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Malsy M, Graf B, Bruendl E, Maier-Stocker C, Bundscherer A. Effect of NFATc2- and Sp1-mediated TNFalpha Regulation on the Proliferation and Migration Behavior of Pancreatic Cancer Cells. Cancer Genomics Proteomics 2023; 20:706-711. [PMID: 38035702 PMCID: PMC10687727 DOI: 10.21873/cgp.20417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND/AIM One in two people will develop a tumor during their lifetime. Adenocarcinoma of the pancreas is one of the most aggressive types of cancer in humans with very poor long-term survival. A central role in the carcinogenesis of pancreatic cancer has been attributed to NFAT transcription factors. Previous studies have identified the transcription factor Sp1 as a binding partner of NFATc2 in pancreatic cancer. Using expression profile analysis, our group was able to identify the tumor necrosis factor TNFalpha as a target gene of the interaction between NFATc2 and Sp1. The present study investigated the effect of TNFalpha over-expression via the transcription factors NFATc2 and Sp1 on the pancreatic cancer cell lines PaTu 8988t and PANC-1. MATERIALS AND METHODS Transient transfection of NFATc2, Sp1, and TNFalpha siRNAs and their effects on the expression were investigated with immunoblot. Cell proliferation was measured with the ELISA BrdU assay. Cell migration was assayed with a Cell Migration Assay Kit using a Boyden chamber. RESULTS Inhibition of the transfection factors NFATc2, Sp1, or TNFalpha by siRNA significantly inhibited proliferation, which was exacerbated when using the combination of NFATc2 and Sp1. TNFalpha was able to counterbalance this effect. In contrast to proliferation, migration of pancreatic cancer cells was increased by inhibiting these transfection factors. CONCLUSION Tumor progression is strongly influenced by transcriptional changes in signaling cascades and oncogene mutations as well as by changes in tumor suppressor genes. Further studies are needed to understand the underlying mechanisms of these processes.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center, Regensburg, Germany;
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center, Regensburg, Germany
| | - Elisabeth Bruendl
- Department of Neurosurgery, University Medical Center, Regensburg, Germany
| | | | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center, Regensburg, Germany
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Malsy M, Graf B, Bruendl E, Maier-Stocker C, Bundscherer A. Over-expression of cFos by the Transcription Factors NFATc2 and Sp1 in Pancreatic Cancer Cells. Anticancer Res 2023; 43:4897-4904. [PMID: 37909980 DOI: 10.21873/anticanres.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM The transcription factors NFATc2 and Sp1 play a key role in the progression of pancreatic cancer because they interact inside the cells and exert their carcinogenic effect through transcriptional modification. Drugs can also induce a variety of oncogenic signalling cascades. The risk of tumour progression and metastasis seems to be significantly increased in the perioperative period. Our research group has previously demonstrated the function of the interaction between NFATc2 and Sp1 in pancreatic cancer and has identified the proto-oncogene cFos as a target gene. We also found that the anaesthetic drug propofol has anti-tumour properties. The aim of the present study was to investigate the effect of propofol on the expression of the transcription factors NFATc2, Sp1 and cFos in the pancreatic cancer cell lines PaTu 8988t and PANC-1 and to analyse the relevance of this effect for the cells. MATERIALS AND METHODS Stimulation with propofol and its effects on the expression of NFATc2, Sp1 and cFos were assessed by immunoblot. Cell cycle distribution was analysed by flow cytometry, and cell proliferation was measured with the ELISA BrdU assay. Propofol and siRNA against cFos were used for stimulation. RESULTS Propofol regulated the expression of NFATc2, Sp1 and cFos. Stimulation with 250 µM or 500 µM propofol decreased NFATc2, Sp1 and cFos signalling in the Western blot analysis. At the same time, propofol significantly inhibited proliferation and activated cell cycle. The same proliferation behaviour was observed after transient cFos inhibition. These effects were potentiated by simultaneous stimulation with propofol and transient inhibition of cFos, further inhibiting cell proliferation. Interestingly, the cell cycle activation observed after stimulation with propofol alone was reversed in both cell lines. CONCLUSION Anaesthetists only see oncological patients in a short time window. However, the perioperative period is increasingly recognised as a very vulnerable time with a major impact on tumour progression. Further studies are needed to identify the underlying mechanisms and to verify their clinical relevance, especially in anaesthesia.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany;
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Elisabeth Bruendl
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
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Wiest C, Philipp A, Lunz D, Steinmann JF, Eissnert C, Kees M, Kieninger M, Dienemann T, Ritzka M, Schweinger S, Pross A, Fisser C, Malfertheiner MV, Schneckenpointner R, Lange TJ, Schulz C, Geismann F, Foltan M, Schettler F, Salzberger B, Hitzenbichler F, Hanses F, Schmidt B, Arzt M, Sinner B, Graf B, Maier LS, Müller T, Lubnow M. The Long-Term Support of COVID-19 Patients With Veno-Venous Extracorporeal Membrane Oxygenation. Dtsch Arztebl Int 2023; 120:56-57. [PMID: 36949640 DOI: 10.3238/arztebl.m2022.0354] [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] [Received: 07/11/2022] [Revised: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
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Kieninger B, Kilger M, Foltan M, Gruber M, Lunz D, Dienemann T, Schmid S, Graf B, Wiest C, Lubnow M, Müller T, Salzberger B, Schneider-Brachert W, Kieninger M. Prognostic factors for favorable outcomes after veno-venous extracorporeal membrane oxygenation in critical care patients with COVID-19. PLoS One 2023; 18:e0280502. [PMID: 36662898 PMCID: PMC9858373 DOI: 10.1371/journal.pone.0280502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients with COVID-19 and severe acute respiratory failure may require veno-venous extracorporeal membrane oxygenation (VV ECMO). Yet, this procedure is resource-intensive and high mortality rates have been reported. Thus, predictors for identifying patients who will benefit from VV ECMO would be helpful. METHODS This retrospective study included 129 patients with COVID-19 and severe acute respiratory failure, who had received VV ECMO at the University Medical Center Regensburg, Germany, between 1 March 2020 and 31 December 2021. Patient-specific factors and relevant intensive-care parameters at the time of the decision to start VV ECMO were investigated regarding their value as predictors of patient survival. In addition, the intensive-care course of the first 10 days of VV ECMO was compared between survivors and patients who had died in the intensive care unit. RESULTS The most important parameters for predicting outcome were patient age and platelet count, which differed significantly between survivors and non-survivors (age: 52.6±8.1 vs. 57.4±10.1 years, p<0.001; platelet count before VV ECMO: 321.3±132.2 vs. 262.0±121.0 /nL, p = 0.006; average on day 10: 199.2±88.0 vs. 147.1±57.9 /nL, p = 0.002). A linear regression model derived from parameters collected before the start of VV ECMO only included age and platelet count. Patients were divided into two groups by using receiver operating characteristics (ROC) analysis: group 1: 78% of patients, mortality 26%; group 2: 22% of patients, mortality 75%. A second linear regression model included average blood pH, minimum paO2, and average pump flow on day 10 of VV ECMO in addition to age and platelet count. The ROC curve resulted in two cut-off values and thus in three groups: group 1: 25% of patients, mortality 93%; group 2: 45% of patients, mortality 31%; group 3: 30% of patients, mortality 0%.
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Affiliation(s)
- Bärbel Kieninger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Magdalena Kilger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiac, Thoracic and Cardiovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Dienemann
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Clemens Wiest
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
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Buder F, Bauswein M, Magnus CL, Audebert F, Lang H, Kundel C, Distler K, Reuschel E, Lubnow M, Müller T, Lunz D, Graf B, Schmid S, Müller M, Poeck H, Hanses F, Salzberger B, Peterhoff D, Wenzel JJ, Schmidt B, Lampl BMJ. Correction to: Contribution of High Viral Loads, Detection of Viral Antigen and Seroconversion to Severe Acute Respiratory Syndrome Coronavirus 2 Infectivity. J Infect Dis 2022; 227:605. [PMID: 35869700 PMCID: PMC9384479 DOI: 10.1093/infdis/jiac123] [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: 11/25/2022] Open
Affiliation(s)
- Felix Buder
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Markus Bauswein
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Clara L Magnus
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | | | | | - Christof Kundel
- Medizinische Klinik 1, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Karin Distler
- Medizinische Klinik 1, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Edith Reuschel
- University Department of Obstetrics and Gynecology at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany,Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany,Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Benedikt M J Lampl
- Correspondence: Benedikt M. J. Lampl, Public Health Department Regensburg, Altmühlstraße 3, 93059 Regensburg, Germany ()
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Kieninger M, Dietl S, Sinning A, Gruber M, Gronwald W, Zeman F, Lunz D, Dienemann T, Schmid S, Graf B, Lubnow M, Müller T, Holzmann T, Salzberger B, Kieninger B. Evaluation of models for prognosing mortality in critical care patients with COVID-19: First- and second-wave data from a German university hospital. PLoS One 2022; 17:e0268734. [PMID: 35617276 PMCID: PMC9135305 DOI: 10.1371/journal.pone.0268734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background In a previous study, we had investigated the intensive care course of patients with coronavirus disease 2019 (COVID-19) in the first wave in Germany by calculating models for prognosticating in-hospital death with univariable and multivariable regression analysis. This study analyzed if these models were also applicable to patients with COVID-19 in the second wave. Methods This retrospective cohort study included 98 critical care patients with COVID-19, who had been treated at the University Medical Center Regensburg, Germany, between October 2020 and February 2021. Data collected for each patient included vital signs, dosage of catecholamines, analgosedation, anticoagulation, and antithrombotic medication, diagnostic blood tests, treatment with extracorporeal membrane oxygenation (ECMO), intensive care scores, ventilator therapy, and pulmonary gas exchange. Using these data, expected mortality was calculated by means of the originally developed mathematical models, thereby testing the models for their applicability to patients in the second wave. Results Mortality in the second-wave cohort did not significantly differ from that in the first-wave cohort (41.8% vs. 32.2%, p = 0.151). As in our previous study, individual parameters such as pH of blood or mean arterial pressure (MAP) differed significantly between survivors and non-survivors. In contrast to our previous study, however, survivors and non-survivors in this study showed significant or even highly significant differences in pulmonary gas exchange and ventilator therapy (e.g. mean and minimum values for oxygen saturation and partial pressure of oxygen, mean values for the fraction of inspired oxygen, positive expiratory pressure, tidal volume, and oxygenation ratio). ECMO therapy was more frequently administered than in the first-wave cohort. Calculations of expected mortality by means of the originally developed univariable and multivariable models showed that the use of simple cut-off values for pH, MAP, troponin, or combinations of these parameters resulted in correctly estimated outcome in approximately 75% of patients without ECMO therapy.
