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Wolfs EML, van Lutterveld R, Varkevisser T, Klaus J, Geuze E, Schutter DJLG. Lower cerebello-cortical functional connectivity in veterans with reactive aggression symptoms: A pilot study. J Psychiatr Res 2023; 159:42-49. [PMID: 36657313 DOI: 10.1016/j.jpsychires.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
A significant number of veterans experience irritability and aggression symptoms as a result of being exposed to extremely stressful and life-threatening situations. In addition to the well-established involvement of the brain's cortico-subcortical circuit in aggression-related behaviours, a role of the deep cerebellar nuclei (DCN) in reactive aggression has been suggested. In the present study, seed-based resting-state functional connectivity between the DCN and cortico-subcortical areas was explored in veterans with and without reactive aggression symptoms. Nineteen male veterans with reactive aggression symptoms and twenty-two control veterans without reactive aggression symptoms underwent 3T resting-state functional MRI scans. Region-of-interest (ROI) analyses that included the amygdala, hypothalamus and periaqueductal grey as ROIs did not yield significant group-related differences in resting-state functional connectivity with the DCN. However, exploratory whole-brain analysis showed that veterans with reactive aggression symptoms exhibited lower functional connectivity between the DCN and the orbitofrontal cortex compared to control veterans. Our findings provide preliminary evidence for the possible involvement of a cerebello-prefrontal pathway in reactive aggression in male veterans.
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Affiliation(s)
- E M L Wolfs
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
| | - R van Lutterveld
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, the Netherlands
| | - T Varkevisser
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, the Netherlands; Research and Documentation Centre, Ministry of Justice and Security, Koningskade 4, 2596 AA, The Hague, the Netherlands
| | - J Klaus
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - E Geuze
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, the Netherlands
| | - D J L G Schutter
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
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Chan T, Klaus J, Meli ML, Hofmann-Lehmann R. [SARS-CoV-2 infections in cats, dogs, and other animal species: Findings on infection and data from Switzerland]. SCHWEIZ ARCH TIERH 2021; 163:821-835. [PMID: 34881715 DOI: 10.17236/sat00329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The pandemic with the novel coronavirus (SARS-CoV-2) has led to infections and deaths worldwide. Apart from humans, certain animal species are susceptible to the viral infection. Spillover between humans and animals is favored by close contact; thus, surveillance of animals is an important component to fight the pandemic from a One Health perspective. The Clinical Laboratory of the Vetsuisse Faculty Zurich has been investigating SARS-CoV-2 infections in animals since the beginning of the pandemic. In November 2020, the first SARS-CoV-2 positive Swiss cat was reported to the World Organisation for Animal Health (OIE-WAHIS). The cat showed respiratory signs and lived in a COVID-19 affected household. By now, over 500 natural SARS-CoV-2 infections have been recorded in animals worldwide. A prevalence study on SARS-CoV-2 infections in dogs and cats was carried out together with clinics from Germany and Italy during the first wave of the pandemic (March-July 2020). Among the tested 1137 animals, only one cat and one dog were positive. The prevalence of infection in dogs and cats presented to veterinary clinics was low, even in pandemic hotspot regions. However, recent studies that focused on animals in COVID-19 households found a higher prevalence of infection. A study is currently underway that specifically collects samples from pets from Swiss COVID-19 affected household and collects data on human-animal interaction.
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Affiliation(s)
- T Chan
- Veterinärmedizinisches Labor, Departement für klinische Diagnostik und Services und Zentrum für Klinische Studien, Vetsuisse-Fakultät, Universität Zürich
| | - J Klaus
- Veterinärmedizinisches Labor, Departement für klinische Diagnostik und Services und Zentrum für Klinische Studien, Vetsuisse-Fakultät, Universität Zürich
| | - M L Meli
- Veterinärmedizinisches Labor, Departement für klinische Diagnostik und Services und Zentrum für Klinische Studien, Vetsuisse-Fakultät, Universität Zürich
| | - R Hofmann-Lehmann
- Veterinärmedizinisches Labor, Departement für klinische Diagnostik und Services und Zentrum für Klinische Studien, Vetsuisse-Fakultät, Universität Zürich
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Pahmeier K, Denkinger M, Seufferlein T, Klaus J, Bauer J, Katus H, Bahrmann A, Geisler T, Muche R, Müller M, Suhr R, Frankenhauser-Mannuß J, Flagmeier AL, Dallmeier D, Leinert C, Wasem J, Biermann-Stallwitz J, Neumann A. Studiendesign – Gesundheitsökonomische Evaluation einer Interventionsstudie zur Delirreduktion (TRADE). Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Pahmeier
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
| | - M Denkinger
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - T Seufferlein
- Universitätsklinikum Ulm, Klinik für Innere Medizin I
| | - J Klaus
- Universitätsklinikum Ulm, Klinik für Innere Medizin I
| | - J Bauer
- AGAPLESION BETHANIEN Krankenhaus Heidelberg, Klinik für Akutgeriatrie
| | - H Katus
- Universitätsklinikum Heidelberg, Klinik für Kardiologie, Angiologie, Pneumologie
| | - A Bahrmann
- Universitätsklinikum Heidelberg, Klinik für Kardiologie, Angiologie, Pneumologie
| | - T Geisler
- Universitätsklinikum Tübingen, Deutsches Herzkompetenzzentrum, Medizinische Klinik III
| | - R Muche
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie
| | - M Müller
- Technische Hochschule Rosenheim, Fakultät für Angewandte Gesundheits- und Sozialwissenschaften
