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Nechaeva T, Verra L, Pucek J, Ranc L, Bergamaschi M, Zevi Della Porta G, Muggli P, Agnello R, Ahdida CC, Amoedo C, Andrebe Y, Apsimon O, Apsimon R, Arnesano JM, Bencini V, Blanchard P, Burrows PN, Buttenschön B, Caldwell A, Chung M, Cooke DA, Davut C, Demeter G, Dexter AC, Doebert S, Farmer J, Fasoli A, Fonseca R, Furno I, Granados E, Granetzny M, Graubner T, Grulke O, Gschwendtner E, Guran E, Henderson J, Kedves MÁ, Kim SY, Kraus F, Krupa M, Lefevre T, Liang L, Liu S, Lopes N, Lotov K, Martinez Calderon M, Mazzoni S, Moon K, Morales Guzmán PI, Moreira M, Okhotnikov N, Pakuza C, Pannell F, Pardons A, Pepitone K, Poimenidou E, Pukhov A, Rey S, Rossel R, Saberi H, Schmitz O, Senes E, Silva F, Silva L, Spear B, Stollberg C, Sublet A, Swain C, Topaloudis A, Torrado N, Turner M, Velotti F, Verzilov V, Vieira J, Welsch C, Wendt M, Wing M, Wolfenden J, Woolley B, Xia G, Yarygova V, Zepp M. Hosing of a Long Relativistic Particle Bunch in Plasma. Phys Rev Lett 2024; 132:075001. [PMID: 38427892 DOI: 10.1103/physrevlett.132.075001] [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] [Received: 09/08/2023] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
Experimental results show that hosing of a long particle bunch in plasma can be induced by wakefields driven by a short, misaligned preceding bunch. Hosing develops in the plane of misalignment, self-modulation in the perpendicular plane, at frequencies close to the plasma electron frequency, and are reproducible. Development of hosing depends on misalignment direction, its growth on misalignment extent and on proton bunch charge. Results have the main characteristics of a theoretical model, are relevant to other plasma-based accelerators and represent the first characterization of hosing.
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Affiliation(s)
- T Nechaeva
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - L Verra
- CERN, 1211 Geneva 23, Switzerland
| | - J Pucek
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - L Ranc
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - M Bergamaschi
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - G Zevi Della Porta
- Max Planck Institute for Physics, 80805 Munich, Germany
- CERN, 1211 Geneva 23, Switzerland
| | - P Muggli
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | - C Amoedo
- CERN, 1211 Geneva 23, Switzerland
| | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - O Apsimon
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - V Bencini
- CERN, 1211 Geneva 23, Switzerland
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - P N Burrows
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - M Chung
- UNIST, Ulsan 44919, Republic of Korea
| | | | - C Davut
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - G Demeter
- Wigner Research Centre for Physics, 1121 Budapest, Hungary
| | - A C Dexter
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - J Farmer
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - R Fonseca
- ISCTE - Instituto Universitéario de Lisboa, 1049-001 Lisbon, Portugal
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - T Graubner
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - O Grulke
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
- Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | | | - E Guran
- CERN, 1211 Geneva 23, Switzerland
| | - J Henderson
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- STFC/ASTeC, Daresbury Laboratory, Warrington WA4 4AD, United Kingdom
| | - M Á Kedves
- Wigner Research Centre for Physics, 1121 Budapest, Hungary
| | - S-Y Kim
- CERN, 1211 Geneva 23, Switzerland
- UNIST, Ulsan 44919, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - M Krupa
- CERN, 1211 Geneva 23, Switzerland
| | | | - L Liang
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - K Lotov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | | | | | - K Moon
- UNIST, Ulsan 44919, Republic of Korea
| | | | - M Moreira
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - N Okhotnikov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | - C Pakuza