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Affiliation(s)
- Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
- * E-mail:
| | - Sarah Dietl
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Annemarie Sinning
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Wolfram Gronwald
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Dienemann
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Holzmann
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Bärbel Kieninger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
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7
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Malsy M, Hackl C, Graf B, Bitzinger D, Bundscherer A. The Effects of Analgesics on the Migration of Pancreatic Cancer Cells. In Vivo 2022; 36:576-581. [PMID: 35241509 DOI: 10.21873/invivo.12740] [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: 12/11/2021] [Revised: 01/16/2022] [Accepted: 02/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Adenocarcinoma of the pancreas is one of the most aggressive malignant diseases in humans. Characteristics of this tumour type are poor response to radiotherapy and chemotherapeutic agents as well as metastasis in the absence of an organ capsule. The best therapeutic option is surgical removal of the tumour followed by chemotherapy or radiotherapy. Yet, even after surgical R0-resection, the 5-year survival probability is only about 20% because of the high recurrence rate of this tumour and complications due to metastases. Furthermore, recent studies have shown that the perioperative period is a particularly vulnerable phase, during which tumour progression and metastasis may be facilitated. The effects of analgesics administered during the perioperative period are still unknown. The present work investigated the effects of analgesics on pancreatic cancer cell migration in vitro. MATERIALS AND METHODS The migratory potential of pancreatic cancer cells was analysed using a Cell Migration Assay Kit with a Boyden chamber, in which cells migrate through a semi-permeable membrane under different stimuli. Cell concentration was measured by reading fluorescence (Ex/Em=530/590 nm) in a plate reader. RESULTS Migration in PANC-1 pancreatic cancer cells was significantly decreased after 24 h stimulation with 100 μM of ropivacaine, 100 nM of sufentanil, 1,000 μM of ropivacaine and 1,000 nM of sufentanil. In the PaTu 8988t cell line, incubation with 10 μM of ropivacaine caused a slight but statistically significant increase in migration, whereas lidocaine, metamizole and paracetamol did not significantly affect migration. CONCLUSION The risk of tumour progression and metastasis seems to be increased during major oncological surgical interventions. The recent advances in the molecular and biological understanding of pathogenesis of pancreatic cancer have not yet significantly improved patient outcome. Therefore, further studies are needed to identify the underlying mechanisms of this aggressive tumour and establish new therapeutic options for the future.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany;
| | - Christina Hackl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
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Malsy M, Hofer V, Schmidbauer S, Graf B, Bundscherer A. Effects of Ketamine, S-Ketamine and MK 801 on Integrin Beta-3-mediated Cell Migration in Pancreatic Carcinoma. J Cancer Sci Clin Ther 2022; 6:446-451. [PMID: 36777697 PMCID: PMC9910313 DOI: 10.26502/jcsct.5079183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Pancreatic ductal adenocarcinoma is one of the most aggressive malignancies in humans. The main reason for its unfavourable prognosis is the combination of rapid tumour growth, early-onset metastasis and currently still inadequate diagnostic and therapeutic options. Thus, only very few patients are eligible for radical resection of the primary tumour as the only curative treatment option available so far. In the perioperative period, tumour progression and metastasis are facilitated by the activation of key signalling pathways and the altered regulation of transcription factors. Various tumour entities have shown increased expression of the integrin-3 receptor subunit, which correlates with more rapid tumour progression and metastasis through advanced migration, invasion and proliferation. The influence of perioperative medication and postoperative pain management remains unclear. To investigate the effects of ketamine, s-ketamine and MK 801 on integrin beta-3-mediated cell migration in pancreatic cancer cells in vitro. Methods The effects of ketamine, s-ketamine and MK 801 on integrin beta-3 expression were investigated with immunoblot. Cell migratory potentials were analysed using a Cell Migration Assay Kit with a Boyden chamber, in which cells migrate through a semipermeable membrane under different stimuli. Results Stimulation with ketamine and MK 801 significantly promoted migration in pancreatic cancer cells, increasing the expression of integrin beta-3. Conclusion Novel therapeutic approaches target the effective modulation of specific signalling and transcription pathways. The prerequisite for such 'target therapies' is comprehensive knowledge about the respective carcinogenesis. Further studies are required to identify the underlying disease mechanisms of pancreatic carcinoma.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Veronika Hofer
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | | | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Germany
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9
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Siska PJ, Decking SM, Babl N, Matos C, Bruss C, Singer K, Klitzke J, Schön M, Simeth J, Köstler J, Siegmund H, Ugele I, Paulus M, Dietl A, Kolodova K, Steines L, Freitag K, Peuker A, Schönhammer G, Raithel J, Graf B, Geismann F, Lubnow M, Mack M, Hau P, Bohr C, Burkhardt R, Gessner A, Salzberger B, Wagner R, Hanses F, Hitzenbichler F, Heudobler D, Lüke F, Pukrop T, Herr W, Wolff D, Spang R, Poeck H, Hoffmann P, Jantsch J, Brochhausen C, Lunz D, Rehli M, Kreutz M, Renner K. Metabolic imbalance of T cells in COVID-19 is hallmarked by basigin and mitigated by dexamethasone. J Clin Invest 2021; 131:148225. [PMID: 34779418 DOI: 10.1172/jci148225] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 02/01/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Metabolic pathways regulate immune responses and disrupted metabolism leads to immune dysfunction and disease. Coronavirus disease 2019 (COVID-19) is driven by imbalanced immune responses, yet the role of immunometabolism in COVID-19 pathogenesis remains unclear. By investigating 87 patients with confirmed SARS-CoV-2 infection, 6 critically ill non-COVID-19 patients, and 47 uninfected controls, we found an immunometabolic dysregulation in patients with progressed COVID-19. Specifically, T cells, monocytes, and granulocytes exhibited increased mitochondrial mass, yet only T cells accumulated intracellular reactive oxygen species (ROS), were metabolically quiescent, and showed a disrupted mitochondrial architecture. During recovery, T cell ROS decreased to match the uninfected controls. Transcriptionally, T cells from severe/critical COVID-19 patients showed an induction of ROS-responsive genes as well as genes related to mitochondrial function and the basigin network. Basigin (CD147) ligands cyclophilin A and the SARS-CoV-2 spike protein triggered ROS production in T cells in vitro. In line with this, only PCR-positive patients showed increased ROS levels. Dexamethasone treatment resulted in a downregulation of ROS in vitro and T cells from dexamethasone-treated patients exhibited low ROS and basigin levels. This was reflected by changes in the transcriptional landscape. Our findings provide evidence of an immunometabolic dysregulation in COVID-19 that can be mitigated by dexamethasone treatment.