| | - R Suhr
- Zentrum für Qualität in der Pflege
| | | | - AL Flagmeier
- AOK Baden-Württemberg, Rehabilitations- und Pflegeforschung
| | - D Dallmeier
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - C Leinert
- AGAPLESION Bethesda Klinik, Geriatrische Forschung der Universität Ulm
| | - J Wasem
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
| | | | - A Neumann
- Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
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Ebner L, Klaus J, Loebelenz L, Munz J, Peters A, Schroeder C, Hourscht C, Drakopoulos D, Sieron D, Heverhagen J, Christe A. INFLUENCE OF SOFT VS HARD COMPUTED TOMOGRAPHY RECONSTRUCTION KERNEL ON RADIOLOGICAL PATTERN RECOGNITION. Chest 2020. [DOI: 10.1016/j.chest.2020.05.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hohwieler M, Renz S, Liebau S, Lin Q, Lechel A, Klaus J, Perkhofer L, Zenke M, Seufferlein T, Illing A, Müller M, Kleger A. “Miniguts” from plucked human hair meet Crohn’s disease. Z Gastroenterol 2016; 54:748-59. [DOI: 10.1055/s-0042-105520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - S. Liebau
- Institute of Neuroanatomy, Eberhard Karls University Tuebingen, Germany
| | - Q. Lin
- Department of Cell Biology, Institute for Biomedical Engineering, Medical Faculty, RWTH University Aachen, Germany
| | - A. Lechel
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - J. Klaus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - L. Perkhofer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - M. Zenke
- Department of Cell Biology, Institute for Biomedical Engineering, Medical Faculty, RWTH University Aachen, Germany
| | - T. Seufferlein
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - A. Illing
- Department of Internal Medicine I, Ulm University, Ulm, Germany
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Müller H, Haag I, Jessen F, Kim EH, Klaus J, Konkol C, Bechdolf A. [Cognitive Behavioral Therapy and Assertive Community Treatment Reduces Days in Hospital and Delays Hospital Admission in Severe Psychotic Disorders]. Fortschr Neurol Psychiatr 2016; 84:76-82. [PMID: 26953546 DOI: 10.1055/s-0042-102055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The primary aim of this study was to assess the effectiveness of integrated home treatment (IV, i. e. intensive cognitive behavioral therapy and pharmacotherapy provided within a framework of assertive community treatment) in individuals with severe mental disorders (n = 13) within the German healthcare system. A treatment-as-usual group (TAU, n = 13) was identified by propensity score matching. Symptoms (CGI), functioning (GAF) and service engagement (SES) were assessed. Quality of life (MSLQ-R) was rated by the IV patients. A reduction of days spent in hospital [IV: 2.3 (6.1); TAU: 33.6 (53.6); Z = 45; p = 0.044], time to admission (IV: 384 days 95% CI 309 - 459.1; TAU: 234.9 days 95% CI 127.2 - 342.5; log rank: Chi-square = 4.31, p < 0.05), severity of the illness (p < 0.01), positive symptoms (p < 0.001), and cognitive symptoms (p < 0.05), as well as functioning (p < 0.05) and service engagement (p < 0.05) was observed in IV patients. Despite differences on a descriptive level, differences in total admissions (IV: 15.3%; TAU: 53.8%; odds ratio = 0.155, 95% CI 0.0243 - 1.00) were not significant. A methodological limitation is that symptom ratings were not performed by independent and blinded raters.
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Affiliation(s)
- H Müller
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - I Haag
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - F Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - E H Kim
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - J Klaus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - C Konkol
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
| | - A Bechdolf
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln
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Zink F, Kratzer W, Schmidt S, Oeztuerk S, Mason RA, Porzner M, Klaus J, Haenle MM, Graeter T. Comparison of Two High-End Ultrasound Systems for Contrast-Enhanced Ultrasound Quantification of Mural Microvascularity in Crohn's Disease. Ultraschall Med 2016; 37:74-81. [PMID: 26251995 DOI: 10.1055/s-0034-1398746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To verify the reproducibility of contrast-enhanced ultrasound (CEUS) quantification results of two different high-end ultrasound systems and to evaluate the clinical utility of the method in patients with Crohn's disease (CD). MATERIALS AND METHODS 18 patients with histologically confirmed CD (36.8 % women, 63.2 % men; mean age 43.7 ± 14.1 years) and wall segments thicker than 5 mm were recruited. CEUS quantification and conventional ultrasound investigation were performed under standardized settings using Toshiba Aplio500 and Siemens Acuson S3000 high-end ultrasound systems. CEUS was performed at a low mechanical index of 0.1 after bolus application of 4.8 ml of SonoVue(®) contrast medium. The recorded DICOM clips were quantified using VueBox(®) (version 4.3) calculating 11 quantitative parameters. Subsequently, CEUS quantification and conventional ultrasound results were analyzed. RESULTS Correlation of quantitative parameters between the Aplio500 and AcusonS3000 systems for peak enhancement (PE), rise time (RT), wash-in-rate (WiR) and quality of fit (QOF) yielded significance levels of p < 0.05 and p < 0.0001 for wash-in-wash-out area under the curve (WiWoAUC). Spearman rank test showed moderate levels of correlation for PE, RT, WiR and QOF (r = 0.5, 0.49, 0.49 and 0.5 respectively), and high correlation for WiWoAUC (r = 0.89) between the two ultrasound systems. CONCLUSION Due to multiple uncontrollable affecting factors, the method of CEUS quantification by VueBox in the intestine cannot be recommended for device-independent multicenter studies. Therefore we suggest to use identical ultrasound systems and probes as well as to establish adequate reference ROIS, like a AIF-ROI.
