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Künzel SR, Winter L, Hoffmann M, Kant TA, Thiel J, Kronstein‐Wiedemann R, Klapproth E, Lorenz K, El‐Armouche A, Kämmerer S. Investigation of mesalazine as an antifibrotic drug following myocardial infarction in male mice. Physiol Rep 2023; 11:e15809. [PMID: 37688424 PMCID: PMC10492006 DOI: 10.14814/phy2.15809] [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: 06/23/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Myocardial infarction (MI) initiates a complex reparative response during which damaged cardiac muscle is replaced by connective tissue. While the initial repair is essential for survival, excessive fibrosis post-MI is a primary contributor to progressive cardiac dysfunction, and ultimately heart failure. Currently, there are no approved drugs for the prevention or the reversal of cardiac fibrosis. Therefore, we tested the therapeutic potential of repurposed mesalazine as a post-MI therapy, as distinct antifibrotic effects have recently been demonstrated. METHODS At 8 weeks of age, MI was induced in male C57BL/6J mice by LAD ligation. Mesalazine was administered orally at a dose of 100 μg/g body weight in drinking water. Fluid intake, weight development, and cardiac function were monitored for 28 days post intervention. Fibrosis parameters were assessed histologically and via qPCR. RESULTS Compared to controls, mesalazine treatment offered no survival benefit. However, no adverse effects on heart and kidney function and weight development were observed, either. While total cardiac fibrosis remained largely unaffected by mesalazine treatment, we found a distinct reduction of perivascular fibrosis alongside reduced cardiac collagen expression. CONCLUSIONS Our findings warrant further studies on mesalazine as a potential add-on therapy post-MI, as perivascular fibrosis development was successfully prevented.
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Affiliation(s)
- Stephan R. Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
- Institute of Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
- German Red Cross Blood Donation Service North‐EastDresdenGermany
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
| | - Theresa A. Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
| | - Jessica Thiel
- Institute of Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
- German Red Cross Blood Donation Service North‐EastDresdenGermany
| | - Romy Kronstein‐Wiedemann
- Institute of Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
- German Red Cross Blood Donation Service North‐EastDresdenGermany
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
| | - Kristina Lorenz
- Institute of Pharmacology and Toxicology, Julius‐Maximilians‐University of WürzburgWürzburgGermany
- Leibniz‐Institut für Analytische Wissenschaften ‐ISAS‐ e.VDortmundGermany
| | - Ali El‐Armouche
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
| | - Susanne Kämmerer
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität DresdenDresdenGermany
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Bierwirth NC, Kim J, Moreira A, Winter L, Winter C, Blanco CL. Early hyperglycemia in extreme prematurity is associated with pulmonary and pancreatic dysfunction. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00600-6] [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: 01/28/2023]
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Gentle S, Travers C, Winter L, Tucker J, Purvis D, Ambalavanan N, Carlo W. Improving survival without bronchopulmonary dysplasia in extremely preterm infants. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is an integral part of thyroid nodule assessment. Nodules with an indeterminate cytology (THY3a-f) require formal histological assessment to confirm benign or malignant pathology. This study aimed to provide data for an evidence-based approach for management of patients with THY3f nodules. METHODS Retrospective review of patients who had a thyroid FNAC reported as suspicious of follicular neoplasm (THY3f) or showing atypia (THY3a) were identified, and clinical, operative and outcomes data were analysed. RESULTS Between 2018 and 2020, 200 patients (167F:33M, median age 51 years (range:18-86 years)) had a THY3f cytology. Most presented with a palpable nodule (n=104; 68.4%). Overall, 152 (76.0%;130F:23M) underwent surgery and 31 (20.4%) were found to have a thyroid carcinoma (22 follicular carcinomas, 7 papillary carcinomas, 1 medullary thyroid carcinoma and 1 metastatic renal carcinoma). An additional incidental carcinoma (size: 0.7-13mm) was found in seven (4.6%). Among those with cancer, a completion thyroidectomy and radioactive iodine treatment was indicated in nine (<6% of the entire cohort). Previously suggested risk factors for malignancy, eg male gender, large tumour size (>4cm) or age, were not found to be associated with increased risk. During the same period, THY3a cytology was reported in 53 patients, of whom 29 underwent diagnostic surgery and 4 patients were found to have a thyroid cancer (follicular, n=3 and medullary, n=1). CONCLUSION One in five patients with features suspicious of a follicular neoplasm (THY3f) has a thyroid carcinoma. This risk is much lower for THY3a. This study reinforces the current recommendation for thyroid surgery in all patients with a reliable THY3f cytology, as no further stratifying risk factors could be identified.
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Affiliation(s)
- M C de Jong
- Oxford University Hospitals NHS Foundation Trust, UK
| | - J McNamara
- Oxford University Hospitals NHS Foundation Trust, UK
| | - L Winter
- Oxford University Hospitals NHS Foundation Trust, UK
| | - D Roskell
- Oxford University Hospitals NHS Foundation Trust, UK
| | - S Khan
- Oxford University Hospitals NHS Foundation Trust, UK
| | - R Mihai
- Oxford University Hospitals NHS Foundation Trust, UK
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Newe M, Kant TA, Hoffmann M, Rausch JSE, Winter L, Künzel K, Klapproth E, Günther C, Künzel SR. Systemic mesalazine treatment prevents spontaneous skin fibrosis in PLK2-deficient mice. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2233-2244. [PMID: 34410453 PMCID: PMC8514377 DOI: 10.1007/s00210-021-02135-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
Skin fibrosis is a complex biological remodeling process occurring in disease like systemic sclerosis, morphea, or eosinophilic fasciitis. Since the knowledge about the underlying pathomechanisms is still incomplete, there is currently no therapy, which prevents or reverses skin fibrosis sufficiently. The present study investigates the role of polo-like kinase 2 (PLK2) and the pro-fibrotic cytokine osteopontin (OPN) in the pathogenesis of cutaneous fibrosis and demonstrates the antifibrotic effects of systemic mesalazine treatment in vivo. Isolated primary dermal fibroblasts of PLK2 wild-type (WT) and knockout (KO) mice were characterized invitro. Skin thickness and histoarchitecture were studied in paraffin-embedded skin sections. The effects of mesalazine treatment were examined in isolated fibroblasts and PLK2 KO mice, which were fed 100 µg/g mesalazine for 6 months via the drinking water. Compared to WT, PLK2 KO fibroblasts displayed higher spontaneous myofibroblast differentiation, reduced proliferation rates, and overexpression of the fibrotic cytokine OPN. Invitro, 72 h of treatment with 10 mmol/L mesalazine induced phenotype conversion in PLK2 KO fibroblasts and attenuated OPN expression by inhibiting ERK1/2. In vivo, dermal myofibroblast differentiation, collagen accumulation, and skin thickening were prevented by mesalazine in PLK2 KO. Plasma creatinine levels indicated good tolerability of systemic long-term mesalazine treatment. The current study reveals a spontaneous fibrotic skin phenotype and ERK1/2-dependent OPN overexpression in PLK2 KO mice. We provide experimental evidence for the antifibrotic effectiveness of systemic mesalazine treatment to prevent fibrosis of the skin, suggesting further investigation in experimental and clinical settings.