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Affiliation(s)
- Peter J Siska
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Sonja-Maria Decking
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Nathalie Babl
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Carina Matos
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Christina Bruss
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Katrin Singer
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg
| | - Jana Klitzke
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Marian Schön
- Department of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Jakob Simeth
- Department of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Josef Köstler
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Heiko Siegmund
- Institute of Pathology, University of Regensburg, Regensburg, Germany.,Central Biobank Regensburg, University Hospital and University of Regensburg, Regensburg, Germany
| | - Ines Ugele
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg
| | | | | | - Kristina Kolodova
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | | | - Katharina Freitag
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Alice Peuker
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Gabriele Schönhammer
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Johanna Raithel
- Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | | | | | | | | | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg
| | | | - Andre Gessner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | | | - Ralf Wagner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Department of Infection Prevention and Infectious Diseases, and.,Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | | | - Daniel Heudobler
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Bavarian Cancer Research Center, Regensburg, Germany
| | - Florian Lüke
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Bavarian Cancer Research Center, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Rainer Spang
- Department of Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Petra Hoffmann
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University of Regensburg, Regensburg, Germany.,Central Biobank Regensburg, University Hospital and University of Regensburg, Regensburg, Germany
| | | | - Michael Rehli
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Marina Kreutz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - Kathrin Renner
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
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10
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Petermichl W, Philipp A, Hiller KA, Foltan M, Floerchinger B, Graf B, Lunz D. Reliability of prognostic biomarkers after prehospital extracorporeal cardiopulmonary resuscitation with target temperature management. Scand J Trauma Resusc Emerg Med 2021; 29:147. [PMID: 34627354 PMCID: PMC8502408 DOI: 10.1186/s13049-021-00961-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Extracorporeal cardiopulmonary resuscitation (ECPR) performed at the emergency scene in out-of-hospital cardiac arrest (OHCA) can minimize low-flow time. Target temperature management (TTM) after cardiac arrest can improve neurological outcome. A combination of ECPR and TTM, both implemented as soon as possible on scene, appears to have promising results in OHCA. To date, it is still unknown whether the implementation of TTM and ECPR on scene affects the time course and value of neurological biomarkers. Methods 69 ECPR patients were examined in this study. Blood samples were collected between 1 and 72 h after ECPR and analyzed for S100, neuron-specific enolase (NSE), lactate, D-dimers and interleukin 6 (IL6). Cerebral performance category (CPC) scores were used to assess neurological outcome after ECPR upon hospital discharge. Resuscitation data were extracted from the Regensburg extracorporeal membrane oxygenation database and all data were analyzed by a statistician. The data were analyzed using non-parametric methods. Diagnostic accuracy of biomarkers was determined by area under the curve (AUC) analysis. Results were compared to the relevant literature. Results Non-hypoxic origin of cardiac arrest, manual chest compression until ECPR, a short low-flow time until ECPR initiation, low body mass index (BMI) and only a minimal need of extra-corporeal membrane oxygenation support were associated with a good neurological outcome after ECPR. Survivors with good neurological outcome had significantly lower lactate, IL6, D-dimer, and NSE values and demonstrated a rapid decrease in the initial S100 value compared to non-survivors. Conclusions A short low-flow time until ECPR initiation is important for a good neurological outcome. Hypoxia-induced cardiac arrest has a high mortality rate even when ECPR and TTM are performed at the emergency scene. ECPR patients with a higher BMI had a worse neurological outcome than patients with a normal BMI. The prognostic biomarkers S100, NSE, lactate, D-dimers and IL6 were reliable indicators of neurological outcome when ECPR and TTM were performed at the emergency scene.
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Affiliation(s)
- Walter Petermichl
- Department of Anaesthesiology, University Hospital Regensburg, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Karl-Anton Hiller
- Department of Operative Dentistry and Periodontology, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernhard Floerchinger
- Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernhard Graf
- Department of Anaesthesiology, University Hospital Regensburg, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Dirk Lunz
- Department of Anaesthesiology, University Hospital Regensburg, University of Regensburg Medical Center, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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11
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Kieninger M, Meichelböck K, Bele S, Bründl E, Graf B, Schmidt NO, Schebesch KM. Brain multimodality monitoring in patients suffering from acute aneurysmal subarachnoid hemorrhage: clinical value and complications. J Integr Neurosci 2021; 20:703-710. [PMID: 34645104 DOI: 10.31083/j.jin2003075] [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: 04/17/2021] [Revised: 05/20/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022] Open
Abstract
Brain multimodality monitoring measuring brain tissue oxygen pressure, cerebral blood flow, and cerebral near-infrared spectroscopy may help optimize the neurocritical care of patients with aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia. We retrospectively looked for complications associated with the placement of the probes and checked the reliability of the different tools used for multimodality monitoring. In addition, we screened for therapeutic measures derived in cases of pathological values in multimodality monitoring in 26 patients with acute aneurysmal subarachnoid hemorrhage. Computed tomography scans showed minor hemorrhage along with the probes in 12 patients (46.2%). Missing transmission of values was observed in 34.1% of the intended time of measurement for cerebral blood flow probes and 15.5% and 16.2%, respectively, for the two kinds of probes measuring brain tissue oxygen pressure. We identified 744 cumulative alarming values transmitted from multimodality monitoring. The most frequent intervention was modifying minute ventilation (29%). Less frequent interventions were escalating the norepinephrine dosage (19.9%), elevating cerebral perfusion pressure (14.9%) or inspiratory fraction of inspired oxygen (7.5%), transfusing red blood cell concentrates (1.2%), initiating further diagnostics (2.3%) and neurosurgical interventions (1.9%). As well, 355 cases of pathological values had no therapeutic consequence. The reliability of the measuring tools for multimodality monitoring regarding a continuous transmission of values must be improved, particularly for cerebral blood flow monitoring. The overall high rate of missing therapeutic responses to pathological values derived from multimodality monitoring in patients with aneurysmal subarachnoid hemorrhage underlines the need for structured tiered algorithms. In addition, such algorithms are the basic requirement for prospective multicenter studies, which are urgently needed to evaluate the role of multimodality monitoring in treating these patients.
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Affiliation(s)
- Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Katharina Meichelböck
- Department of Anesthesiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany
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12
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Kieninger M, Sinning A, Vadász T, Gruber M, Gronwald W, Zeman F, Lunz D, Dienemann T, Schmid S, Graf B, Lubnow M, Müller T, Holzmann T, Salzberger B, Kieninger B. Lower blood pH as a strong prognostic factor for fatal outcomes in critically ill COVID-19 patients at an intensive care unit: A multivariable analysis. PLoS One 2021; 16:e0258018. [PMID: 34587211 PMCID: PMC8480873 DOI: 10.1371/journal.pone.0258018] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of the disease and to refine treatment strategies but also to improve clinical decision-making. For clinical decision-making in particular, prognostic factors of a lethal course of the disease would be highly relevant. METHODS In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed for prognosing in-hospital mortality. RESULTS Within the cohort, 19 patients died (mortality 32.2%). Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant prognostic factors of in-hospital mortality. However, no significant differences were found for other parameters expected to be relevant prognostic factors, like low arterial partial pressure of oxygen or high lactate levels. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential prognostic factors for a lethal course.
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Affiliation(s)
- Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Annemarie Sinning
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Timea Vadász
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Wolfram Gronwald
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Dienemann
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Holzmann
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
| | - Bärbel Kieninger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Regensburg, Germany
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13
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Kieninger M, Mandlinger A, Doblinger N, Kieninger B, Bele S, Salzberger B, Schneider-Brachert W, Graf B, Zeman F, Holzmann T. Impact of the implementation of a standard for preanalytical handling of samples for microbiological diagnostics on the quality of results at a neurocritical care unit. Medicine (Baltimore) 2021; 100:e27060. [PMID: 34449497 PMCID: PMC10545238 DOI: 10.1097/md.0000000000027060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Antibiotic stewardship (ABS) programs intend to improve outcomes of nosocomial infections and to counteract the emergence of further antimicrobial resistances. At the anesthesiologic-neurosurgical intensive care unit (ICU) of the University Medical Center Regensburg (Germany) we implemented a standard operating procedure (SOP) with clear instructions for the preanalytical handling and storage of microbiological samples. We intended to find out whether the instructions given in the SOP led to a higher rate of ideal material being sent to the laboratory and to overall better quality of the received results.We retraced retrospectively all samples taken in cases of suspected pneumonia, urinary tract infection, bloodstream infection, catheter infection associated with a central venous or arterial catheter and ventriculitis due to external ventricular drainage as well as all smears taken for the screening for multi-resistant bacteria within a time period of 1 year before to 1 year after the implementation of the SOP.In the case of suspected pneumonia and urinary tract infection, large amounts of ideal material were sent to the microbiological laboratory. A remarkable improvement after the implementation of the SOP, however, could only be observed regarding the number of urine samples taken from older urinary catheters, which was significantly lower in the "SOP group". Samples for microbiological diagnostics were taken much more often in the daytime, although storage of the probes did not lead to worse results.Concrete instructions enable adequate preanalytical handling of microbiological probes. However, we could not recognize substantial improvements probably due to a preexisting high process quality on the ICU. Microbiological diagnostics during the night shift has to be improved.
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Affiliation(s)
- Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Andreas Mandlinger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Nina Doblinger
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Bärbel Kieninger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Germany
| | - Thomas Holzmann
- Department of Infection Prevention and Infectious Diseases, University Medical Center Regensburg, Germany
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14
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Buder F, Bauswein M, Magnus CL, Audebert F, Lang H, Kundel C, Distler K, Reuschel E, Lubnow M, Müller T, Lunz D, Graf B, Schmid S, Müller M, Poeck H, Hanses F, Salzberger B, Peterhoff D, Wenzel JJ, Schmidt B, Lampl BMJ. SARS-CoV-2 infectivity correlates with high viral loads and detection of viral antigen and is terminated by seroconversion. J Infect Dis 2021; 225:190-198. [PMID: 34427652 PMCID: PMC8513404 DOI: 10.1093/infdis/jiab415] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background From a public health perspective, effective containment strategies for SARS-CoV-2 should be balanced with individual liberties. Methods We collected 79 respiratory samples from 59 patients monitored in an outpatient center or in the intensive care unit of the University Hospital Regensburg. We analyzed viral load by quantitative real-time PCR, viral antigen by point-of-care assay, time since onset of symptoms and presence of SARS-CoV-2 IgG antibodies in the context of virus isolation from respiratory specimen. Results The odds ratio for virus isolation increased 1.9-fold for each log10 level of SARS-CoV-2 RNA and 7.4-fold with detection of viral antigen, while it decreased 6.3-fold beyond 10 days of symptoms and 20.0-fold with presence of SARS-CoV-2 antibodies. The latter was confirmed for B.1.1.7 strains. The positive predictive value for virus isolation was 60.0% for viral loads above 10 7 RNA copies/mL and 50.0% for the presence of viral antigen. Symptom onset before 10 days and seroconversion predicted lack of infectivity with 93.8% and 96.0%. Conclusions Our data support quarantining patients with high viral load and detection of viral antigen, and lifting restrictive measures with increasing time to symptom onset and seroconversion. Delay of antibody formation may prolong infectivity.