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Affiliation(s)
- F Zink
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - W Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - S Schmidt
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
| | - S Oeztuerk
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - R A Mason
- Department of Veterans Affairs, Louis Stokes Cleveland Medical Center, Brecksville, USA
| | - M Porzner
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - J Klaus
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - M M Haenle
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | - T Graeter
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
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Dannlowski U, Grabe HJ, Wittfeld K, Klaus J, Konrad C, Grotegerd D, Redlich R, Suslow T, Opel N, Ohrmann P, Bauer J, Zwanzger P, Laeger I, Hohoff C, Arolt V, Heindel W, Deppe M, Domschke K, Hegenscheid K, Völzke H, Stacey D, Meyer Zu Schwabedissen H, Kugel H, Baune BT. Multimodal imaging of a tescalcin (TESC)-regulating polymorphism (rs7294919)-specific effects on hippocampal gray matter structure. Mol Psychiatry 2015; 20:398-404. [PMID: 24776739 DOI: 10.1038/mp.2014.39] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/09/2014] [Accepted: 03/17/2014] [Indexed: 02/07/2023]
Abstract
In two large genome-wide association studies, an intergenic single-nucleotide polymorphism (SNP; rs7294919) involved in TESC gene regulation has been associated with hippocampus volume. Further characterization of neurobiological effects of the TESC gene is warranted using multimodal brain-wide structural and functional imaging. Voxel-based morphometry (VBM8) was used in two large, well-characterized samples of healthy individuals of West-European ancestry (Münster sample, N=503; SHIP-TREND, N=721) to analyze associations between rs7294919 and local gray matter volume. In subsamples, white matter fiber structure was investigated using diffusion tensor imaging (DTI) and limbic responsiveness was measured by means of functional magnetic resonance imaging (fMRI) during facial emotion processing (N=220 and N=264, respectively). Furthermore, gene x environment (G × E) interaction and gene x gene interaction with SNPs from genes previously found to be associated with hippocampal size (FKBP5, Reelin, IL-6, TNF-α, BDNF and 5-HTTLPR/rs25531) were explored. We demonstrated highly significant effects of rs7294919 on hippocampal gray matter volumes in both samples. In whole-brain analyses, no other brain areas except the hippocampal formation and adjacent temporal structures were associated with rs7294919. There were no genotype effects on DTI and fMRI results, including functional connectivity measures. No G × E interaction with childhood maltreatment was found in both samples. However, an interaction between rs7294919 and rs2299403 in the Reelin gene was found that withstood correction for multiple comparisons. We conclude that rs7294919 exerts highly robust and regionally specific effects on hippocampal gray matter structures, but not on other neuropsychiatrically relevant imaging markers. The biological interaction between TESC and RELN pointing to a neurodevelopmental origin of the observed findings warrants further mechanistic investigations.
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Affiliation(s)
- U Dannlowski
- 1] Department of Psychiatry, University of Münster, Münster, Germany [2] Department of Psychiatry, University of Marburg, Marburg, Germany
| | - H J Grabe
- 1] Department of Psychiatry, University Medicine Greifswald, HELIOS-Hospital Stralsund, Stralsund, Germany [2] German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - K Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - J Klaus
- Department of Psychiatry, University of Münster, Münster, Germany
| | - C Konrad
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - D Grotegerd
- Department of Psychiatry, University of Münster, Münster, Germany
| | - R Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - T Suslow
- 1] Department of Psychiatry, University of Münster, Münster, Germany [2] Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - N Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - P Ohrmann
- Department of Psychiatry, University of Münster, Münster, Germany
| | - J Bauer
- Department of Psychiatry, University of Münster, Münster, Germany
| | - P Zwanzger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - I Laeger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - C Hohoff
- Department of Psychiatry, University of Münster, Münster, Germany
| | - V Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - W Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - M Deppe
- Department of Neurology, University of Münster, Münster, Germany
| | - K Domschke
- Department of Psychiatry, University of Würzburg, Würzburg, Germany
| | - K Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - D Stacey
- Discipline of Psychiatry, School of Medicine, University of Adelaide: North Terrace, Adelaide, SA, Australia
| | | | - H Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - B T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide: North Terrace, Adelaide, SA, Australia
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Kasckow J, Klaus J, Morse J, Oslin D, Luther J, Fox L, Reynolds C, Haas GL. Using problem solving therapy to treat veterans with subsyndromal depression: a pilot study. Int J Geriatr Psychiatry 2014; 29:1255-61. [PMID: 24789736 PMCID: PMC4216632 DOI: 10.1002/gps.4105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/25/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We conducted a pilot study comparing problem solving therapy for primary care (PST-PC) to a dietary education control condition in middle-aged and older veterans with symptoms of emotional distress and subsyndromal depression. METHODS This was a two-site study at the VA Pittsburgh Healthcare System and Philadelphia VA Medical Center. Participants included veterans >50 years of age referred from primary care clinics who were eligible if they obtained a pre-screen score >11 on the Centers for Epidemiologic Studies Depression (CES-D) scale. Exclusions were a DSM-IV Major Depressive Episode within the past year, active substance abuse/dependence within 1 month, current antidepressant therapy, and a Mini mental status exam score <24. Participants were randomized to receive one of two interventions--either PST-PC or an attention control condition consisting of dietary education (DIET)--each consisting of six to eight sessions within a 4-month period. RESULTS Of 45 individuals randomized, 23 (11 PST-PC and 12 DIET) completed treatment. Using regression models in completers that examined outcomes at end of treatment while controlling for baseline scores, there were significant differences between treatment groups in SF-36 mental health component scores but not in depressive symptoms (as assessed with either the 17-item Hamilton Rating Scale for Depression or the Beck Depression Inventory), social problem solving skills, or physical health status (SF-36 physical health component score). CONCLUSIONS These pilot study findings suggest that a six-to-eight session version of PST-PC may lead to improvements in mental health functioning in primary care veterans with subsyndromal depressive symptoms.
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Affiliation(s)
- J. Kasckow
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA,UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - J. Klaus
- Philadelphia Veterans Affairs Medical Center VISN 4 MIRECC,
Philadelphia, PA, USA
| | - J. Morse
- UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - D. Oslin
- Philadelphia Veterans Affairs Medical Center VISN 4 MIRECC,
Philadelphia, PA, USA,Section of Geriatric Psychiatry, Department of Psychiatry,
University of Pennsylvania, Philadelphia, PA, USA
| | - J. Luther
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA
| | - L. Fox
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA
| | - C. Reynolds
- UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
| | - G. L. Haas
- VA Pittsburgh Behavioral Health, VISN 4 CHERP and VISN 4
MIRECC, University Dr, Pittsburgh, PA, USA,UPMC Western Psychiatric Institute and Clinics, Pittsburgh,
PA, USA
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van der Ham S, Hänle MM, Klaus J, Oztürk S, Lorenz R, Kratzer W. [Ultrasonographically guided biopsy procedures: current practice in hospitals with established departments of gastroenterology]. Z Gastroenterol 2012; 50:989-95. [PMID: 22965628 DOI: 10.1055/s-0031-1299309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Ultrasonographically guided adominal biopsies are a frequent daily procedure in German hospitals. There are, however, few guidelines or recommendations for these common procedures. The oive of the current study was to assess current practice with respect to ultrasonographically guided biopsy procedures in a survey of hospitals with established departments of gastroenterology or with over 500 beds. MATERIAL AND METHOD A questionnaire addressing the preparation for, procedure during, and post-interventional monitoring following ultrasonographically guided biopsies was mailed to 349 German hospitals. The response rate was 51 % (n = 177). RESULTS Establishment of an intravenous access is standard in 51.2 % (88/172) of the hospitals. Sedation analgesia is standard in 19.1 % (33/173) of the hospitals and is an option in a further 60.1 % (104/173). Local anesthesia is performed in 84.8 % (145/171) of the hospitals. A dedicated transducer for targeted biopsy is used in 40.6 % (81/176) of the hospitals, while 29.5 % (52/176) use a separate biopsy bracket attached to the probe. In 80.6 % (141/175) of the hospitals, a minimum platelet count of 50,000/µL is required. A minimum of 50 % is used as limit for quick in 86.5 % (147/170) of the hospitals. A value of 1 - 1.5 for the international normalized ratio (INR) is most commonly used in the hospitals. A partial thromboplastin time (PTT) between 28 and 50 sec. is used as the upper limit. Interruption of anticoagulants is handled in a very heterogeneous manner. Postinterventional monitoring following biopsy in ambulatory patients ranges from two to 24 hours. CONCLUSION Our survey shows relevant differences in preparation, execution and postinterventional monitoring in ultrasonographically guided biopsy procedures as routinely performed in German hospitals. There seems to be a need for a guideline standardising ultrasonographically guided biopsy procedures.
