptitude is a dynamic process, requiring a variety of neural resources at different processing stages over time.
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Affiliation(s)
- Xiaochen Hu
- Research Group Neurophonetics, Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; MR Research Group, Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Germany; Department of Psychiatry and Psychotherapy, University of Bonn, Germany.
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Hermsdorf A, Pessler F, Luksch H, Winkler S, Naumann R, Roesler J, Roers A, Rösen-Wolff A. PW03-024 - A transgenic mouse model for variant procaspase-1. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953107 DOI: 10.1186/1546-0096-11-s1-a250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Hermsdorf
- Department of Pediatrics, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - F Pessler
- TWINCORE Center for Clinical and Experimental Infection Research, Hannover, Germany
| | - H Luksch
- Department of Pediatrics, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - S Winkler
- Department of Pediatrics, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Naumann
- Max Planck Institute of Molecular Cell Biology and Genetics, Germany
| | - J Roesler
- Department of Pediatrics, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - A Roers
- Insitute of Immunology, TU Dresden, Dresden, Germany
| | - A Rösen-Wolff
- Department of Pediatrics, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
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Heymann M, Winkler S, Özen S, Yilmaz E, Kallinich T, Rösen-Wolff A, Roesler J, Hofmann S. PW03-025 - Procaspase-1 contributes to inflammation via NF-KB. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952740 DOI: 10.1186/1546-0096-11-s1-a251] [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: 11/12/2022] Open
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