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Affiliation(s)
- Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Theresa A Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Johanna S E Rausch
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan R Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany.
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Kant TA, Newe M, Winter L, Hoffmann M, Kämmerer S, Klapproth E, Künzel K, Kühnel MP, Neubert L, El-Armouche A, Künzel SR. Genetic Deletion of Polo-Like Kinase 2 Induces a Pro-Fibrotic Pulmonary Phenotype. Cells 2021; 10:617. [PMID: 33799608 PMCID: PMC8001503 DOI: 10.3390/cells10030617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
Pulmonary fibrosis is the chronic-progressive replacement of healthy lung tissue by extracellular matrix, leading to the destruction of the alveolar architecture and ultimately death. Due to limited pathophysiological knowledge, causal therapies are still missing and consequently the prognosis is poor. Thus, there is an urgent clinical need for models to derive effective therapies. Polo-like kinase 2 (PLK2) is an emerging regulator of fibroblast function and fibrosis. We found a significant downregulation of PLK2 in four different entities of human pulmonary fibrosis. Therefore, we characterized the pulmonary phenotype of PLK2 knockout (KO) mice. Isolated pulmonary PLK2 KO fibroblasts displayed a pronounced myofibroblast phenotype reflected by increased expression of αSMA, reduced proliferation rates and enhanced ERK1/2 and SMAD2/3 phosphorylation. In PLK2 KO, the expression of the fibrotic cytokines osteopontin and IL18 was elevated compared to controls. Histological analysis of PLK2 KO lungs revealed early stage remodeling in terms of alveolar wall thickening, increased alveolar collagen deposition and myofibroblast foci. Our results prompt further investigation of PLK2 function in pulmonary fibrosis and suggest that the PLK2 KO model displays a genetic predisposition towards pulmonary fibrosis, which could be leveraged in future research on this topic.
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Affiliation(s)
- Theresa A. Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Susanne Kämmerer
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Mark P. Kühnel
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany; (M.P.K.); (L.N.)
| | - Lavinia Neubert
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany; (M.P.K.); (L.N.)
| | - Ali El-Armouche
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
| | - Stephan R. Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (T.A.K.); (M.N.); (L.W.); (M.H.); (S.K.); (E.K.); (K.K.)
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Lisberg A, Liu B, Salehi-Rad R, Lee J, Tran L, Krysan K, Li R, Lin Y, Abtin F, Suh R, Oh S, Aberle D, Winter L, Wallace W, Elashoff D, Garon E, Sharma S, Dubinett S. P15.08 Phase I Trial of in situ Vaccination With Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined With Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.545] [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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Valencia RG, Mihailovska E, Winter L, Bauer K, Fischer I, Walko G, Jorgacevski J, Potokar M, Zorec R, Wiche G. Plectin dysfunction in neurons leads to tau accumulation on microtubules affecting neuritogenesis, organelle trafficking, pain sensitivity and memory. Neuropathol Appl Neurobiol 2021; 47:73-95. [PMID: 32484610 PMCID: PMC7891324 DOI: 10.1111/nan.12635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/19/2020] [Indexed: 12/26/2022]
Abstract
AIMS Plectin, a universally expressed multi-functional cytolinker protein, is crucial for intermediate filament networking, including crosstalk with actomyosin and microtubules. In addition to its involvement in a number of diseases affecting skin, skeletal muscle, heart, and other stress-exposed tissues, indications for a neuropathological role of plectin have emerged. Having identified P1c as the major isoform expressed in neural tissues in previous studies, our aim for the present work was to investigate whether, and by which mechanism(s), the targeted deletion of this isoform affects neuritogenesis and proper nerve cell functioning. METHODS For ex vivo phenotyping, we used dorsal root ganglion and hippocampal neurons derived from isoform P1c-deficient and plectin-null mice, complemented by in vitro experiments using purified proteins and cell fractions. To assess the physiological significance of the phenotypic alterations observed in P1c-deficient neurons, P1c-deficient and wild-type littermate mice were subjected to standard behavioural tests. RESULTS We demonstrate that P1c affects axonal microtubule dynamics by isoform-specific interaction with tubulin. P1c deficiency in neurons leads to altered dynamics of microtubules and excessive association with tau protein, affecting neuritogenesis, neurite branching, growth cone morphology, and translocation and directionality of movement of vesicles and mitochondria. On the organismal level, we found P1c deficiency manifesting as impaired pain sensitivity, diminished learning capabilities and reduced long-term memory of mice. CONCLUSIONS Revealing a regulatory role of plectin scaffolds in microtubule-dependent nerve cell functions, our results have potential implications for cytoskeleton-related neuropathies.