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Affiliation(s)
- Felix Buder
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Markus Bauswein
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Clara L Magnus
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | | | | | - Christof Kundel
- Medizinische Klinik 1, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Karin Distler
- Medizinische Klinik 1, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Edith Reuschel
- University Department of Obstetrics and Gynecology At The Hospital St. Hedwig of The Order of St. John, University of Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany.,Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.,Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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15
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Dreier E, Malfertheiner MV, Dienemann T, Fisser C, Foltan M, Geismann F, Graf B, Lunz D, Maier LS, Müller T, Offner R, Peterhoff D, Philipp A, Salzberger B, Schmidt B, Sinner B, Lubnow M. ECMO in COVID-19-prolonged therapy needed? A retrospective analysis of outcome and prognostic factors. Perfusion 2021. [PMID: 33612020 DOI: 10.1177/0267659121995997]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. METHODS A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. RESULTS Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8-32.1) ml/cmH2O vs 18.7 (17.7-25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16-23) days vs 5 (5-9) days, p = 0.002) and SOFA score was higher (12.0 (10.5-17.0) vs 10.0 (9.0-10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. CONCLUSIONS VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.
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Affiliation(s)
- Esther Dreier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Thomas Dienemann
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Geismann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Lars Siegfried Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Sinner
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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16
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Dreier E, Malfertheiner MV, Dienemann T, Fisser C, Foltan M, Geismann F, Graf B, Lunz D, Maier LS, Müller T, Offner R, Peterhoff D, Philipp A, Salzberger B, Schmidt B, Sinner B, Lubnow M. ECMO in COVID-19-prolonged therapy needed? A retrospective analysis of outcome and prognostic factors. Perfusion 2021; 36:582-591. [PMID: 33612020 PMCID: PMC8369905 DOI: 10.1177/0267659121995997] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.
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Affiliation(s)
- Esther Dreier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Thomas Dienemann
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Maik Foltan
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Geismann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Lars Siegfried Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Sinner
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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17
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Peterhoff D, Glück V, Vogel M, Schuster P, Schütz A, Neubert P, Albert V, Frisch S, Kiessling M, Pervan P, Werner M, Ritter N, Babl L, Deichner M, Hanses F, Lubnow M, Müller T, Lunz D, Hitzenbichler F, Audebert F, Hähnel V, Offner R, Müller M, Schmid S, Burkhardt R, Glück T, Koller M, Niller HH, Graf B, Salzberger B, Wenzel JJ, Jantsch J, Gessner A, Schmidt B, Wagner R. A highly specific and sensitive serological assay detects SARS-CoV-2 antibody levels in COVID-19 patients that correlate with neutralization. Infection 2021; 49:75-82. [PMID: 32827125 PMCID: PMC7441844 DOI: 10.1007/s15010-020-01503-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic challenges national health systems and the global economy. Monitoring of infection rates and seroprevalence can guide public health measures to combat the pandemic. This depends on reliable tests on active and former infections. Here, we set out to develop and validate a specific and sensitive enzyme linked immunosorbent assay (ELISA) for detection of anti-SARS-CoV-2 antibody levels. METHODS In our ELISA, we used SARS-CoV-2 receptor-binding domain (RBD) and a stabilized version of the spike (S) ectodomain as antigens. We assessed sera from patients infected with seasonal coronaviruses, SARS-CoV-2 and controls. We determined and monitored IgM-, IgA- and IgG-antibody responses towards these antigens. In addition, for a panel of 22 sera, virus neutralization and ELISA parameters were measured and correlated. RESULTS The RBD-based ELISA detected SARS-CoV-2-directed antibodies, did not cross-react with seasonal coronavirus antibodies and correlated with virus neutralization (R2 = 0.89). Seroconversion started at 5 days after symptom onset and led to robust antibody levels at 10 days after symptom onset. We demonstrate high specificity (99.3%; N = 1000) and sensitivity (92% for IgA, 96% for IgG and 98% for IgM; > 10 days after PCR-proven infection; N = 53) in serum. CONCLUSIONS With the described RBD-based ELISA protocol, we provide a reliable test for seroepidemiological surveys. Due to high specificity and strong correlation with virus neutralization, the RBD ELISA holds great potential to become a preferred tool to assess thresholds of protective immunity after infection and vaccination.
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Affiliation(s)
- David Peterhoff
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
| | - Vivian Glück
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Vogel
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Schuster
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Anja Schütz
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Philip Neubert
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Veruschka Albert
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Stefanie Frisch
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Mara Kiessling
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Philip Pervan
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Maren Werner
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Nicole Ritter
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Leon Babl
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Maria Deichner
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Hitzenbichler
- Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | | | - Viola Hähnel
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Hans Helmut Niller
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Jonathan Jantsch
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - André Gessner
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Schmidt
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany.
| | - Ralf Wagner
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany.
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Lubnow M, Schmidt B, Fleck M, Salzberger B, Müller T, Peschel G, Schneckenpointner R, Lange T, Hitzenbichler F, Kieninger M, Lunz D, Graf B, Brochhausen C, Weber F, Lüke F, Peterhoff D, Schuster P, Hiergeist A, Offner R, Hehr U, Wallner S, Hanses F, Schmid S, Weigand K, Geismann F, Poeck H, Pukrop T, Evert M, Gessner A, Burkhardt R, Herr W, Maier LS, Heudobler D. Secondary hemophagocytic lymphohistiocytosis and severe liver injury induced by hepatic SARS-CoV-2 infection unmasking Wilson's disease: Balancing immunosuppression. Int J Infect Dis 2021; 103:624-627. [PMID: 33412272 PMCID: PMC7781512 DOI: 10.1016/j.ijid.2020.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
A 21-year-old woman was hospitalized due to coronavirus disease 2019 (COVID-19)-associated respiratory and hepatic impairment concomitant with severe hemolytic anemia. Upon diagnosis of secondary hemophagocytic lymphohistiocytosis, immunosuppression with anakinra and steroids was started, leading to a hepatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and viremia. Subsequent liver biopsy revealed virus particles in hepatocytes by electron microscopy and SARS-CoV-2 virus could be isolated and cultured. Immunosuppression was stopped and convalescent donor plasma given. In the differential diagnosis, an acute crisis of Wilson’s disease was raised by laboratory and genetic testing. This case highlights the complexity of balancing immunosuppression to control hyperinflammation versus systemic SARS-CoV-2 dissemination.
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Affiliation(s)
- Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Barbara Schmidt
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany; Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Martin Fleck
- Department of Rheumatology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Georg Peschel
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | | | - Tobias Lange
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Martin Kieninger
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Florian Weber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Florian Lüke
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Philipp Schuster
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ute Hehr
- Institute for Human Genetics, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Emergency Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Schmid
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Kilian Weigand
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Florian Geismann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany; Bavarian Center for Cancer Research, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Andre Gessner
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Heudobler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany; Bavarian Center for Cancer Research, Regensburg, Germany.
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Schneider F, Schulz CM, May M, Schneider G, Ernst C, Jacob M, Zacharowski K, Hachenberg T, Schmidt M, Kretzschmar M, Graf B, Kees MG, Pawlik M, Sander M, Koch C, Zoller M, Heim M. The association of the anesthesiologist’s academic and educational status with self-confidence, self-rated knowledge and objective knowledge in rational antibiotic application. BMC Res Notes 2020; 13:161. [PMID: 32188509 PMCID: PMC7079461 DOI: 10.1186/s13104-020-05010-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to investigate the association of anesthetists’ academic and educational status with self-confidence, self-rated knowledge and objective knowledge about rational antibiotic application. Therefore, anesthetists in Germany were asked about their self-confidence, self-rated knowledge and objective knowledge on antibiotic therapy via the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. Other analysis from the survey have been published elsewhere, before. Results 361 (52.8%) questionnaires were completed by specialists and built the study group. In overall analysis the Certification in Intensive Care (CIC) was significantly associated with self-confidence (p < 0.001), self-rated knowledge (p < 0.001) and objective knowledge (p = 0.029) about antibiotic prescription. Senior consultant status was linked to self-confidence (p < 0.001) and self-rated knowledge (p = 0.005) but not objective knowledge. Likewise, working on Intensive Care Unit (ICU) during the last 12 months was significantly associated with self-rated knowledge and self-confidence (all p < 0.001). In a logistic regression model, senior consultant status was not associated with any tested influence factor. This analysis unveiled that CIC and working on ICU were more associated with anesthesiologists’ self-confidence and self-rated knowledge than senior consultant status. However, neither of the characteristics was thoroughly associated with objective knowledge.