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Affiliation(s)
- S van der Ham
- Klinik für Innere Medizin I, Zentrum für Innere Medizin, Universitätsklinikum Ulm
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Güttler FV, Ipczynski R, Klaus J, Heinrich A, de Bucourt M, Teichgräber U. Etablierung eines webbasierten Qualitätsmanagementssystems in der Radiologie. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311194] [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: 10/28/2022]
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Lohmann M, Hänle M, Klaus J, Kratzer W. Aus- und Weiterbildungssituation in der Abdomensonografie an deutschen Universitätskliniken – Vergleich 1999 – 2009. Z Gastroenterol 2011; 49:971-6. [DOI: 10.1055/s-0031-1273361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kratzer W, Akinli AS, Bommer M, Arnold F, Eggink S, Imhof A, Mason RA, Klaus J, Schuler A, Boehm BO, Haenle MM. Prevalence and risk factors of focal sparing in hepatic steatosis. Ultraschall Med 2010; 31:37-42. [PMID: 20157869 DOI: 10.1055/s-0028-1109894] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The prevalence, localization and potential risk factors for focal sparing were prospectively assessed in subjects with sonographically detectable hepatic steatosis as part of a population-based cross-sectional study. MATERIALS AND METHODS A total of 1,624 persons (n = 906 women; n = 718 men) were evaluated using ultrasonography, laboratory testing and a standardized questionnaire. The following were excluded from the analysis: subjects with reported alcohol consumption > 40 g/day (males) or > 20 g/day (females), those with known chronic hepatitis B or C infection, elevated serum transaminases (AST: m > 44 U/l, f > 33 U/l; ALT: m > 45 U/l, f > 35 U/l) and prior right nephrectomy. RESULTS The prevalence of focal sparing in patients with hepatic steatosis (grade I) was 25.6 % for men and 13.0 % for women. In patients with grade II/III disease, the prevalence was 70.9 % for men and 77.6 % for women. The most common site of focal sparing was in segment IV. The average diameter was 22.3 mm (range 7 - 84 mm). No correlation was found for postulated risk "age" (p = 0.09) or "status post cholecystectomy" (p = 0.09). Male sex (p = 0.02) and metabolic syndrome (odds ratio, 2.1; 95 % confidence interval, 1.1 - 4.1; p = 0.02) were confirmed as risk factors. CONCLUSION Sonographic evidence of focal sparing in subjects with hepatic steatosis is associated with an increased risk for metabolic syndrome and may be an easily obtained diagnostic criterion in routine clinical settings.
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Affiliation(s)
- W Kratzer
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Zentrum für Innere Medizin, Ulm, Germany.
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Dzietko M, Sifringer M, Klaus J, Endesfelder S, Brait D, Hansen H, Bendix I, Felderhoff-Mueser U. Neurotoxic Effects of MDMA (Ecstasy) on the Developing Rodent Brain. Dev Neurosci 2010; 32:197-207. [DOI: 10.1159/000313473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/06/2010] [Indexed: 11/19/2022] Open
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Kunsch S, Neesse A, Huth J, Steinkamp M, Klaus J, Adler G, Gress TM, Ellenrieder V. Increased Duodeno-Gastro-Esophageal Reflux (DGER) in symptomatic GERD patients with a history of cholecystectomy. Z Gastroenterol 2009; 47:744-8. [PMID: 19662586 DOI: 10.1055/s-0028-1109176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Duodenal-Gastro-Esophageal Reflux (DGER) represents an independent risk factor for the development of complicated Gastro-esophageal-reflux-disease (GERD) and Barrett's esophagus. Clinical and epidemiological data suggest a potential association between cholecystectomy (CCE) and augmented bile reflux. METHODS 132 patients (67 women, 65 men, median age 55) with typical symptoms of GERD were enrolled in the study and divided in cholecystectomized (CCE-group: n = 107) and non- cholecystectomized (nCCE-group: n = 25) patients. Standardized clinical work-up of patients included combined esophageal 24 h pH-measurement and Bilitec 2000 esophageal manometry and upper endoscopy. RESULTS In the statistical analysis no differences between the cholecystectomized group (CCE-group, n = 25) and the patients without cholecystectomy (nCCE-group, n = 107) could be observed in quantity or quality of reflux symptoms. Furthermore, neither acid reflux nor severity of inflammation and frequency of Barrett's esophagus significantly differed between the nCCE and CCE-group. However, the percentage of patients with pathological DGER were significantly higher in the CCE-group as compared to the nCCE-group (76 vs. 55 %, p < 0.01). Moreover, the CCE-group revealed significant higher levels of pathological DGER compared to the nCCE-group (15.5 % +/- 14.1 vs. 8.6 % +/- 15.4; p < 0.05). CONCLUSION To conclude, our data provide first evidence of elevated DGER after CCE in patients with typical clinical symptoms of GERD using the Bilitec device. Both the frequency and the extent of DGER was significantly increased in the CCE-group. Prospective studies are urgently needed to elucidate the impact of CCE on DGER in patients with clinical symptoms of a reflux disease.