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Affiliation(s)
- R. G. Valencia
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
- Present address:
Department of ImmunologyUniversity Children’s Hospital ZurichZurichSwitzerland
| | - E. Mihailovska
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
- Present address:
AFFiRiS AGViennaAustria
| | - L. Winter
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
- Neuromuscular Research DepartmentCenter for Anatomy and Cell BiologyMedical University of ViennaViennaAustria
| | - K. Bauer
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
| | - I. Fischer
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
| | - G. Walko
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
- Present address:
Department of Biology and BiochemistryUniversity of BathBathUK
| | - J. Jorgacevski
- Laboratory of Neuroendocrinology – Molecular Cell PhysiologyFaculty of MedicineInstitute of PathophysiologyUniversity of LjubljanaLjubljanaSlovenia
- Celica Biomedical SloveniaLjubljanaSlovenia
| | - M. Potokar
- Laboratory of Neuroendocrinology – Molecular Cell PhysiologyFaculty of MedicineInstitute of PathophysiologyUniversity of LjubljanaLjubljanaSlovenia
- Celica Biomedical SloveniaLjubljanaSlovenia
| | - R. Zorec
- Laboratory of Neuroendocrinology – Molecular Cell PhysiologyFaculty of MedicineInstitute of PathophysiologyUniversity of LjubljanaLjubljanaSlovenia
- Celica Biomedical SloveniaLjubljanaSlovenia
| | - G. Wiche
- Max F. Perutz LaboratoriesDepartment of Biochemistry and Cell BiologyUniversity of ViennaViennaAustria
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Leroux AC, Bartels E, Winter L, Mann M, Otte K, Zehe C. Transferability of miRNA-technology to bioprocessing: Influence of cultivation mode and media. Biotechnol Prog 2020; 37:e3107. [PMID: 33300297 PMCID: PMC8244005 DOI: 10.1002/btpr.3107] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023]
Abstract
The biopharmaceutical industry strives for improvement of their production processes. In recent years, miRNAs have been shown to positively impact the production capacity of recombinant CHO cells, especially with regard to difficult to express proteins. Effective and reliable gene regulation of process relevant target genes by miRNAs is a prerequisite for integrating them into the toolbox of industrial cell engineering strategies. However, most studies rely on transient transfection of miRNA mimics; there is low standardization in evaluation of miRNA function and little knowledge on transferability of effects found during transient expression to stable expression during industry relevant fed‐batch cultivation. In order to provide more insight into this topic, we used the pcDNA6.2 vector for stable miRNA overexpression during batch and fed‐batch cultivation in CHO DG44 cells, optimized the vector, and compared the miRNA levels and effects with those achieved by transfection of miRNA mimics. We found that miR‐1 downregulated TWF1 mRNA in different recombinant CHO DG44 clones in a dose‐dependent manner during transient batch cultivation. Cells stably overexpressing miR‐1 also showed a TWF1 mRNA downregulation when cultivated in batch mode using in‐house medium 1. However, when the cells stably overexpressing miR‐1 were cultivated in fed‐batch mode using in‐house medium 2. Consequently, a change of cultivation mode and medium seems to have an impact on target gene regulation by miRNA. Taken together, our findings highlight the importance to standardize miRNA evaluations and test miRNAs in the final application environment.
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Affiliation(s)
- Ann-Cathrin Leroux
- Product Development, Sartorius Stedim Cellca GmbH, Ulm, Germany.,Advanced Biotech Applications Corporate Research, Sartorius Stedim Cellca GmbH, Ulm, Germany
| | - Elisabeth Bartels
- Product Development, Sartorius Stedim Cellca GmbH, Ulm, Germany.,Operations, Sartorius Stedim Cellca GmbH, Ulm, Germany
| | - Luise Winter
- Product Development, Sartorius Stedim Cellca GmbH, Ulm, Germany.,Upstream Process Development, Rentschler Biopharma, Laupheim, Germany
| | - Melanie Mann
- Product Development, Sartorius Stedim Cellca GmbH, Ulm, Germany
| | - Kerstin Otte
- Biology, Cell- and Molecular Biology, Biberach University of Applied Sciences, Biberach an der Riß, Germany
| | - Christoph Zehe
- Advanced Biotech Applications Corporate Research, Sartorius Stedim Cellca GmbH, Ulm, Germany
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Hoffmann M, Kant TA, Emig R, Rausch JSE, Newe M, Schubert M, Künzel K, Winter L, Klapproth E, Peyronnet R, Ravens U, El-Armouche A, Künzel SR. Repurposing mesalazine against cardiac fibrosis in vitro. Naunyn Schmiedebergs Arch Pharmacol 2020; 394:533-543. [PMID: 33064167 PMCID: PMC7892689 DOI: 10.1007/s00210-020-01998-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular diseases are exacerbated and driven by cardiac fibrosis. TGFβ induces fibroblast activation and differentiation into myofibroblasts that secrete excessive extracellular matrix proteins leading to stiffening of the heart, concomitant cardiac dysfunction, and arrhythmias. However, effective pharmacotherapy for preventing or reversing cardiac fibrosis is presently unavailable. Therefore, drug repurposing could be a cost- and time-saving approach to discover antifibrotic interventions. The aim of this study was to investigate the antifibrotic potential of mesalazine in a cardiac fibroblast stress model. TGFβ was used to induce a profibrotic phenotype in a human cardiac fibroblast cell line. After induction, cells were treated with mesalazine or solvent control. Fibroblast proliferation, key fibrosis protein expression, extracellular collagen deposition, and mechanical properties were subsequently determined. In response to TGFβ treatment, fibroblasts underwent a profound phenoconversion towards myofibroblasts, determined by the expression of fibrillary αSMA. Mesalazine reduced differentiation nearly by half and diminished fibroblast proliferation by a third. Additionally, TGFβ led to increased cell stiffness and adhesion, which were reversed by mesalazine treatment. Collagen 1 expression and deposition—key drivers of fibrosis—were significantly increased upon TGFβ stimulation and reduced to control levels by mesalazine. SMAD2/3 and ERK1/2 phosphorylation, along with reduced nuclear NFκB translocation, were identified as potential modes of action. The current study provides experimental pre-clinical evidence for antifibrotic effects of mesalazine in an in vitro model of cardiac fibrosis. Furthermore, it sheds light on possible mechanisms of action and suggests further investigation in experimental and clinical settings.
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Affiliation(s)
- Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Theresa A Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Ramona Emig
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Johanna S E Rausch
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Mario Schubert
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Rémi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany
| | - Ali El-Armouche
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Stephan R Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany.
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Thomson R, Bourne D, Winter L, Gemmell L. Can we meet patients’ energy and nitrogen requirements with standard peripheral parenteral nutrition bags? Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kumar D, Vachharajani AJ, Wertheimer F, Vergales B, Glass K, Dannaway D, Winter L, Delaney H, Ganster A, Arnold J, Urban A, Johnston L, Bruno C, Gray MM, Sawyer T. Boot camps in neonatal-perinatal medicine fellowship programs: A national survey. J Neonatal Perinatal Med 2020; 12:231-237. [PMID: 30829620 DOI: 10.3233/npm-18117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.