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | | | | | - K Pepitone
- Angstrom Laboratory, Department of Physics and Astronomy, 752 37 Uppsala, Sweden
| | | | - A Pukhov
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
- Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - S Rey
- CERN, 1211 Geneva 23, Switzerland
| | - R Rossel
- CERN, 1211 Geneva 23, Switzerland
| | - H Saberi
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - O Schmitz
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - E Senes
- CERN, 1211 Geneva 23, Switzerland
| | - F Silva
- INESC-ID, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - L Silva
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - B Spear
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - C Stollberg
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - A Sublet
- CERN, 1211 Geneva 23, Switzerland
| | - C Swain
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | | | - N Torrado
- CERN, 1211 Geneva 23, Switzerland
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - M Turner
- CERN, 1211 Geneva 23, Switzerland
| | | | - V Verzilov
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - J Vieira
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - C Welsch
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - M Wendt
- CERN, 1211 Geneva 23, Switzerland
| | - M Wing
- UCL, London WC1 6BT, United Kingdom
| | - J Wolfenden
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | | | - G Xia
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - V Yarygova
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin 53706, USA
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Kaffes M, Bondi F, Geisler F, Grittner U, Haacke L, Ihl T, Lorenz M, Schehadat MS, Schwabauer E, Wendt M, Zuber M, Kübler-Weller D, Lorenz-Meyer I, Sanchez JC, Montaner J, Audebert HJ, Weber JE. Optimization of sensitivity and specificity of a biomarker-based blood test (LVOCheck-Opti): A protocol for a multicenter prospective observational study of patients suspected of having a stroke. Front Neurol 2024; 14:1327348. [PMID: 38371304 PMCID: PMC10870936 DOI: 10.3389/fneur.2023.1327348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Acute ischemic stroke (AIS) is a time-critical medical emergency. For patients with large-vessel occlusions (LVO), mechanical thrombectomy (MT) is the gold-standard treatment. Mobile Stroke Units (MSUs) provide on-site diagnostic capabilities via computed tomography (CT) and have been shown to improve functional outcomes in stroke patients, but are cost-efficient only in urban areas. Blood biomarkers have recently emerged as possible alternative to cerebral imaging for LVO diagnosis. Prehospital LVO diagnosis offers the potential to transport patients directly to centers that have MT treatment available. In this study, we assess the accuracy of combining two biomarkers, HFABP and NT-proBNP, with clinical indicators to detect LVO using ultra-early prehospital blood samples. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00030399). Methods and analysis We plan a multicenter prospective observational study with 800 patients with suspected stroke enrolled within 24 h of symptom onset. Study participants will be recruited at three sites (MSUs) in Berlin, Germany. Blood-samples will be taken pre-hospitally at the scene and tested for HFABP and NT-proBNP levels. Additional clinical data and information on final diagnosis will be collected and documented in an electronic case report form (eCRF). Sensitivity and specificity of the combination will be calculated through iterative permutation-response calculations. Discussion This study aims to evaluate the diagnostic capabilities of a combination of the biomarkers HFABP and NT-proBNP in LVO prediction. In contrast to most other biomarker studies to date, by employing MSUs as study centers, ultra-early levels of biomarkers can be analyzed. Point-of-care LVO detection in suspected stroke could lead to faster treatment in both urban and rural settings and thus improve functional outcomes on a broader scale. Clinical trial registration Deutsches Register klinischer Studien https://drks.de/search/de/trial/DRKS00030399, DRKS00030399.