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Affiliation(s)
- S Kunsch
- University of Marburg, Germany, Department of Gastroenterology, Endocrinology and Metabolism, Faculty of Medicine, 35043 Marburg.
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Drews BH, Barth TFE, Hänle MM, Akinli AS, Mason RA, Muche R, Thiel R, Pauls S, Klaus J, von Boyen G, Kratzer W. Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn's disease. Eur Radiol 2009; 19:1379-86. [PMID: 19184036 DOI: 10.1007/s00330-008-1290-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 11/17/2008] [Accepted: 12/07/2008] [Indexed: 12/16/2022]
Abstract
The purposes of this study was to provide a retrospective comparison of semiquantitatively measured bowel wall vascularity by power Doppler sonography, endoscopic-histopathological biopsy findings, and disease activity in patients with confirmed Crohn's disease. Thirty-two out of 1,332 patients with histologically confirmed Crohn's disease (18 female, 14 male; mean age 38.8 years) met the inclusion criteria: ileocolonoscopy with biopsy and power Doppler sonographic determination of bowel wall vascularity with assessment of disease activity within a period of 5 days. Sonographic determination of bowel wall vascularity was based on a semiquantitative score. Endoscopic bowel wall biopsy specimens were assessed using a self-developed inflammation score and the disease activity was calculated using Crohn's disease activity index (CDAI). A significant association (p < 0.05) was shown for results of histology and bowel wall vascularity in the terminal ileum (kappa = 0.66; sensitivity 95%; specificity 69%). There was no observed association between CDAI and histology, although there was an association between CDAI and bowel wall vascularity (sensitivity 82%). Increased bowel wall vascularity in the terminal ileum measured by power Doppler ultrasound reflects inflammatory activity in histologically examined bowel wall. Power Doppler ultrasound may be able to monitor activity changes of the bowel wall determined by pharmaceutical treatment.
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Affiliation(s)
- B H Drews
- Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Klaus J, Reinshagen M, Adler G, Boehm B, von Tirpitz C. Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density. BMC Gastroenterol 2008; 8:48. [PMID: 18947388 PMCID: PMC2577678 DOI: 10.1186/1471-230x-8-48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/23/2008] [Indexed: 01/20/2023] Open
Abstract
Background Reduced bone mineral density (BMD) and osteoporosis are frequent in Crohn's disease (CD), but the underlying mechanisms are still not fully understood. Deficiency of sex steroids, especially estradiol (E2), is an established risk factor in postmenopausal osteoporosis. Aim To assess if hormonal deficiencies in male CD patients are frequent we investigated both, sex steroids, bone density and bone metabolism markers. Methods 111 male CD patients underwent osteodensitometry (DXA) of the spine (L1–L4). Disease related data were recorded. Disease activity was estimated using Crohn's disease activity index (CDAI). Testosterone (T), dihydrotestosterone (DHT), estradiol (E2), sex hormone binding globulin (SHBG), Osteocalcin and carboxyterminal cross-linked telopeptids (ICTP) were measured in 111 patients and 99 age-matched controls. Results Patients had lower T, E2 and SHBG serum levels (p < 0.001) compared to age-matched controls. E2 deficiency was seen in 30 (27.0%) and T deficiency in 3 (2.7%) patients but only in 5 (5.1%) and 1 (1%) controls. Patients with E2 deficiency had significantly decreased T and DHT serum levels. Use of corticosteroids for 3 of 12 months was associated with lower E2 levels (p < 0.05). Patients with life-time steroids >10 g had lower BMD. 32 (28.8%) patients showed osteoporosis, 55 (49.5%) osteopenia and 24 (21.6%) had normal BMD. Patients with normal or decreased BMD showed no significant difference in their hormonal status. No correlation between markers of bone turnover and sex steroids could be found. ICTP was increased in CD patients (p < 0.001), and patients with osteoporosis had higher ICTP levels than those with normal BMD. Conclusion We found an altered hormonal status – i.e. E2 and, to a lesser extent T deficiency – in male CD patients but failed to show an association to bone density or markers of bone turnover. The role of E2 in the negative skeletal balance in males with CD, analogous to E2 deficiency in postmenopausal females, deserves further attention.
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Affiliation(s)
- J Klaus
- University of Ulm, Department of Internal Medicine I, Robert Koch Str, 8, 89081 Ulm, Germany.
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Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version). Arch Dermatol Res 2007; 299:111-38. [PMID: 17497162 PMCID: PMC1910890 DOI: 10.1007/s00403-007-0744-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [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: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 11/30/2022]
Abstract
Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).
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Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany.
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Fruehauf S, Klaus J, Huesing J, Veldwijk MR, Buss EC, Topaly J, Seeger T, Zeller LWJ, Moehler T, Ho AD, Goldschmidt H. Efficient mobilization of peripheral blood stem cells following CAD chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma. Bone Marrow Transplant 2007; 39:743-50. [PMID: 17450182 DOI: 10.1038/sj.bmt.1705675] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
High-dose chemotherapy followed by autologous blood stem cell transplantation is the standard treatment for myeloma patients. In this study, CAD (cyclophosphamide, adriamycin, dexamethasone) chemotherapy and a single dose of pegfilgrastim (12 mg) was highly effective in mobilizing peripheral blood stem cells (PBSCs) for subsequent transplantation, with 88% of patients (n = 26) achieving the CD34+ cell harvest target of > or = 7.50 x 10(6) CD34+ cells/kg body weight, following a median of two apheresis procedures (range 1-4) and with first apheresis performed at a median day 13 after CAD application (range 10-20). Patients treated with pegfilgrastim showed a reduced time to first apheresis procedure from mobilization compared with filgrastim-mobilized historical matched controls (n = 52, P = 0.015). The pegfilgrastim mobilization regimen allowed for transplantation of a median of 3.58 x 10(6) CD34+ cells/kg body weight while leaving sufficient stored cells for a second high-dose regimen and back-ups in most patients. Engraftment following transplantation was comparable to filgrastim, with a median time of 14 days to leucocyte > or =1.0 x 10(9)/l (range 10-21) and 11 days to platelets > or = 20 x 10(9)/l (range 0-15). The results of this study thus provide further support for the clinical utility of pegfilgrastim for the mobilization of PBSC following chemotherapy in cancer patients scheduled for transplantation.