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Affiliation(s)
- D Kumar
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - A J Vachharajani
- Department of Pediatrics, Division of Newborn Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - F Wertheimer
- Department of Pediatrics, Division of Neonatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - B Vergales
- Department of Pediatrics, Division of Neonatology, University of Virginia Health System, Charlottesville, VA, USA
| | - K Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - D Dannaway
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L Winter
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Delaney
- Department of Pediatrics, Division of Neonatology, Brooke Army Medical Center, San Antonio, TX, USA
| | - A Ganster
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Arnold
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - A Urban
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - C Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - M M Gray
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
| | - T Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
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Clemen C, Winter L, Unger A, Berwanger C, Spörrer M, Linke W, Schröder R. P.80Imbalances in protein homeostasis caused by mutant desmin. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Winter L, Unger A, Berwanger C, Spörrer M, Türk M, Chevessier F, Strucksberg KH, Schlötzer-Schrehardt U, Wittig I, Goldmann WH, Marcus K, Linke WA, Clemen CS, Schröder R. Imbalances in protein homeostasis caused by mutant desmin. Neuropathol Appl Neurobiol 2018; 45:476-494. [PMID: 30179276 DOI: 10.1111/nan.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 12/19/2022]
Abstract
AIMS We investigated newly generated immortalized heterozygous and homozygous R349P desmin knock-in myoblasts in conjunction with the corresponding desminopathy mice as models for desminopathies to analyse major protein quality control processes in response to the presence of R349P mutant desmin. METHODS We used hetero- and homozygous R349P desmin knock-in mice for analyses and for crossbreeding with p53 knock-out mice to generate immortalized R349P desmin knock-in skeletal muscle myoblasts and myotubes. Skeletal muscle sections and cultured muscle cells were investigated by indirect immunofluorescence microscopy, proteasomal activity measurements and immunoblotting addressing autophagy rate, chaperone-assisted selective autophagy and heat shock protein levels. Muscle sections were further analysed by transmission and immunogold electron microscopy. RESULTS We demonstrate that mutant desmin (i) increases proteasomal activity, (ii) stimulates macroautophagy, (iii) dysregulates the chaperone assisted selective autophagy and (iv) elevates the protein levels of αB-crystallin and Hsp27. Both αB-crystallin and Hsp27 as well as Hsp90 displayed translocation patterns from Z-discs as well as Z-I junctions, respectively, to the level of sarcomeric I-bands in dominant and recessive desminopathies. CONCLUSIONS Our findings demonstrate that the presence of R349P mutant desmin causes a general imbalance in skeletal muscle protein homeostasis via aberrant activity of all major protein quality control systems. The augmented activity of these systems and the subcellular shift of essential heat shock proteins may deleteriously contribute to the previously observed increased turnover of desmin itself and desmin-binding partners, which triggers progressive dysfunction of the extrasarcomeric cytoskeleton and the myofibrillar apparatus in the course of the development of desminopathies.
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Affiliation(s)
- L Winter
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany.,Neuromuscular Research Department, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - A Unger
- Department of Cardiovascular Physiology, Ruhr-University Bochum, Bochum, Germany.,Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - C Berwanger
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Spörrer
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Türk
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - F Chevessier
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - K-H Strucksberg
- Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - I Wittig
- Functional Proteomics, SFB815 Core Unit, Medical School, Goethe University, Frankfurt, Germany
| | - W H Goldmann
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - K Marcus
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - W A Linke
- Department of Cardiovascular Physiology, Ruhr-University Bochum, Bochum, Germany.,Institute of Physiology II, University of Münster, Münster, Germany
| | - C S Clemen
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | - R Schröder
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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Petersen J, Winter L, Vettorazzi E, Schmied W, Girdauskas E, Reichenspurner H, Schäfers H. Physical and Mental Recovery after Aortic Valve Repair. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598966] [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)
- J. Petersen
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - L. Winter
- Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany
| | - E. Vettorazzi
- University Heart Center Hamburg, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - W. Schmied
- Saarland University Medical Center, Clinic for Psychosomatic Medicine, Homburg/Saar, Germany
| | - E. Girdauskas
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - H. Reichenspurner
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - H.J. Schäfers
- Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg/Saar, Germany
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Diermeier S, Haug M, Reischl B, Buttgereit A, Schürmann S, Spörrer M, Goldmann W, Fabry B, Elhimine F, Stehle R, Pfitzer G, Winter L, Clemen C, Schröder R, Friedrich O. DesR349P Mutation Results in Ultrastructural Disruptions and Compromise of Skeletal Muscle Biomechanics Already at Preclinical Stages in Young Mice before the Onset of Protein Aggregation. Biophys J 2016. [DOI: 10.1016/j.bpj.2015.11.1629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Petersen J, Winter L, Schmied W, Kindermann I, Schäfers HJ. Physical and Mental Recovery after Conventional Aortic Valve Surgery. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571614] [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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Batista AD, English R, Sidebottom R, Adams R, Winter L, Noble A, Harris A. PB.45. Correlation of perilesional tissue stiffness measured by ultrasound strain elastography with breast density. Breast Cancer Res 2014. [PMCID: PMC4243770 DOI: 10.1186/bcr3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Westhoff-Bleck M, Briest J, Widder J, Tutarel O, Winter L, Bleich S, Bauersachs J, Kahl K. Psychiatric morbidity in adults with congenital heart disease: Rare disease or frequent problem? Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394050] [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: 10/24/2022]
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Meltzer A, Ding R, Winter L, Benedict C, Rabovsky Z, McCarthy M. Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient Reported Outcomes of Testing and Treating for H. Pylori Infection. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.351] [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: 11/27/2022]
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Öksüz MÖ, Winter L, Pfannenberg C, Reischl G, Müssig K, Bares R, Dittmann H. Peptide receptor radionuclide therapy of neuroendocrine tumors with (90)Y-DOTATOC: is treatment response predictable by pre-therapeutic uptake of (68)Ga-DOTATOC? Diagn Interv Imaging 2013; 95:289-300. [PMID: 24034971 DOI: 10.1016/j.diii.2013.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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] [Indexed: 11/19/2022]
Abstract
PURPOSE PET with (68)Ga-DOTATOC allows for imaging and quantitative assessment of somatostatin receptor expression in neuroendocrine tumors (NET). The aim of this retrospective study was to analyze whether pre-therapeutic (68)Ga-DOTATOC PET/CT is able to predict response to Peptide Receptor Radionuclide Therapy (PRRT). PATIENTS AND METHODS Forty patients with advanced stage NET were treated with a fixed dose of (90)Y-DOTATOC (5550 or 3700MBq). Prior to PRRT, each patient received (68)Ga-DOTATOC PET/CT. Treatment results were evaluated after 3months by CT, tumor marker levels and clinical course and correlated with (68)Ga-DOTATOC uptake (SUVmax) and the assumed uptake of (90)Y-DOTATOC in tumor manifestations (MBq/g). ROC analysis and pairwise comparison of area under the curve (AUC) were performed with pre-treatment uptake of (68)Ga-DOTATOC, assumed uptake of (90)Y-DOTATOC and treatment activity alone and in relation to body weight as continuous variables, and response/no response as classification variable. RESULTS According to conventional criteria (tumor shrinkage, decrease of tumor markers, improved or stable clinical condition), 20 patients were classified as responders, 16 as non-responders and in four patients findings were equivocal. Using a SUV more than 17.9 as cut-off for favorable outcome, PET was able to predict treatment response of all responders and 15 out of 16 non-responders. All four patients with equivocal findings showed SUV less than or equal to 17.9 and soon experienced tumor progression. The assumed uptake of (90)Y-DOTATOC in tumor manifestations using a cut-off more than 1.26MBq/g as predictor of response was able to correctly classify 19 out of 20 responders, and 14 out of 16 non-responders. In all patients with equivocal findings, the assumed uptake of (90)Y-DOTATOC was below 1.26MBq/g. CONCLUSION Pre-therapeutic (68)Ga-DOTATOC tumor uptake as well as assumed uptake of (90)Y-DOTATOC are strongly associated with the results of subsequent PRRT. The defined cut-off values should be confirmed by prospective studies and may then provide the rationale for individual dosing and selecting patients with high likelihood of favorable treatment outcome.