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Affiliation(s)
- Maximilian Kaffes
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fulvio Bondi
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frederik Geisler
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Haacke
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Ihl
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maren Lorenz
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marc S. Schehadat
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eugen Schwabauer
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Martina Zuber
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dorothee Kübler-Weller
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Irina Lorenz-Meyer
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jean-Charles Sanchez
- Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Joan Montaner
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Heinrich J. Audebert
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim E. Weber
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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Schwabauer E, Piccininni M, Freitag E, Ebinger M, Geisler F, Harmel P, Hille A, Lorenz-Meyer I, Rohrpasser-Napierkowski I, Kurth T, Rohmann JL, Endres M, Schlunk F, Weber J, Wendt M, Audebert HJ. Effects of Mobile Stroke Unit dispatch on blood pressure management and outcomes in patients with intracerebral haematoma: Results from the Berlin_Prehospital Or Usual Care Delivery in acute Stroke (B_PROUD) controlled intervention study. Eur Stroke J 2023:23969873231213156. [PMID: 38014623 DOI: 10.1177/23969873231213156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION In patients with acute intracerebral haemorrhage (ICH) and elevated systolic blood pressure (BP), guidelines suggest that systolic BP reduction to <140 mmHg should be rapidly initiated. Compared with conventional care, Mobile Stroke Units (MSUs) allow for earlier ICH diagnosis through prehospital imaging and earlier BP lowering. PATIENTS AND METHODS ICH patients were prospectively evaluated as a cohort of the controlled B_PROUD-study in which MSU availability alone determined MSU dispatch in addition to conventional ambulance. We used inverse probability of treatment weighting to adjust for confounding to estimate the effect of additional MSU dispatch in ICH patients. Outcomes of interest were 7-day mortality (primary), systolic BP (sBP) at hospital arrival, dispatch-to-imaging time, largest haematoma volume, anticoagulation reversal, length of in-hospital stay, 3-month functional outcome. RESULTS Between February 2017 and May 2019, MSUs were dispatched to 95 (mean age: 72 ± 13 years, 45% female) and only conventional ambulances to 78 ICH patients (mean age: 71 ± 12 years, 44% female). After adjusting for confounding, we found shorter dispatch-to-imaging time (mean difference: -17.75 min, 95% CI: -27.16 to -8.21 min) and lower sBP at hospital arrival (mean difference = -16.31 mmHg, 95% CI: -30.64 to -6.19 mmHg) in the MSU group. We found no statistically significant difference for the other outcomes, including 7-day mortality (adjusted odds ratio: 1.43, 95% CI: 0.68 to 3.31) or favourable outcome (adjusted odds ratio = 0.67, 95% CI: 0.27 to 1.67). CONCLUSIONS Although MSU dispatch led to sBP reduction and lower dispatch-to-imaging time compared to conventional ambulance care, we found no evidence of better outcomes in the MSU dispatch group.
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Affiliation(s)
- Eugen Schwabauer
- Klinik für Neurologie mit Stroke Unit; Vivantes Klinikum Neukölln, Berlin, Germany
| | - Marco Piccininni
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Freitag
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Frederik Geisler
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Harmel
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Annegret Hille
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lorenz-Meyer
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jessica L Rohmann
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
| | - Frieder Schlunk
- Berlin Institute of Health (BIH), Berlin, Germany
- Institut für Neuroradiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Weber
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Geisler F, Haacke L, Lorenz M, Schwabauer E, Wendt M, Bernhardt L, Dashti E, Freitag E, Kunz A, Hofmann-Shen C, Zuber M, Waldschmidt C, Kandil FI, Kappert K, Dang-Heine C, Lorenz-Meyer I, Audebert HJ, Weber JE. Prospective collection of blood plasma samples to identify potential biomarkers for the prehospital stroke diagnosis (ProGrEss-Bio): study protocol for a multicenter prospective observational study. Front Neurol 2023; 14:1201130. [PMID: 37483444 PMCID: PMC10359480 DOI: 10.3389/fneur.2023.1201130] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are well-established, evidence-based, time-critical therapies that reduce morbidity and mortality in acute ischemic stroke (AIS) patients. The exclusion of intracerebral hemorrhage (ICH) is mandatory and has been performed by cerebral imaging to date. Mobile stroke units (MSUs) have been shown to improve functional outcomes by bringing cerebral imaging and IVT directly to the patient, but they have limited coverage. Blood biomarkers clearly distinguishing between AIS, ICH, and stroke mimics (SM) could provide an alternative to cerebral imaging if concentration changes are detectable in the hyperacute phase after stroke with high diagnostic accuracy. In this study, we will take blood samples in a prehospital setting to evaluate potential biomarkers. The study was registered in the German Clinical Trials Register (https://drks.de/search/de) with the identifier DRKS00023063. Methods and analysis We plan a prospective, observational study involving 300 patients with suspected stroke and symptom onset of ≤4.5 h before the collection of biomarkers. Study participants will be recruited from three sites in Berlin, Germany during MSU deployments. The focus of the study is the collection of blood samples from participants at the prehospital scene and from participants with AIS or ICH at a second-time point. All samples will be analyzed using targeted and untargeted analytical approaches. Study-related information about participants, including medical information and discharge diagnoses from the subsequent treating hospital, will be collected and documented in an electronic case report form (eCRF). Discussion This study will evaluate whether a single blood biomarker or a combination of biomarkers can distinguish patients with AIS and ICH from patients with stroke and SM in the early phase after symptom onset in the prehospital setting. In addition, the kinetics of blood biomarkers in AIS and ICH patients will be investigated. Our goal is to evaluate new ways to reliably diagnose stroke in the prehospital setting and thus accelerate the application of evidence-based therapies to stroke patients.