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Affiliation(s)
- S Fruehauf
- Department of Tumor Diagnostics and Therapy, Paracelsus Hospital, Osnabrueck, Germany.
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Dinter DJ, Klaus J, Metzgeroth G, Buesing KA, Neff KW. Ganzkörper-MRT: Wertigkeit im Vergleich zum konventionellen Röntgen-Skelettstatus bei Patienten mit Plasmozytom und ihr Einfluss auf Änderungen im therapeutischen Vorgehen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977093] [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: 10/21/2022]
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von Tirpitz C, Steder-Neukamm U, Glas K, Sander S, Ring C, Klaus J, Reinshagen M. Osteoporose bei chronisch entzündlichen Darmerkrankungen - Ergebnisse einer Umfrage an Mitgliedern der Deutschen M. Crohn und Colitis ulcerosa Vereinigung (DCCV). Z Gastroenterol 2003; 41:1145-50. [PMID: 14661123 DOI: 10.1055/s-2003-45280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Osteoporosis is a frequent and clinically important complication in inflammatory bowel disease (IBD). Prevalence and risk factors have been examined in small numbers of patients. With a nationwide survey of members of the German Crohn's and Ulcerative Colitis Association (DCCV) we wanted to evaluate the situation in a larger group of patients. METHODS Questionnaires were sent with the autumn issue of the members journal to approx. 14,620 affected members of the DCCV. Items covered osteoporosis, clinical symptoms, anamnesis and sociodemographic topics. Results are presented as descriptive analysis and in a logistic regression analysis of factors contributing to the osteoporosis risk. RESULTS 2,536 questionnaires could be used (17.3 %). Mean age and distribution concerning diagnosis and gender were comparable to the DCCV members in total. The prevalence of pathologic bone density was 62.3 % in those 1,265 patients (50.1 %) who underwent bone densitometry in the course of their disease. The analysis led to the following possible risk factors: disease activity (high chronic activity or more than 1 acute flare annually vs. remission, p < 0.001), lifetime steroid dosage > 10 g (p = 0.002), Crohn's disease vs. ulcerative colitis (p = 0.02), multiple bowel resection (p = 0.032), age (p = 0.018) and low body mass index (p = 0.034). 83.4 % of the patients with pathologic bone density received specific therapy, but most of those (63.5 %) were solely substituted with calcium and vitamin D. CONCLUSION This is the first study looking at epidemiology and risk factors of osteoporosis in a large study population of patients with inflammatory bowel disease. Although the prevalence may be overestimated due to selection bias in our study, osteoporosis is confirmed as a frequent and clinically relevant complication in IBD. Bone densitometry is recommended in those patients with one or more risk factors.
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Affiliation(s)
- C von Tirpitz
- Abteilung Innere Medizin I, Universitätsklinikum Ulm.
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von Tirpitz C, Klaus J, Steinkamp M, Hofbauer LC, Kratzer W, Mason R, Boehm BO, Adler G, Reinshagen M. Therapy of osteoporosis in patients with Crohn's disease: a randomized study comparing sodium fluoride and ibandronate. Aliment Pharmacol Ther 2003; 17:807-16. [PMID: 12641503 DOI: 10.1046/j.1365-2036.2003.01448.x] [Citation(s) in RCA: 48] [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] [Indexed: 12/08/2022]
Abstract
BACKGROUND Osteoporosis is a frequent complication in Crohn's disease. Although the efficacy of both sodium fluoride and aminobisphosphonates in postmenopausal osteoporosis has been investigated in long-term therapy studies, no long-term results are available regarding the effect of these agents in the management of osteoporosis in patients with Crohn's disease. METHODS Eighty-four patients with Crohn's disease and pathological bone mineral density findings were randomized to receive either vitamin D3 (1000 IU) and calcium citrate (800 mg) daily (group A) or sodium fluoride (25 mg b.d., group B) or intravenous ibandronate (1 mg every 3 months, group C) in addition to daily calcium/vitamin D substitution. On admission to the study and after 12 and 27 months, patients underwent dual-energy X-ray absorptiometry and radiological examination of the spine. RESULTS Sixty-eight patients completed the 1-year observation period and were available for the intention-to-treat analysis. No new vertebral fractures were diagnosed. In group A, lumbar bone density increased by 2.6% (P = 0.066, N.S.), in group B by 5.7% (P = 0.003) and in group C by 5.4% (P = 0.003). Therapy with sodium fluoride was associated with an increase in osteocalcin (N.S.), whereas administration of ibandronate was associated with a decrease in the resorption parameter, carboxy-terminal cross-linked type-I collagen telopeptide (P < 0.05). Both sodium fluoride and ibandronate resulted in significant decreases in the serum concentration of osteoprotegerin after 9 months (P < 0.001). CONCLUSIONS The findings of the present study show that both sodium fluoride and ibandronate are effective in combination with calcium and vitamin D substitution in the management of osteopenia and osteoporosis in patients with Crohn's disease. Both agents are safe and well tolerated, and induce continuous increases in lumbar bone density.
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Affiliation(s)
- C von Tirpitz
- Department of Medicine I, University of Ulm, Ulm, Germany.
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Klaus J, Armbrecht G, Steinkamp M, Brückel J, Rieber A, Adler G, Reinshagen M, Felsenberg D, von Tirpitz C. High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease. Gut 2002; 51:654-8. [PMID: 12377802 PMCID: PMC1773437 DOI: 10.1136/gut.51.5.654] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [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] [Accepted: 03/28/2002] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Osteopenia and osteoporosis are frequent in Crohn's disease. However, there are few data on related vertebral fractures. Therefore, we evaluated prospectively the prevalence of osteoporotic vertebral fractures in these patients. METHODS A total of 293 patients were screened with dual energy x ray absorptiometry of the lumbar spine (L1-L4) and proximal right femur. In 156 patients with lumbar osteopenia or osteoporosis (T score <-1), x ray examinations of the thoracic and lumbar spine were performed. Assessment of fractures included visual reading of x rays and quantitative morphometry of the vertebral bodies (T4-L4), analogous to the criteria of the European Vertebral Osteoporosis Study. RESULTS In 34 (21.8%; 18 female) of 156 Crohn's disease patients with reduced bone mineral density, 63 osteoporotic vertebral fractures (50 fx. (osteoporotic fracture with visible fracture line running into the vertebral body and/or change of outer shape) and 13 fxd. (osteoporotic fracture with change of outer shape but without visible fracture line)) were found, 50 fx. in 25 (16%, 15 female) patients and 13 fxd. in nine (5.8%, three female) patients. In four patients the fractures were clinically evident and associated with severe back pain. Approximately one third of patients with fractures were younger than 30 years. Lumbar bone mineral density was significantly reduced in patients with fractures compared with those without (T score -2.50 (0.88) v -2.07 (0.66); p<0.025) but not at the hip (-2.0 (1.1) v -1.81 (0.87); p=0.38). In subgroups analyses, no significant differences were observed. CONCLUSIONS In patients with Crohn's disease and reduced bone mineral density, the prevalence of vertebral fractures-that is, manifest osteoporosis-was strikingly high at 22%, even in those aged less than 30 years, a problem deserving further clinical attention.