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Affiliation(s)
- M Ö Öksüz
- Département d'Imagerie Médicale, Hôpital neuchâtelois, Maladière 45, 2000 Neuchâtel, Switzerland; Department of Nuclear Medicine, Tübingen University Hospital, Otfried-Müller-Strasse 14, 72076 Tübingen, Germany.
| | - L Winter
- Department of Radiology and Nuclear Medicine, Basel University Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - C Pfannenberg
- Department of Radiology, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany
| | - G Reischl
- Department of Radiopharmacy, Tübingen University Hospital, Röntgenweg 15, 72076 Tübingen, Germany
| | - K Müssig
- Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - R Bares
- Department of Nuclear Medicine, Tübingen University Hospital, Otfried-Müller-Strasse 14, 72076 Tübingen, Germany
| | - H Dittmann
- Department of Nuclear Medicine, Tübingen University Hospital, Otfried-Müller-Strasse 14, 72076 Tübingen, Germany
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Dieringer MA, Deimling M, Fuchs K, Winter L, Kraus O, Knobelsdorff-Brenkenhoff FV, Schulz-Menger J, Niendorf T. 1045Blood/myocardium contrast-to-noise ratio for cardiac
morphology and function imaging increases with field strength. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070bl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Graessl A, Ruehle A, Renz W, Winter L, Pfeiffer H, Ruff J, Rieger J, Niendorf T. Sodium imaging of the heart at 7T: design, evaluation and application of a four-channel transmit/receive surface coil array. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560029 DOI: 10.1186/1532-429x-15-s1-w14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Winter L, Kellman P, Renz W, Graessl A, Hezel F, Thalhammer C, von Knobelsdorff-Brenkenhoff F, Tkachenko V, Schulz-Menger J, Niendorf T. Comparison of three multichannel TX/RX coils for anatomic and functional CMR at 7.0T. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560092 DOI: 10.1186/1532-429x-15-s1-w24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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English RE, Di Battista A, Adams RF, Winter L, Noble JA. Use of ultrasound elasticity imaging to monitor the response of a primary breast cancer to neoadjuvant chemotherapy in one patient in a pilot study. Breast Cancer Res 2011. [PMCID: PMC3238280 DOI: 10.1186/bcr2995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Type 3 Von Willebrand disease (VWD) is a rare, severe, autosomal recessive bleeding disorder. In our institution, we follow 17 children with type 3 VWD. We have observed a high prevalence of dental disease in these patients prompting us to undertake a retrospective review of our cohort of patients with type 3 VWD to catalogue the extent of their dental disease. Sixteen of these patients have been assessed by our dentistry department. Five children have undergone minor dental procedures (e.g. restorations, stainless steel crowns) and seven major procedures (e.g. dental extractions, pulpotomies and root canal treatments). These patients have collectively used 85,400 (ristocetin cofactor) IU of Humate-P on dental procedures alone. In addition to the considerable costs of factor are the cost of operating room time, dentists' costs, and the cost of other topical haemostatic agents (e.g. Tisseel) used during their dental procedures. As such there is considerable morbidity and cost from dental disease in these patients that is much higher than what is seen in patients with haemophilia or in the normal paediatric population. We speculate that the combination of these patients having a significant mucosal bleeding disorder together with various socioeconomic factors contribute to the significant degree of dental disease seen in this group of patients. We would suggest that better preventive dental care needs to be provided to these patients to avoid the considerable morbidity and very high burden of dental disease in type 3 VWD.
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Affiliation(s)
- M D Carcao
- Child Health Evaluative Sciences, Research Institute, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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Koligi K, Mertz D, Benz D, Vogt T, Bloemberg G, Winter L, Tyndall A, Battegay M, Walker U. Oligoarthritis durch Tropheryma whipplei. Internist (Berl) 2010; 52:884-8. [DOI: 10.1007/s00108-010-2741-z] [Citation(s) in RCA: 5] [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: 12/19/2022]
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Winter L, Wolf KJ, Hohmann J. Computertomografische Diagnostik einer Gallenblasenperforation Typ II/III. ROFO-FORTSCHR RONTG 2010; 182:527-9. [DOI: 10.1055/s-0029-1245276] [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: 10/19/2022]
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Winter L, Zellweger MJ, Bremerich J. [Endomyocardial fibrosis in chronic eosinophilic leukemia]. ROFO-FORTSCHR RONTG 2009; 181:691-3. [PMID: 19401974 DOI: 10.1055/s-0028-1109295] [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: 10/20/2022]
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Abstract
BACKGROUND There is a paucity of research on the relationship between parental knowledge, parenting and parenting self-efficacy, and some inconsistencies have been reported in the literature. METHOD Parent knowledge of effective parenting strategies was assessed among 68 parents from a non-clinic sample, who also completed questionnaires relating to parenting confidence, quality of parenting and child behaviour. RESULTS Parents with greater knowledge tended to be less dysfunctional, and reported significantly higher education and income levels. Parenting confidence explained a significant proportion of the variance in reported frequency of disruptive child behaviour while knowledge did not independently contribute to the prediction. However, the relationship between parenting confidence and dysfunctional parenting was moderated by the level of knowledge. There was a stronger negative relationship between confidence and dysfunctional parenting when knowledge level was low than when it was high. Post hoc analyses indicated that the relationship between parenting knowledge and disruptive child behaviour was moderated by the level of parenting dysfunction. Parenting knowledge and reported frequency of disruptive behaviour were positively related when the level of dysfunction was low, but were unrelated when it was high. CONCLUSIONS Parents with low levels of knowledge and confidence in their parenting may be at greater risk of dysfunctional parenting and might benefit from interventions designed to enhance both knowledge and confidence. Results are interpreted in relation to inconsistencies with previous research and implications for future methodologies.