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Hähnel V, Weber I, Tuemmler S, Graf B, Gruber M, Burkhardt R, Ahrens N. Matrix-dependent absorption of 8-methoxypsoralen in extracorporeal photopheresis. Photochem Photobiol Sci 2020; 19:1099-1103. [PMID: 32638713 DOI: 10.1039/c9pp00378a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is an effective immunomodulatory therapy for various diseases. Autologous leukocytes are collected, photoactivated with a photosensitizer (8-methoxypsoralen, 8-MOP) and UVA light, and subsequently reinfused back to the patient. Leukapheresis and UVA irradiation systems can be integrated into one device (inline) or handled by two separate devices (offline). ECP works via intercalation of 8-MOP into DNA helices and UVA-based interactions to inhibit DNA replication. 8-MOP is known to adhere to plastic materials, which might reduce its availability for intercalation. In the present study we examined the bioavailability of 8-MOP when different plastic materials and solvents are used as matrices. METHODS Varying amounts of shredded ethylene vinyl acetate (EVA) and polyvinylchloride (PVC) from the MacoGenic irradiation bag (EVA1), UVA PIT irradiation bag (EVA2), UVA PIT recirculation bag (PVC A) and UVA PIT tubing (PVC B) by MacoPharma and PIT Medical Systems, respectively, were incubated with 200 ng mL-1 8-MOP dissolved in diisopropyl ether (DIPE) plus toluene 90/10 vol%, deionized water or plasma. After 2 h 8-MOP concentrations were determined by GC-MS. RESULTS After incubation, 8-MOP concentrations varied depending on the amount and type of plastic (PVC > EVA) and solvent (water > plasma > DIPE/toluene). Absorption to 200 mg EVA1 or EVA2 resulted in 8-MOP concentrations of 57% or 32% in water, 91% or 80% in plasma, and 93% or 92% in DIPE/toluene, while 200 mg PVC A and PVC B yielded recovery rates of 26% and 10% in water, 76% and 75% in plasma, and 55% and 30% in DIPE/toluene, respectively. Remaining 8-MOP differed significantly between container materials (EVA vs. PVC; p < 0.022) but not manufacturers (MacoPharma vs. PIT Medical Systems). CONCLUSION Absorption loss of 8-MOP depends on the type of plastic and solvent and is more pronounced with water than with plasma. As the DNA binding effect of 8-MOP is dose-dependent, ECP starting doses should be adjusted to ensure that a sufficient concentration of free bioavailable 8-MOP is present during UV irradiation.
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Affiliation(s)
- Viola Hähnel
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Isabell Weber
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Simon Tuemmler
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
| | - Ralph Burkhardt
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
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22
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Unterbuchner C, Werkmann M, Ziegleder R, Kraus S, Seyfried T, Graf B, Zeman F, Blobner M, Sinner B, Metterlein T. Shortening of the twitch stabilization period by tetanic stimulation in acceleromyography in infants, children and young adults (STSTS-Study): a prospective randomised, controlled trial. J Clin Monit Comput 2019; 34:1343-1349. [PMID: 31786715 DOI: 10.1007/s10877-019-00435-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
Abstract
Acceleromyography is characterised by an increase of the twitch response T1 (first twitch of the train-of-four [TOF]) during first 30 min of monitoring known as the staircase phenomenon. In adults the staircase phenomenon can be avoided by tetanic prestimulation. This study examined, if tetanic prestimulation eliminates the staircase phenomenon in children. After written informed consent, the neuromuscular function of 80 children, 10 in each age group (< 6 months, 6-12 months, 12-24 months, 2-3 years, 3-6 years, 6-12 years, 12-18 years, and ≥ 18 years) was measured on both arms simultaneously over 30 min under general anaesthesia. The ulnaris nerve was stimulated using the TOF technique every 15 s. The twitch response (T1, TOF ratio [TOFR]) was measured by acceleromyography. Before calibration, tetanic prestimmulation (50 Hz for 5 s) was administered to one randomly selected arm. The effect of tetanic prestimulation and age was analysed using general linear models based on the normalized T1 and TOFRs of both arms. Tetanic prestimulation significantly affected T1 values avoiding the staircase phenomenon (p < 0.0001). After 5.8 min [1.0-17.2 min] the normalized T1 values increased to 117% [102-147%] without prestimulation (p < 0.0001) independent of the age group (p = 0.539). The normalized TOFR was stable throughout the observation period of 30 min 100% [95-107%]. Infants (> 12 weeks), children, and young adults (< 18 years) develop similar characteristics of the staircase phenomenon than adults. Tetanic prestimulation prevents the staircase phenomenon in these age groups. The stability of the TOFR reading confirms its value to monitor neuromuscular function over time.Registration: The study was registered as NCT02552875 on Clinical Trials.gov on July 29, 2014.
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Affiliation(s)
- Christoph Unterbuchner
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Markus Werkmann
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Raphael Ziegleder
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stephanie Kraus
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Timo Seyfried
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre, Regensburg, Germany
| | - Manfred Blobner
- Department of Anaesthesiology and Intensive Care Medicine, Medical School, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Barbara Sinner
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Thomas Metterlein
- Department of Anesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Malsy M, Graf B, Bundscherer A. The Effects of Analgesics and Local Anesthetics on Gene Transcription Mediated by NFATc2 and Sp1 in Pancreatic Carcinoma. Anticancer Res 2019; 39:4721-4728. [PMID: 31519571 DOI: 10.21873/anticanres.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Recent research has identified the transcription factors NFATc2 and Sp1 as key regulators in the carcinogenesis of pancreatic carcinoma. This study aimed to examine the effect of clinically achievable dosages of analgesics including ketamine, s-ketamine, metamizole, and paracetamol as well as that of sufentanil, ropicavaine, and lidocaine on pancreatic carcinoma cells and the expression of NFATc2 and Sp1. MATERIALS AND METHODS The effects of analgesics on the expression of NFATc2 and Sp1 were investigated with immunoblotting. Cell proliferation was measured with the ELISA BrdU assay. RESULTS In PaTu8988t pancreatic carcinoma cells, 48 h stimulation with ketamine and s-ketamine significantly inhibited proliferation and decreased expression of NFATc2 in the nucleus. The addition of metamizole and lidocaine reduced proliferation of PaTu8988t cells after 48 h. CONCLUSION New treatment concepts target specific signaling and transcription pathways. The extent to which drugs influence these mechanisms in pancreatic carcinoma cells needs to be investigated in future studies.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
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Lunz D, Philipp A, Müller T, Pfister K, Foltan M, Rupprecht L, Schmid C, Lubnow M, Graf B, Sinner B. Ischemia-related vascular complications of percutaneously initiated venoarterial extracorporeal membrane oxygenation: Indication setting, risk factors, manifestation and outcome. J Crit Care 2019; 52:58-62. [DOI: 10.1016/j.jcrc.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/18/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
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Kieninger M, Windorfer M, Eissnert C, Zech N, Bele S, Zeman F, Bründl E, Graf B, Künzig H. Impact of bedside percutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients. Medicine (Baltimore) 2019; 98:e17011. [PMID: 31464959 PMCID: PMC6736110 DOI: 10.1097/md.0000000000017011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.
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Affiliation(s)
| | | | | | | | | | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
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Doblinger N, Bredthauer A, Mohrez M, Hähnel V, Graf B, Gruber M, Ahrens N. Impact of hydroxyethyl starch and modified fluid gelatin on granulocyte phenotype and function. Transfusion 2019; 59:2121-2130. [PMID: 30934131 DOI: 10.1111/trf.15279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with neutropenia or granulocyte dysfunction may require granulocyte transfusions for adequate immune restoration. High-molecular-weight hydroxyethyl starch (HES) is the most commonly used sedimentation agent to enhance granulocyte collection efficiency. However, authorities recently restricted the use of HES due to its unfavorable risk-benefit profile. As modified fluid gelatin (MFG) is already used as an alternative sedimentation agent, we tested the hypothesis that MFG is not inferior to HES in terms of the functionality and viability of granulocytes. STUDY DESIGN AND METHODS Granulocytes from ten healthy donors were isolated, aliquoted and incubated in parallel for 2 hours with either 0% (control), 7.5%, 15%, or 30% MFG (Gelafundin) or HES (Hespan), respectively, and granulocyte migration, chemotaxis, reactive oxygen species (ROS) production, neutrophil extracellular trap formation (NETosis), antigen expression, and viability were subsequently investigated in vitro. RESULTS Relative to the controls, all three concentrations of HES compared to only 15% and 30% MFG lowered migration distances, and the 15% and 30% concentrations of both sedimentation agents reduced track straightness. HES resulted in lower CD11b expression and higher CD62L expression compared to MFG and the controls, whereas the differences for CD66b did not reach statistical significance. No significant differences in the timing of ROS production or NETosis, or in neutrophil viability or respiratory burst were observed. CONCLUSION These results indicate that MFG is not inferior to HES in terms of granulocyte function in vitro when used at equal concentrations, and that potential impairment of granulocyte function can occur with HES.