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Affiliation(s)
- J Klaus
- Department of Medicine I, University of Ulm, Germany
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Abstract
Mitogen-induced activation of a nuclear-acting PC-phospholipase D (PLD) is mediated, at least in part, by the translocation of RhoA to the nucleus. A remaining question is whether PLD in all subcellular compartments is regulated in the same manner. To address this question, we identified PLD in another subcellular compartment and determined whether its activity was influenced by alpha-thrombin in a RhoA-dependent manner. The data in this manuscript show that nuclear PLD is selectively regulated. alpha-Thrombin stimulates an increase in PLD activity in IIC9 fibroblast nuclei while Golgi PLD activity is unaffected. We cloned PLD1 from IIC9s (hamPLD1b) to show that it is present in both nuclei and Golgi. Interestingly, only nuclear PLD1 is modulated by alpha-thrombin, demonstrating that this activity is selectively regulated. These data provide support for the physiological importance of agonist-induced nuclear signalling enzymes.
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Affiliation(s)
- J J Baldassare
- Department of Pharmacological, St Louis University School of Medicine, USA
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Alkayed NJ, Goto S, Sugo N, Joh HD, Klaus J, Crain BJ, Bernard O, Traystman RJ, Hurn PD. Estrogen and Bcl-2: gene induction and effect of transgene in experimental stroke. J Neurosci 2001; 21:7543-50. [PMID: 11567044 PMCID: PMC6762919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2001] [Revised: 07/03/2001] [Accepted: 07/12/2001] [Indexed: 02/21/2023] Open
Abstract
Female rodents producing endogenous estrogens are protected from stroke damage in comparison with male counterparts. This natural protection is lost after ovariectomy or reproductive senescence. The aim of this study is to determine whether estrogen reduces early neuronal injury and cell loss after ischemia by increasing the expression of Bcl-2. Male, intact female, ovariectomized, and estrogen-repleted ovariectomized rats were subjected to middle cerebral artery occlusion, and 22 hr later the level and localization of Bcl-2 mRNA and protein were determined. The levels of post-ischemic bcl-2 mRNA and protein were increased exclusively in neurons within the peri-infarct region. Intact females and estrogen-treated castrates demonstrated increased bcl-2 mRNA and protein expression compared with males and estrogen-deficient females, accompanied by a decrease in infarct size. To test the hypothesis that the neuroprotective mechanism of estrogen functions via Bcl-2, we compared ischemic outcome in male, female, and ovariectomized wild-type mice and mice overexpressing Bcl-2 exclusively in neurons. Wild-type female mice sustained smaller infarcts compared with males. Bcl-2 overexpression reduced infarct size in males, but provided no added protection in the female. Moreover, ovariectomy exacerbated infarction in wild-type females, but had no effect in Bcl-2 overexpressors. These data indicate that overexpression of Bcl-2 simulates the protection against ischemic injury conferred by endogenous female sex steroids. We concluded that estrogen rescues neurons after focal cerebral ischemia by increasing the level of Bcl-2 in peri-infarct regions and that estrogen-induced bcl-2 gene expression is an important downstream component of neuronal protection in female stroke.
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Affiliation(s)
- N J Alkayed
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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von Tirpitz C, Klaus J, Brückel J, Rieber A, Scholer A, Adler G, Böhm BO, Reinshagen M. Increase of bone mineral density with sodium fluoride in patients with Crohn's disease. Eur J Gastroenterol Hepatol 2000; 12:19-24. [PMID: 10656205 DOI: 10.1097/00042737-200012010-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Low bone density with an increased risk of vertebral fractures is a frequent complication in inflammatory bowel disease. Since the aetiology of osteopathia in these patients is different compared to postmenopausal or steroid-induced osteoporosis, no treatment strategy is established. Supplementation of calcium and vitamin D has been shown to prevent further bone loss, but no data are available showing the anabolic effect of sodium fluoride in Crohn's disease. METHODS We carried out a one-year prospective clinical trial in 33 patients with chronic active Crohn's disease who were randomly assigned to receive either calcium (500 mg b.i.d.) and 1000 IU vitamin D3 only, or retarded-release sodium fluoride (25 mg t.i.d.) additionally. The diagnosis of Crohn's disease had been made at least two years ago, and all patients had received systemic high-dose steroid therapy during the previous year. Eleven of 15 patients who received calcium/vitamin D and 15 of 18 patients who additionally received sodium fluoride completed the study. The primary endpoint of the study was the increase of bone mineral density, measured by dual energy X-ray absorptiometry (DXA) after one year of treatment. Bone-specific alkaline phosphatase and osteocalcin were used as markers for bone turnover. RESULTS In the calcium/vitamin D only group, bone density was not significantly changed after one year of treatment, whereas in the calcium/vitamin D/fluoride group, bone density of the lumbar spine increased from -1.39+/-0.3 (Z-score, mean +/- SEM) to -0.65+/-0.3 (P<0.05) after one year of treatment. Increase of bone density was positively correlated to the osteoblastic markers bone-specific alkaline phosphatase (r = 0.53) and osteocalcin (r = 0.43). CONCLUSIONS Sodium fluoride in combination with vitamin D and calcium is an effective, well-tolerated and inexpensive treatment to increase lumbar bone density in patients with chronic active Crohn's disease and osteoporosis.