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Affiliation(s)
- A Morawska
- School of Psychology, University of Queensland, Qld, Australia.
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Pollard JA, Winter L, Borinstein S, Hawkins DS. Pegfilgrastim for treatment of chemotherapy associated myelosuppression in pediatric patients with solid tumor malignancies. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10022] [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: 11/20/2022] Open
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Kesten F, Sutter R, Winter L, Engelter S, Fluri F, Bingisser R, Bodmer M. [Really drunk?]. Praxis (Bern 1994) 2007; 96:1767-1771. [PMID: 18050602 DOI: 10.1024/1661-8157.96.45.1767] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report about a 42-year-old patient who was admitted to the emergency department because of suspected alcohol abuse. He declared himself to be drunk. He stated in his case history that he had suffered from right sided neck and facial pain for several days. The clinical examination revealed a left sided hemiparesis. Together with the demonstrated right hemispherical brain ischemia by computed tomography, a presumptive diagnosis of a dissection of the right internal carotid artery was made. This diagnosis was finally confirmed by ultrasound and magnetic resonance imaging. A therapy with full dose heparin was begun and oral anticoagulation was subsequently initiated. After two weeks of follow-up, the neurological deficiencies were partially regredient.
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Affiliation(s)
- F Kesten
- Interdisziplinäre Notfallstation, Universitätsspital Basel
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Winter L, Bruhn H, Langrehr J, Neuhaus P, Felix R, Hänninen LE. Magnetic resonance imaging in suspected rectal cancer: determining tumor localization, stage, and sphincter-saving resectability at 3-Tesla-sustained high resolution. Acta Radiol 2007; 48:379-87. [PMID: 17453515 DOI: 10.1080/02841850701196914] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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: 01/11/2023]
Abstract
PURPOSE To assess image quality and overall accuracy of 3-Tesla (3T)-sustained high-resolution magnetic resonance (MR) imaging for diagnostic preoperative workup in suspected rectal carcinoma. MATERIAL AND METHODS Twenty-three patients with suspected rectal cancer underwent unenhanced and contrast-enhanced fat-suppressed pelvic high-resolution MR imaging using a four-channel phased-array pelvic coil at 3T. Image quality, tumor stage, distance from the anorectal margin, and sphincter-saving resectability were prospectively assessed by two blinded readers. The results were correlated with clinical, surgical, and histopathologic findings. RESULTS In all 23 patients, MR images were of diagnostic quality, and malignancy was correctly identified in 21 patients. The accuracy for determining sphincter-saving resectability was 100% (19/19). T stage and N stage were correctly diagnosed in 95% and 91%, respectively. MRI allowed correct identification of tumor extension and its relation to surgically relevant pelvic structures including the anorectal margin and mesorectal fascia. Transverse T2-weighted fast spin-echo images compared superiorly to all other sequences for the diagnosis of mesorectal infiltration and lymph node involvement. Moreover, transverse fat-suppressed contrast-enhanced T1-weighted images were valuable for identifying tumor infiltration, while sagittal sections were useful for the detection of longitudinal tumor extension. CONCLUSION MR imaging with phased-array receiver coils at 3T facilitated both visualization of different pathologic conditions of the rectum and accurate determination of tumor stage in rectal carcinomas. Thus, this noninvasive diagnostic approach appeared highly suitable for the assessment of patients with suspected rectal carcinoma.
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Affiliation(s)
- L Winter
- Department of Radiology, Charite Medical University Center, Campus Virchow Clinic, Berlin, Germany
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Balami JS, Jones HW, Alp N, Dwight J, Casser C, Martin A, Winter L. Atrial myxoma presenting as transient ischaemic attack and acute coronary syndrome in an octogenarian. Age Ageing 2006; 35:644. [PMID: 16951262 DOI: 10.1093/ageing/afl097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J S Balami
- Department of Clinical Geratology, Oxford Radcliffe Hospital NHS Trust, Headington, Oxford OX3 9DU, UK.
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Hawkins DS, Taylor J, Winter L, Geyer L. Oral out-patient chemotherapy medication errors in children with acute lymphoblastic leukemia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9028 Background: Oral out-patient chemotherapy medications (OOCMs) compromise the majority of therapy for children with acute lymphoblastic leukemia (ALL). OOCM are administered at the patient’s home, usually by parents with limited medical training. The frequency of errors in OOCM dose or schedule is unknown in children with ALL. Methods: We conducted a prospective case series. After providing informed consent, parents were interviewed during an ambulatory clinic visit to determine the dose and frequency of OOCMs administered since the last ambulatory clinic visit or hospitalization. Parents also completed a questionnaire regarding their understanding of the child’s OOCMs. Patient medical records were reviewed to determine the appropriate OOCM doses and schedules and then compared to the parent report. Pharmacy records were reviewed to determine how OOCMs were prescribed. OOCM errors included omission of any OOCM, use of an incorrect OOCM, > 10% deviation from the intended OOCM dose, or incorrect OOCM schedule. Results: 69 children (median age 6.4 years, range 1.3–17.9 years) participated, with a total of 171 OOCMs assessed. Fifteen (8.7%) OOCMs were given incorrectly, including 10 OOCMs administered incorrectly by parents, and five prescribed incorrectly. Eight errors involved under- or over-dosing within 10–20% of the intended OOCM dose. There were no errors in pharmacy dispensing. Errors were more common with glucocorticoids (9/60 OOCMs evaluated) than anti-metabolites (6/111 OOCMs evaluated). Conclusions: OOCM errors are unusual in children with ALL. Both administration and prescription errors were observed. Efforts to improve optimal use of OOCMs should include prevention of errors, potentially by identifying patients at higher risk for OOCM errors. No significant financial relationships to disclose.