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Affiliation(s)
- Nina Doblinger
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Andre Bredthauer
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Morad Mohrez
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Viola Hähnel
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Institute of Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
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Kieninger M, Gruber M, Knott I, Dettmer K, Oefner PJ, Bele S, Wendl C, Tuemmler S, Graf B, Eissnert C. Incidence of Arterial Hypotension in Patients Receiving Peroral or Continuous Intra-arterial Nimodipine After Aneurysmal or Perimesencephalic Subarachnoid Hemorrhage. Neurocrit Care 2019; 31:32-39. [DOI: 10.1007/s12028-019-00676-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Malsy M, Graf B, Almstedt K. The active role of the transcription factor Sp1 in NFATc2-mediated gene regulation in pancreatic cancer. BMC Biochem 2019; 20:2. [PMID: 30696421 PMCID: PMC6352339 DOI: 10.1186/s12858-019-0105-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adenocarcinoma of the pancreas is one of the most aggressive tumor diseases affecting the human body. The oncogenic potential of pancreatic cancer is mainly characterized by extremely rapid growth triggered by the activation of oncogenic signaling cascades, which suggests a change in the regulation of important transcription factors. Amongst others, NFAT transcription factors are assumed to play a central role in the carcinogenesis of pancreatic cancer. Recent research has shown the importance of the transcription factor Sp1 in the transcriptional activity of NFATc2 in pancreatic cancer. However, the role of the interaction between these two binding partners remains unclear. The current study investigated the role of Sp1 proteins in the expression of NFATc2 target genes and identified new target genes and their function in cells. A further objective was the domain of the Sp1 protein that mediates interaction with NFATc2. The involvement of Sp1 proteins in NFATc2 target genes was shown by means of a gene expression profile analysis, and the results were confirmed by quantitative RT-PCR. The functional impact of this interaction was shown in a thymidine incorporation assay. A second objective was the physical interaction between NFATc2 and different Sp1 deletion mutants that was investigated by means of immunoprecipitation. RESULTS In pancreatic cancer, the proto-oncogene c-Fos, the tumor necrosis factor TNF-alpha, and the adhesion molecule integrin beta-3 are target genes of the interaction between Sp1 and NFATc2. Loss of just one transcription factor inhibits oncogenic complex formation and expression of cell cycle-regulating genes, thus verifiably decreasing the carcinogenic effect. The current study also showed the interaction between the transcription factor NFATc2 and the N-terminal domain of Sp1 in pancreatic cancer cells. Sp1 increases the activity of NFATc2 in the NFAT-responsive promoter. CONCLUSIONS The regulation of gene promotors during transcription is a rather complex process because of the involvement of many proteins that - as transcription factors or co-factors - regulate promotor activity as required and control cell function. NFATc2 and Sp1 seem to play a key role in the progression of pancreatic cancer.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center, Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center, Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, University Hospital, Mainz, Mainz, Germany
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Malsy M, Bitzinger D, Graf B, Bundscherer A. Staurosporine induces apoptosis in pancreatic carcinoma cells PaTu 8988t and Panc-1 via the intrinsic signaling pathway. Eur J Med Res 2019; 24:5. [PMID: 30686270 PMCID: PMC6348604 DOI: 10.1186/s40001-019-0365-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/18/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer, one of the leading causes of death worldwide, develops when the normal balance between mitosis and apoptosis is disrupted. The subsequently increased proliferation rate or decreased apoptosis rate of cells leads to uncontrolled cellular growth. Thus, the current aim of cancer research is to increase the apoptosis rate in tumor cells-while limiting the concurrent death of healthy cells-and to induce controlled apoptosis in abnormal cells. Staurosporine is a very potent inducer of apoptosis because it inhibits many different kinases. So far, many different kinase pathways of staurosporine-induced apoptosis have been discussed for various tumor entities. AIMS To identify the effect of staurosporine in pancreatic and colorectal carcinoma cells and its apoptosis-inducing signaling pathway. METHODS The apoptosis rate in pancreatic and colorectal carcinoma cells was analyzed by annexin V staining after staurosporine administration. Staurosporine stimulation and its effects on the expression of Bcl2, BAX, Bad, caspase-8, and caspase-9 were investigated with immunoblot. RESULTS Staurosporine significantly increased apoptosis in pancreatic carcinoma cells. Western blot analysis showed activation of caspase-9 in PaTu 8988t and Panc-1 cells with 1 µM staurosporine. In addition, expression of Bcl2 and Bad was decreased in PaTu 8988t cells. In colorectal carcinoma cells SW 480, staurosporine stimulation did not induce apoptosis. CONCLUSION Modern therapeutic strategies for tumor diseases target the efficient modulation of specific signaling and transcription pathways. In this respect, the therapeutic potential of protein kinase inhibitors has been repeatedly discussed. Our study showed that staurosporine induces apoptosis in pancreatic carcinoma cells via the intrinsic signaling pathway. Thus, staurosporine is a suitable positive control for in vitro apoptosis tests for the pancreatic cancer cell lines PaTu 8988t and Panc-1. Further clinical studies should analyze the impact of this finding on cancer treatment.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053 Regensburg, Germany
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Mustroph J, Wagemann O, Trum M, Lebek S, Tarnowski D, Reinders J, Schmid C, Schopka S, Hilker M, Graf B, Pabel S, Sossalla S, Schweda F, Maier LS, Wagner S. 3145Empagliflozin potently reduces sarcoplasmic Ca leak and increases Ca transient amplitude of human failing ventricular cardiomyocytes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Mustroph
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - O Wagemann
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - M Trum
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Lebek
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - D Tarnowski
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - J Reinders
- University of Regensburg, Institute of Functional Genomics, Regensburg, Germany
| | - C Schmid
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - S Schopka
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - M Hilker
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - B Graf
- University Hospital Regensburg, Department of Anesthesiology, Regensburg, Germany
| | - S Pabel
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Sossalla
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - F Schweda
- University of Regensburg, Department of Physiology, Regensburg, Germany
| | - L S Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Wagner
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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Abstract
Background Sudden cardiac death is one of the most frequent causes of death in Germany and the third leading cause of death in the industrialized world. Yet, the percentage of people providing first aid in the case of sudden cardiac arrest in Germany is alarmingly low by international comparison. Training Germans or reminding them of the simple but effective steps of resuscitation, so that everybody can save a live in an emergency. Methods For the campaign ‘Resuscitation Week’, physicians and paramedics trained passers-by in cardiovascular resuscitation free of charge. Skills were evaluated before and after the instruction by means of a questionnaire. Results Three hundred three people aged between 9 and 89 years were trained and evaluated. Forty-nine passers-by had never participated in a resuscitation course, and 46.8% had participated in a course more than 20 years ago. Before the instruction, 41.6% of the passers-by were confident to be capable of resuscitating a person; after the instruction, however, this percentage had risen to 100%! Conclusions Saving a life is simple, but one has to know what to do in the case of sudden cardiac arrest. The German population is being gradually trained in resuscitation using campaigns such as ‘Resuscitation Week’ and ‘Kids Save Lives’ to break down barriers in the long term. However, lives are not only saved by training but also by refreshing knowledge and skills; thus, a further effective approach may be training all holders of a driving license in cardiopulmonary resuscitation in intervals of 5 years.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Richard Leberle
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany
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Kieninger M, Eissnert C, Seitz M, Judemann K, Seyfried T, Graf B, Sinner B. [Analysis and options for optimization of preoperative assessment for anesthesia at a university hospital]. Anaesthesist 2017; 67:93-108. [PMID: 29230500 DOI: 10.1007/s00101-017-0392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/14/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Risk assessment prior to elective surgery is an important tool in the context of perioperative patient care; however, only a few studies have been carried out to address the processes and problems during preoperative assessment for anesthesia. AIM Over a period of several weeks all preoperative anesthesia evaluations prior to elective surgery were prospectively recorded in order to generate a data pool with a view to identifying options for process optimization. MATERIAL AND METHODS All preoperative evaluations over a period of 38 working days at the University Medical Center Regensburg were recorded and analyzed with respect to waiting time for the patient and the duration of the preoperative consultation on medication. Also documented were the patient age, ASA score, the faculty carrying out the operation, type and risk of surgery, planned time of surgery, professional experience of the anesthesiologist and the approval status for surgery. In addition, all problems which occurred during the preoperative anesthesia evaluation were documented using a questionnaire. RESULTS Overall 2233 preoperative assessments for anesthesia were recorded and analyzed. The number of patients attending the preoperative assessment clinic differed markedly in the course of a day and was lower at the end of the week. Approval for surgery with no reservations was given more frequently by anesthesiologists with more than 5 years professional experience and consultants compared to younger colleagues. The main reason for approval with reservations or no approval was the lack of patient records and test results, which should have been presented according to the in-house standard for preoperative assessment for anesthesia. The mean waiting time was 58.6 ± 30.3 min, the mean duration of the patient documentation review and physician-patient consultation together was 33.6 ± 16.3 min. Anesthesiologists with 2-5 years professional experience needed significantly less time for patient documentation reviews and physician-patient consultations than younger and more experienced colleagues. The duration of the preoperative assessment for anesthesia correlated with the ASA score and risks of surgery. CONCLUSION The analysis of processes and problems in the context of preoperative assessment for anesthesia revealed several options for optimization. Major efforts should be the implementation of an appointment system for the preoperative assessment clinic in order to generate a homogeneous distribution of patients during the course of a day. Furthermore, surgeons and case managers should be requested to refer patients to the preoperative assessment clinic only with complete records and test results according to the in-house standard.