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Affiliation(s)
- C von Tirpitz
- Department of Medicine I, University of Ulm, Germany
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Von Tirpitz C, Pischulti G, Klaus J, Rieber A, Brückel J, Böhm BO, Adler G, Reinshagen M. [Pathological bone density in chronic inflammatory bowel diseases--prevalence and risk factors]. Z Gastroenterol 1999; 37:5-12. [PMID: 10091278] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Osteopenia and osteoporosis are frequent but often underestimated complications in inflammatory bowel disease. In patients with IBD, several factors could contribute to osteopenia, but the pathogenetic mechanisms are still not completely understood. We carried out a prospective study to evaluate the prevalence and possible etiologic factors for osteopenia and subsequent osteoporosis in IBD-patients. METHODS 140 patients with inflammatory bowel disease (Crohn's disease n = 125, ulcerative colitis n = 15) underwent clinical and spine radiological assessments. Lumbar bone mineral densities were measured by dual energy X-ray absorptiometry (DXA). Markers of bone formation and resorption and vitamin D were assessed in n = 95 patients. Patients were asked about medication, previous or actual intestinal stenosis, smoking and intestinal resection. A lactose-H2-breath test was undertaken if lactose intolerance was clinically suspected. RESULTS Compared to age- and sex-matched healthy controls (Z-score), the prevalence of osteopenia (Z < -1) was 62%, while osteoporosis (Z < -2) occurred in 38%. The mean bone density of IBD-patients was osteopenic with no significant differences between Crohn's disease (Z = -1.24) and ulcerative colitis (Z = -1.25). Osteoporotic fractures were seen in three patients (2.1%). Crohn's disease patients with osteoporosis showed a significant lower body mass index (BMI) than patients with normal bone density. 52.9% of patients with manifest osteoporosis underwent systemic steroid treatment in the preceding year, but only 34% of those with normal bone density. Except hemoglobin, none of the biochemical markers showed a significant difference between osteoporosis, osteopenia and patients with normal bone density. CONCLUSION The results show a high prevalence of osteopenia and osteoporosis in IBD. Since osteoporosis is often associated with low body mass index, multiple intestinal resections and previous systemic steroid treatment, we suggest a bone densitometry in these patients. Since etiology of osteoporosis in IBD is multifactorious and not completely understood, there is still no standard treatment. The effect of osteoanabolic and antiresorptive agents must be evaluated in further studies.
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Affiliation(s)
- C Von Tirpitz
- Abteilung Innere Medizin I, Universitätsklinikum Ulm
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Klaus J. [Cold shower and hay flower. Sebastian Kneipp died 100 years ago]. Pflege Z 1997; 50:312-3. [PMID: 9277252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Dipeptides containing fluorescein or biotin have been incorporated into proteolytic substrate cleavage products of bovine serum albumin generated by human cathepsin S or neutrophil elastase and into a fragment of the 31-kDa interleukin 1beta precursor by human interleukin 1beta-converting enzyme. Incorporation of the nucleophile is blocked by prior inhibition of the enzymes, and is not seen when proteolysis occurs in the absence of label, and the protease is then inhibited before the addition of label. Labeling is dependent on the pH, the time of reaction, and the concentrations of the nucleophile and substrate. Labeling of proteins can be readily detected by SDS-polyacrylamide gel electrophoresis. The pattern of elastase-labeled bovine serum albumin bands differs among P1' Phe, Ala, and Gly, suggesting that nucleophilic attack on acyl enzyme intermediates derived from a large protein may differ from attack on small intermediates. The only observed labeled fragment catalyzed by interleukin 1beta-converting enzyme is fragment 28-116 from the interleukin 1beta precursor, suggesting that the cleavage between residues 27 and 28 is at least as efficient as between residues 116 and 117. This labeling method does not require organic solvent or nonphysiological pH values and thus may be useful for the discovery of novel protease substrates in cells or other in vivo systems or for diagnostic applications.
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Affiliation(s)
- Y Wang
- Khepri Pharmaceuticals, South San Francisco, California 94080, USA
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Stiehl A, Rudolph G, Raedsch R, Möller B, Hopf U, Lotterer E, Bircher J, Fölsch U, Klaus J, Endele R, Senn M. Ursodeoxycholic acid-induced changes of plasma and urinary bile acids in patients with primary biliary cirrhosis. Hepatology 1990; 12:492-7. [PMID: 2401455 DOI: 10.1002/hep.1840120308] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ursodeoxycholic acid treatment of patients with primary biliary cirrhosis may lead to relief of pruritus and improvement of biochemical liver tests. The changes in serum and urinary bile acids induced by ursodeoxycholic acid treatment were studied. After 29 patients with primary biliary cirrhosis were treated with ursodeoxycholic acid (750 to 1,000 mg/day) for 6 to 12 mo because of an increase in ursodeoxycholic acid, total plasma bile acids increased from 30.5 +/- 6 mumol/L (mean +/- S.E.M.) to 52.7 +/- 11.7 mumol/L (p less than 0.01). The increase in total plasma bile acids correlated significantly with concentrations of plasma bile acid before treatment (p less than 0.01). The concentrations of endogenous bile acids decreased, mainly because of a decrease of cholic acid. During treatment, glycine conjugation increased and taurine conjugation decreased, whereas sulfation and glucuronidation of bile acids were unchanged. In 10 patients with primary biliary cirrhosis in stages III and IV, urinary excretion of bile acids was also studied. After treatment, ursodeoxycholic acid and its 3-beta isomer and C-1-hydroxylated and C-6-hydroxylated derivatives were also excreted. During treatment, urinary excretion of endogenous bile acids decreased. The increase of ursodeoxycholic acid and the decrease of endogenous bile acids may both be related to the improvement of biochemical liver tests in precirrhotic stages of the disease. In cirrhosis, endogenous bile acids in plasma remained high and changes in liver tests were small.
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Affiliation(s)
- A Stiehl
- Department of Internal Medicine, University of Heidelberg, FRG
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Klaus J, Pudlik B. [Accessory pancreas as a cause of small intestine intussusception]. Pol Przegl Chir 1975; 47:1579-80. [PMID: 1208263] [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: 12/26/2022]
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