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Affiliation(s)
- D. S. Hawkins
- Children’s Hospital and Regional Medical Center, Seattle, WA
| | - J. Taylor
- Children’s Hospital and Regional Medical Center, Seattle, WA
| | - L. Winter
- Children’s Hospital and Regional Medical Center, Seattle, WA
| | - L. Geyer
- Children’s Hospital and Regional Medical Center, Seattle, WA
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Hänninen EL, Pech M, Jonas S, Ricke J, Thelen A, Langrehr J, Hintze R, Röttgen R, Denecke T, Winter L, Neuhaus P, Felix R. Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions. Acta Radiol 2005; 46:462-70. [PMID: 16224919 DOI: 10.1080/02841850510021625] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 10/25/2022]
Abstract
PURPOSE To assess image quality and overall accuracy of magnetic resonance imaging (MRI), including two magnetic cholangiopancreatography (MRCP) techniques, for the diagnostics and preoperative work-up of malignant hilar obstructions. MATERIAL AND METHODS Thirty-one patients with malignant hilar obstructions (hilar cholangiocarcinoma, n=30; hepatocellular carcinoma, n=1) received MRCP by two techniques (single-shot thick-slab and multisection thin-slice MRCP) and unenhanced and contrast material-enhanced MRI. MR assessment included the evaluation of image quality and visualization of bile ducts (5-point scale), and the classification of tumor status. MR results were subsequently correlated with the results from surgery and pathology. RESULTS The maximum intensity projections of multisection thin-slice MRCP had significantly more artifacts compared to MRCP in the single-shot thick-slab technique, and overall image quality of single-shot thick-slab MRCP was rated significantly superior compared to multisection thin-slice MRCP (4.4 +/- 0.7 and 4.1 +/- 0.9, respectively). Moreover, ductal visualization of different parts of the biliary system was rated superior with single-shot thick-slab MRCP. In contrast, the original data from multisection thin slice MRCP facilitated visualization of periductal lesions and adjacent structures. Overall MR accuracy for the assessment of tumor status, periductal infiltration, and lymph node metastases was 90%, 87%, and 66%, respectively. CONCLUSION For evaluation of malignant hilar obstructions, MRCP by the single-shot thick-slab technique had superior image quality and fewer artifacts; in contrast, besides sole biliary visualization, multisection MRCP depicted complementary adjacent parenchymal and periductal structures. We therefore recommend MRI, with a combination of both MRCP techniques, for the diagnostic work-up and therapy planning of malignant hilar obstructions.
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Affiliation(s)
- E L Hänninen
- Department of Radiology, Charité Medical University Center, Campus Virchow Clinic, Berlin, Germany.
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Winter L, Lopez-Haeninnen E, Tullius S, Bruhn H, Ricke J, Felix R. Prospective Evaluation of Preoperative 3 Tesla MRI in the Diagnosis of Rectal Carcinoma. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-865268] [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: 10/19/2022]
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Röttgen R, Haltaufderheide K, Schröder RJ, Lorenz M, Herzog H, Neumann F, Lehmkuhl L, Winter L, Felix R, Bruhn H. Auswirkung der Feldstärke bei der standardisierten Kernspintomographie des Gehirns am Beispiel der Darstellung von Hirnnerven und Gefäßen in den basalen Zisternen: Vergleich zwischen 1,5 und 3,0 Tesla. ROFO-FORTSCHR RONTG 2005; 177:530-5. [PMID: 15838758 DOI: 10.1055/s-2005-857958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Comparison of MR images acquired as routine examinations at a field strength of 3.0 T and 1.5 T to determine whether and to which degree the image quality improves at the higher field strength of 3.0 T. MATERIALS AND METHODS Routine MR images of 200 patients were examined retrospectively, with 100 images obtained at 1.5 T and 100 obtained at 3.0 T. The examinations were performed with a quadrature head coil and focused on the basal cisterns because of the abundance of small distinct structures in this region. We selected the T2-weighted 2D-FSE sequence in transverse direction for comparison. At both field strengths, the same section thickness of 5 mm and a matrix of 512 x 388 (FOV: 220 mm) were used. The quality of the images was evaluated with regard to depicting the cranial nerves N. III, V - X, the AICA and PICA. For comparison, image quality was rated with a score from 1 (well defined) to 5 (not depicted). RESULTS A score of 1 was obtained in 46 % of the anatomic structures examined at 3.0 T and in only 9.2 % at 1.5 T. A score of 2 was given in 27.6 % of the anatomic structures at 3.0 T vs. 23.5 % at 1.5 T, a score of 3 in 17.2 % vs. 28.1 %, a score of 4 in 8.6 % vs. 28.7 %, and a score of 5 in 0.4 % vs. 10.3 %, respectively. The Mann-Whitney U test showed significance at p < 0.001 for the comparison of images at 1.5 and 3.0 Tesla. CONCLUSION Routine magnetic resonance imaging using the same quadrature coil technique and similar acquisition times at 3.0 T and 1.5 T shows an improvement for T2-weighted images at the higher field strength.
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Affiliation(s)
- R Röttgen
- Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin.
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Haley WE, Gitlin LN, Wisniewski SR, Mahoney DF, Coon DW, Winter L, Corcoran M, Schinfeld S, Ory M. Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study. Aging Ment Health 2004; 8:316-29. [PMID: 15370048 DOI: 10.1080/13607860410001728998] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [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: 12/13/2022]
Abstract
Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers.
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Affiliation(s)
- W E Haley
- School of Aging Studies, University of South Florida, Tampa 33620, USA.