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Affiliation(s)
- M Kieninger
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - C Eissnert
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M Seitz
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - K Judemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Seyfried
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Graf
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Sinner
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Malsy M, Graf B, Bundscherer A. Effects of metamizole, MAA, and paracetamol on proliferation, apoptosis, and necrosis in the pancreatic cancer cell lines PaTu 8988 t and Panc-1. BMC Pharmacol Toxicol 2017; 18:77. [PMID: 29208039 PMCID: PMC5717838 DOI: 10.1186/s40360-017-0185-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adenocarcinoma of the pancreas is one of the most aggressive cancer diseases affecting the human body. Recent research has shown the importance of the perioperative phase in disease progression. Particularly during this vulnerable phase, substances such as metamizole and paracetamol are given as general anesthetics and postoperative analgesics. Therefore, the effects of metamizole and paracetamol on tumor progression should be investigated in more detail because the extent to which these substances influence the carcinogenesis of pancreatic carcinoma is still unclear. This study analyzed the influence of metamizole and its active metabolites MAA (4-N-methyl-aminoantipyrine) and paracetamol on the proliferation, apoptosis, and necrosis of the pancreatic cancer cell lines PaTu 8988t and Panc-1 in vitro. METHODS Cell proliferation was measured by means of the ELISA BrdU assay and the rate of apoptosis by flow cytometry using the Annexin V assay. RESULTS Metamizole and paracetamol significantly inhibited cell proliferation in pancreatic cancer cells. After the addition of metamizole to PaTu 8988t cells, the rate of apoptosis was reduced after 3 h of incubation but significantly increased after 9 h of incubation. CONCLUSION The oncogenic potential of pancreatic adenocarcinoma is mainly characterized by its extreme growth rate. Non-opioid analgesics such as metamizole and paracetamol are given as general anesthetics and postoperative analgesics. The combination of metamizole or paracetamol with cytotoxic therapeutic approaches may achieve synergistic effects. Further studies are necessary to identify the underlying mechanisms so that new therapeutic options may be developed for the treatment of this aggressive tumor.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany
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Malsy M, Graf B, Almstedt K. Interaction between NFATc2 and the transcription factor Sp1 in pancreatic carcinoma cells PaTu 8988t. BMC Mol Biol 2017; 18:20. [PMID: 28774282 PMCID: PMC5543739 DOI: 10.1186/s12867-017-0097-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nuclear factors of activated T-cells (NFATs) have been mainly characterized in the context of immune response regulation because, as transcription factors, they have the ability to induce gene transcription. NFAT proteins are found in several types of tumors, for instance, pancreatic carcinoma. The role of NFATs in carcinogenesis is regulating central genes in cell differentiation and cell growth. NFAT proteins are primarily located in cytoplasm and only transported to the cell nucleus after activation. Here, they interact with other transcription factors cooperating with NFAT proteins, thus influencing the selection and regulation of NFAT-controlled genes. To identify and characterize possible interaction partners of the transcription factor NFATc2 in pancreatic carcinoma cells PaTu 8988t. METHODS NFATc2 expression and the mode of action of Ionomycin in the pancreatic tumor cell lines PaTu 8988t were shown with Western blotting and immunofluorescence tests. Potential partner proteins were verified by means of immunoprecipitation and binding partners, their physical interactions with DNA pull-down assays, siRNA technologies, and GST pull-down assays. Functional evidence was complemented by reporter-promoter analyses. RESULTS NFATc2 and Sp1 are co-localized in cell nuclei and physically interact at the NFAT target sequence termed NFAT-responsive promotor construct. Sp1 increases the functional activity of its binding partner NFATc2. This interaction is facilitated by Ionomycin in the early stimulation phase (up to 60 min). CONCLUSIONS Oncological therapy concepts are becoming more and more specific, aiming at the efficient modulation of specific signal and transcription pathways. The oncogenic transcription partner Sp1 is important for the transcriptional and functional activity of NFATc2 in pancreatic carcinoma. The binding partners interact in cells. Further studies are necessary to identify the underlying mechanisms and establish future therapeutic options for treating this aggressive type of tumor.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Bernhard Graf
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, University Hospital Mainz, Mainz, Germany
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Wick M, Schneiker A, Bele S, Pawlik M, Meyringer H, Graf B, Wendl C, Kieninger M. [Cerebellar Infarction After Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52:463-470. [PMID: 28614865 DOI: 10.1055/s-0043-105146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report on a patient who developed a space-occupying cerebellar infarction with occlusive hydrocephalus after a poisoning with carbon monoxide with the intention to commit suicide. A neurosurgical and intensive care therapy were needed. The patient's survival without severe neurological deficits could be secured due to the early detection of the intracerebral lesions.
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Metterlein T, Dintenfelder A, Plank C, Graf B, Roth G. Uma comparação de vários dispositivos supraglóticos para intubação traqueal guiada por fibra óptica. Braz J Anesthesiol 2017; 67:166-171. [DOI: 10.1016/j.bjan.2016.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/22/2015] [Indexed: 11/27/2022] Open
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Erdmann JH, Graf B, Blau I, Fischer F, Timm G, Hemmati P, Arnold R, Penack O. Anti-Aspergillusimmunoglobulin-G testing in serum of hematopoietic stem cell transplant recipients. Transpl Infect Dis 2016; 18:354-60. [DOI: 10.1111/tid.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/02/2016] [Accepted: 01/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J.-H. Erdmann
- Pharmacy; Charité University Medical School; Berlin Germany
| | - B. Graf
- Labor Berlin - Charité Vivantes GmbH; Berlin Germany
| | - I.W. Blau
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
| | - F. Fischer
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
| | - G. Timm
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
| | - P. Hemmati
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
| | - R. Arnold
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
| | - O. Penack
- Department of Hematology, Oncology and Tumor immunology; Charité University Medical School; Berlin Germany
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Hanke T, Stierle U, Graf B, Sievers HH, Ziegler P, Charitos E. The Temporal Atrial Fibrillation Pattern during the Blanking Period after Atrial Fibrillation Ablation Is Associated with Later AF Recurrence. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hanke T, Stierle U, Graf B, Ziegler P, Sievers HH, Charitos E. Predictors of AF Recurrence after Surgical Ablation: Insights from Continuous Heart Rhythm Monitoring. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Blecha S, Thomann-Hackner K, Brandstetter S, Dodoo-Schittko F, Seboek P, Apfelbacher C, Graf B, Bein T. Die Rolle von Ethikkommissionen für die nationale Versorgungsforschung – eine Querschnittsstudie des Aufwandes zur Erlangung von Sekundärvoten anhand der DACAPO-Studie. Dtsch Med Wochenschr 2015; 140:e186-93. [DOI: 10.1055/s-0041-103170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Susanne Brandstetter
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
| | - Frank Dodoo-Schittko
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
| | - Philipp Seboek
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
| | - Christian Apfelbacher
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
| | - Bernhard Graf
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg
| | - Thomas Bein
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg
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Charitos EI, Ziegler PD, Stierle U, Graf B, Sievers HH, Hanke T. Long-term outcomes after surgical ablation for atrial fibrillation in patients with continuous heart rhythm monitoring devices. Interact Cardiovasc Thorac Surg 2015; 21:712-21. [PMID: 26362625 DOI: 10.1093/icvts/ivv248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/31/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Surgical ablation for atrial fibrillation (AF) is an established therapy for the treatment of concomitant AF in cardiac surgery patients. We aim to present our prospective experience with 99 continuously monitored patients and investigate whether enhanced monitoring can identify patterns and factors influencing AF recurrence after surgical AF ablation. METHODS Ninety-nine patients (73 males; age: 68.0 ± 9.2 years) with documented preoperative AF (paroxysmal: 29; persistent: 18; long-lasting persistent: 52, mean preoperative duration: 46 ± 53 months) underwent concomitant biatrial surgical ablation (Cox Maze III: 29), full set left atrial cryoablation (n = 22), high-intensity focused ultrasound (HIFU) box lesion (n = 46) or right-sided ablation (n = 2). Postoperative rhythm disclosure was provided via an implantable device. Scheduled follow-up was performed quarterly (mean ± standard deviation: 1.75 ± 1.16 years, 173.7 patient-years). RESULTS The mean postoperative AF burden during the follow-up was 7 ± 19% (median: 0.2%). Seventy-one and 82 patients had AF burden <1% and <5%, respectively. The preoperative AF duration, preoperative ejection fraction, mitral valve surgery and HIFU in patients with more persistent AF were associated with statistically significant higher postoperative AF burdens. The pattern of AF recurrence during the 3-month blanking period was associated with the amount of later AF recurrence. CONCLUSIONS Continuous rhythm disclosure reveals that very small amounts of AF burden after surgical ablation are common. The preoperative duration of AF and the use of a box lesion only in patients with longer AF persistence history were independently associated with higher postoperative AF burden recurrence. The temporal AF pattern during the blanking period after ablation should be considered for further patient management and might serve as a prognostic factor.
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Affiliation(s)
| | | | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Bernhard Graf
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Thorsten Hanke
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
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Malsy M, Gebhardt K, Gruber M, Wiese C, Graf B, Bundscherer A. Effects of ketamine, s-ketamine, and MK 801 on proliferation, apoptosis, and necrosis in pancreatic cancer cells. BMC Anesthesiol 2015. [PMID: 26219286 PMCID: PMC4517358 DOI: 10.1186/s12871-015-0076-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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] [Indexed: 02/16/2023] Open
Abstract
Background Adenocarcinoma of the pancreas is one of the most aggressive cancer diseases affecting the human body. The oncogenic potential of this type of cancer is mainly characterized by its extreme growth rate triggered by the activation of signaling cascades. Modern oncological treatment strategies aim at efficiently modulating specific signaling and transcriptional pathways. Recently, anti-tumoral potential has been proven for several substances that are not primarily used in cancer treatment. In some tumor entities, for example, administration of glutamate antagonists inhibits cell proliferation, cell cycle arrest, and finally cell death. To attain endogenic proof of NMDA receptor type expression in the pancreatic cancer cell lines PaTu8988t and Panc-1 and to investigate the impact of ketamine, s-ketamine, and the NMDA receptor antagonist MK 801 on proliferation, apoptosis, and necrosis in pancreatic carcinoma. Methods Cell proliferation was measured by means of the ELISA BrdU assay, and the apoptosis rate was analyzed by annexin V staining. Immunoblotting were also used. Results The NMDA receptor type R2a was expressed in both pancreatic carcinoma cell lines. Furthermore, ketamine, s-ketamine, and MK 801 significantly inhibited proliferation and apoptosis. Conclusions In this study, we showed the expression of the NMDA receptor type R2a in pancreatic cancer cells. The NMDA antagonists ketamine, s-ketamine, and MK 801 inhibited cell proliferation and cell death. Further clinical studies are warranted to identify the impact of these agents on the treatment of cancer patients.
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Affiliation(s)
- Manuela Malsy
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Kristina Gebhardt
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Michael Gruber
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Christoph Wiese
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Bernhard Graf
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
| | - Anika Bundscherer
- Department of Anesthesiology, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany.
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Klein A, Karrer S, Horner C, Werner A, Heinlin J, Zeman F, Koller M, Landthaler M, Szeimies RM, Gruber M, Graf B, Hansen E, Kerscher C. Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol 2015; 173:192-200. [DOI: 10.1111/bjd.13547] [Citation(s) in RCA: 18] [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] [Accepted: 11/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- A. Klein
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - S. Karrer
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - C. Horner
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - A. Werner
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - J. Heinlin
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - F. Zeman
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Koller
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Landthaler
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - R.-M. Szeimies
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - M. Gruber
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - B. Graf
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - E. Hansen
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - C. Kerscher
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
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Breu A, Scheidhammer I, Kujat R, Graf B, Angele P. Local anesthetic cytotoxicity on human mesenchymal stem cells during chondrogenic differentiation. Knee Surg Sports Traumatol Arthrosc 2015; 23:937-45. [PMID: 25217319 DOI: 10.1007/s00167-014-3312-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/03/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE This study was to investigate the cytotoxic potency of local anesthetics on human mesenchymal stem cells during chondrogenesis. METHODS Aggregates were created from density-gradient centrifugation-separated bone marrow-derived mesenchymal stem cells. After 7, 14, and 21 days, aggregates were analyzed histologically and immunohistochemically and exposed to equipotent concentrations of bupivacaine, ropivacaine, and mepivacaine for 1 h. Cell viability, apoptosis, and necrosis were determined using live-dead and caspase staining. Additionally, following a 1-h exposure on day 7, aggregates were cultured under chondrogenic conditions until day 21 to assess the effects of local anesthetics on differentiation potency of mesenchymal stem cells. RESULTS In the course of chondrogenesis, mesenchymal stem cells were embedded in varying amount and structure of cartilage-specific extracellular matrix. Contents of sulfated glycosaminoglycan, type I and II collagen increased from day 7 to day 21. Compared to control, death rates of mesenchymal stem cells were significantly elevated 1 day after treatment at 7 and 14 days. Four days after exposure, death rates were 13-15 % at 7 and 11-17 % at 14 days. Mesenchymal stem cell viability in aggregates at 21 days was unchanged to controls. The width of the superficial aggregate zone containing stem cell necrosis decreased with elongated differentiation time. Apoptosis rates were elevated in the edge regions of aggregates, reaching maximum values 4 days after treatment. Local anesthetic exposure on day 7 reduced Collagen II, but not DNA contents in aggregates at 21 days. Bupivacaine, ropivacaine, and mepivacaine did not differ in mesenchymal stem cell cytotoxicity in aggregates. CONCLUSION Local anesthetic exposure results in cytotoxicity of mesenchymal stem cells undergoing chondrogenesis, especially in superficial layers. Therefore, induced cell damage should be avoided during chondrogenesis of mesenchymal stem cells, particularly early after cartilage repair.
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Affiliation(s)
- Anita Breu
- Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany,
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Seemann M, Zech N, Graf B, Hansen E. Das Prämedikationsgespräch – Anregungen zu einer patientenfreundlichen Gestaltung. Anasthesiol Intensivmed Notfallmed Schmerzther 2015; 50:142-6. [DOI: 10.1055/s-0040-100082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zech N, Seemann M, Graf B, Hansen E. Nocebo-Effekte – Negativwirkungen der Aufklärung. Anasthesiol Intensivmed Notfallmed Schmerzther 2015; 50:64-9. [DOI: 10.1055/s-0040-100081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Metterlein T, Haubner F, Knoppke B, Graf B, Zausig Y. An unexpected ferromagnetic foreign body detected during emergency magnetic resonance imaging: a case report. BMC Res Notes 2014; 7:808. [PMID: 25403316 PMCID: PMC4252995 DOI: 10.1186/1756-0500-7-808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 07/01/2014] [Accepted: 10/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sedation or anesthesia is often necessary in pediatrics when magnetic resonance imaging is performed. This anesthesia outside of the operation room combines specific requirements and risks. Ferromagnetic foreign bodies are a clear contraindication for magnetic resonance imaging due to the high magnetic field within the scanner. However, insertion of various small objects in mouth, nose or external auditory is not uncommon in small children and often remains unnoticed until specific symptoms develop. Early warning sings like movement of the object or heat development are then concealed by sedation or anesthesia preventing a timely termination of the possibly hazardous procedure. CASE PRESENTATION We present a case of a three year old Caucasian with an acute sinusitis due to unknown ferromagnetic foreign body in his nasal cavity. As soon as the suspicion was raised the procedure was aborted and the object that revealed to be a small button battery was successfully removed. CONCLUSIONS The potential of unwelcome side effects and effective safety strategies of magnetic resonance imaging are discussed as well as the complications arising from ingested batteries.
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Affiliation(s)
- Thomas Metterlein
- Department of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93051 Regensburg, Germany.
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Seemann M, Zech N, Kieninger M, Graf B, Künzig H. [Not Available]. Anaesthesist 2014; 63:700-702. [PMID: 25401186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Seemann M, Zech N, Kieninger M, Graf B, Künzig H. [Placement of a central venous catheter in cases of persistent left superior vena cava]. Anaesthesist 2014; 63:231-3. [PMID: 24566941 DOI: 10.1007/s00101-014-2304-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/20/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Abstract
This article presents a case report on the placement of a central venous catheter (CVC) in a patient with an unknown persistent left superior vena cava (PLSVC). Normally, PLSVCs remain asymptomatic but can be associated with disastrous consequences for the patient during placement of a CVC particularly due to vascular perforation and pulmonary injury. A PLSCV is particularly common in association with congenital heart defects; however, otherwise healthy patients can also be affected. As the presence of a PLSCV is normally unknown special attention must be paid in every patient during placement of a CVC.
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Affiliation(s)
- M Seemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Charitos EI, Ziegler PD, Stierle U, Robinson DR, Graf B, Sievers HH, Hanke T. How often should we monitor for reliable detection of atrial fibrillation recurrence? Efficiency considerations and implications for study design. PLoS One 2014; 9:e89022. [PMID: 24563690 PMCID: PMC3923076 DOI: 10.1371/journal.pone.0089022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022] Open
Abstract
Objective Although atrial fibrillation (AF) recurrence is unpredictable in terms of onset and duration, current intermittent rhythm monitoring (IRM) diagnostic modalities are short-termed and discontinuous. The aim of the present study was to investigate the necessary IRM frequency required to reliably detect recurrence of various AF recurrence patterns. Methods The rhythm histories of 647 patients (mean AF burden: 12±22% of monitored time; 687 patient-years) with implantable continuous monitoring devices were reconstructed and analyzed. With the use of computationally intensive simulation, we evaluated the necessary IRM frequency to reliably detect AF recurrence of various AF phenotypes using IRM of various durations. Results The IRM frequency required for reliable AF detection depends on the amount and temporal aggregation of the AF recurrence (p<0.0001) as well as the duration of the IRM (p<0.001). Reliable detection (>95% sensitivity) of AF recurrence required higher IRM frequencies (>12 24-hour; >6 7-day; >4 14-day; >3 30-day IRM per year; p<0.0001) than currently recommended. Lower IRM frequencies will under-detect AF recurrence and introduce significant bias in the evaluation of therapeutic interventions. More frequent but of shorter duration, IRMs (24-hour) are significantly more time effective (sensitivity per monitored time) than a fewer number of longer IRM durations (p<0.0001). Conclusions Reliable AF recurrence detection requires higher IRM frequencies than currently recommended. Current IRM frequency recommendations will fail to diagnose a significant proportion of patients. Shorter duration but more frequent IRM strategies are significantly more efficient than longer IRM durations. Clinical Trial Registration URL Unique identifier: NCT00806689.
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Affiliation(s)
- Efstratios I. Charitos
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
- * E-mail:
| | - Paul D. Ziegler
- Medtronic Inc., Minneapolis, Minnesota, United States of America
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Derek R. Robinson
- Department of Mathematics, School of Mathematical and Physical Sciences, University of Sussex, Brighton, United Kingdom
| | - Bernhard Graf
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Thorsten Hanke
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
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