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Faull K, Hills MD, Cochrane G, Gray J, Hunt M, McKenzie C, Winter L. Investigation of health perspectives of those with physical disabilities: the role of spirituality as a determinant of health. Disabil Rehabil 2004; 26:129-44. [PMID: 14754624 DOI: 10.1080/09638280310001636419] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 10/26/2022]
Abstract
PURPOSE To identify key determinants of health and the process of health attainment for people with musculoskeletal disabilities. METHOD Focus groups of people with musculoskeletal disorders, including 30 members and their five trained facilitators, provided data. Discussed were 'What is health for you?' and 'What has helped, or would help you achieve this health?' Delphi-structured analysis identified health themes and a health process model was developed with the facilitators comprising the expert panel. RESULTS Health was perceived as centred on relationships that required a spiritual awareness for a strong and resilient identity. The Self Attributes Model developed portrays the processes perceived to be required for health. CONCLUSIONS Although physical, social and psychological interventions are essential aspects of health intervention, by themselves they are not sufficient. Also required for health is a strong resilient self resulting from interaction and connection with other people and the natural world. Moreover, development of such an identity requires a spiritual world-view comprising an acknowledgement of the essence of self and focus upon the nature of the connection of this essence with all other aspects of life. Further research is required to advance understanding of the process by which this occurs for people with chronic disorders.
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Schirmer T, Thormann M, Fischbach F, Winter L, Bruhn H, Ricke J. Ortsaufgelöste H1-MR-Spektroskopie der Leber bei 3.0T: Etablierung eines klinisch praktikablen Protokolls zur Datenaufnahme und -auswertung. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828018] [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: 10/19/2022]
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Thormann M, Fischbach F, Schirmer T, Winter L, Lisowski A, Bruhn H, Felix R, Ricke J. Lokalisierte H1-Magnetresonanzspektroskopie der Leber und maligner Leberläsionen bei 3.0T. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827574] [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: 10/19/2022]
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Winter L, Kämena A, Pinkernelle J, Hothan T, Knollmann F. Kontrastmittelinduzierte Nephropathie im klinischen Alltag der Computertomographie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827939] [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: 10/19/2022]
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Winter L, Nadeson R, Tucker AP, Goodchild CS. Antinociceptive properties of neurosteroids: a comparison of alphadolone and alphaxalone in potentiation of opioid antinociception. Anesth Analg 2003; 97:798-805. [PMID: 12933405 DOI: 10.1213/01.ane.0000075835.73967.f3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study, we investigated the antinociceptive and sedative effects of the opioids fentanyl, morphine, and oxycodone given alone and in combination with two neurosteroids: alphadolone and alphaxalone. An open-field activity monitor and rotarod apparatus were used to define the sedative effects caused by opioid and neurosteroid compounds given alone intraperitoneally to male Wistar rats. Dose-response curves for antinociception were constructed using only nonsedative doses of these drugs. At nonsedating doses, fentanyl, morphine, and oxycodone all caused dose-dependent tail flick latency (TFL) antinociceptive effects. Because neither neurosteroid altered TFL, electrical current was used as the test to determine doses of neurosteroid that caused antinociceptive effects at nonsedative doses. Alphadolone 10 mg/kg intraperitoneally caused significant antinociceptive effects in the electrical test but alphaxalone did not. All three opioid dose-response curves for TFL antinociception were shifted to the left by coadministration of alphadolone even though alphadolone alone had no effect on TFL. Alphaxalone given alone had no antinociceptive effects at nonsedative doses and it had no effect on opioid antinociception. Neither neurosteroid caused sedative effects when combined with opioids. We conclude that coadministration of alphadolone, but not alphaxalone, with morphine, fentanyl, or oxycodone potentiates antinociception and that this effect is not caused by an increase in sedation.
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Affiliation(s)
- L Winter
- Monash University Department of Anaesthesia, Monash Medical Centre, Clayton, Victoria, Australia
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Winter L, Murphy G, Crespin X, Boucar AM. How quality assurance facilitates decentralization in a primary health care system: the case of Niger. QA Brief 2002; 5:22-4. [PMID: 12347469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Winter L. Applying quality assurance to the primary health care service delivery system in Tahoua, Niger. QA Brief 2002; 3:22-4. [PMID: 12319097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Gitlin LN, Schinfeld S, Winter L, Corcoran M, Boyce AA, Hauck W. Evaluating home environments of persons with dementia: interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP). Disabil Rehabil 2002; 24:59-71. [PMID: 11827156 DOI: 10.1080/09638280110066325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This article reports on an interrater reliability and preliminary validity study of an investigator-developed tool, the Home Environmental Assessment Protocol (HEAP) for use in homes of persons with dementia. METHOD The HEAP consists of 192 items that are summed into separate indices representing the number of hazards, adaptations, and level of clutter and comfort in eight areas of the home. Interrater reliability was examined among four raters, two environmental experts and two non-experts, who observed 22 dementia households. RESULTS The Kappa statistic was used to evaluate agreement level for each measured item and found that agreement ranged from slight to almost perfect. Intraclass correlations (ICCs), were used to evaluate agreement level for indices. The hazard index in each room ranged from fair (0.36) to moderate (0.66) for all raters. For the adaptation, clutter and comfort indices in each room, ICCs ranged from 0.51 to 0.90 for all raters. Agreement level between expert and non-expert raters differed minimally for all indices. Adaptations to dining rooms (r= -0.080, p = 0.001), kitchens (r = -0.52, p = 0.02) and bedrooms (r = -0.76, p = 0.001) were associated with patient deficits such that more adaptations were made in homes of dependent persons. Low Mini-Mental Status Examination scores were associated with fewer hazards, more adaptations, and less clutter. CONCLUSION Findings show that both experts and non-expert raters use the HEAP consistently. Also, measured attributes are related to cognitive and functional status in the expected direction.
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Affiliation(s)
- L N Gitlin
- Community and Homecare Research Division, College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA.
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Gitlin LN, Corcoran M, Winter L, Boyce A, Hauck WW. A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Gerontologist 2001; 41:4-14. [PMID: 11220813 DOI: 10.1093/geront/41.1.4] [Citation(s) in RCA: 252] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients. They also determined if treatment effect varied by caregiver gender, race, and relationship to patient. DESIGN AND METHODS Families (N = 171) of dementia patients were randomized to intervention or usual care control group. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications. RESULTS Compared with controls, intervention caregivers reported fewer declines in patients' instrumental activities of daily living (p = .030) and less decline in self-care and fewer behavior problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset (p = .049), women reported enhanced self-efficacy in managing behaviors (p = .038), and women (p = .049) and minorities (p = .037) reported enhanced self-efficacy in managing functional dependency. IMPLICATIONS The environmental program appears to have a modest effect on dementia patients' IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.
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Affiliation(s)
- L N Gitlin
- Community and Homecare Research Division, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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