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Affiliation(s)
- Frederik Geisler
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Haacke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maren Lorenz
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eugen Schwabauer
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lydia Bernhardt
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Eman Dashti
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erik Freitag
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Kunz
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Hofmann-Shen
- Kliniken Beelitz, Teaching Hospital of Brandenburg Medical School Theodor Fontane, Beelitz-Heilstätten, Germany
| | - Martina Zuber
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Farid I. Kandil
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kai Kappert
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Chantip Dang-Heine
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lorenz-Meyer
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heinrich J. Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim E. Weber
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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Czycholl I, Büttner K, Becker D, Schwennen C, Baumgärtner W, Otten W, Wendt M, Puff C, Krieter J. Are biters sick? Health status of tail biters in comparison to control pigs. Porcine Health Manag 2023; 9:19. [PMID: 37161469 PMCID: PMC10170755 DOI: 10.1186/s40813-023-00314-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Tail biting is a multifactorial problem. As the health status is one of the factors commonly linked to tail biting, this study focuses on the health of identified biters. 30 (obsessive) biters are compared to 30 control animals by clinical and pathological examination as well as blood and cerebrospinal fluid samples. In that way, altogether 174 variables are compared between the groups. Moreover, connections between the variables are analysed. RESULTS In the clinical examination, 6 biters, but only 2 controls (P = 0.019) were noticeably agitated in the evaluation of general behaviour, while 8 controls were noticeably calmer (2 biters, P = 0.02). Biters had a lower body weight (P = 0.0007) and 13 biters had overlong bristles (4 controls, P = 0.008). In the pathological examination, 5 biters, but none of the controls had a hyperceratosis or inflammation of the pars proventricularis of the stomach (P = 0.018). However, 7 controls and only 3 biters were affected by gut inflammation (P = 0.03). In the blood sample, protein and albumin levels were below normal range for biters (protein: 51.6 g/l, albumin: 25.4 g/l), but not for controls (protein: 53.7 g/l, albumin: 27.4 g/l), (protein: P = 0.05, albumin: P = 0.02). Moreover, 14 biters, but only 8 controls had poikilocytosis (P = 0.05). Although not statistically different between groups, many animals (36/60) were affected by hypoproteinemia and hyponatremia as well as by hypokalemia (53/60) and almost all animals (58/60) had hypomagnesemia. For hypomagnesemia, significant connections with variables linked to tail damage and ear necrosis were detected (rs/V/ρ ≥ 0.4, P ≤ 0.05). CONCLUSION The results suggest that behavioural tests might be helpful in identifying biters. Moreover, cornification and inflammation of the pars proventricularis is linked to becoming a biter. Furthermore, the results highlight the need for appropriate and adjusted nutrient and mineral supply, especially with regard to magnesium.
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Affiliation(s)
- I Czycholl
- Institute of Animal Breeding and Husbandry, Kiel University, 24098, Kiel, Germany.
- Pig Improvement Company (PIC), Hendersonville, TN, 37075, USA.
- Department for Animal Welfare and Disease Control, University of Copenhagen, 1870, Frederiksberg, Denmark.
| | - K Büttner
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University, 35392, Giessen, Germany
| | - D Becker
- Institute of Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196, Dummerstorf, Germany
| | - C Schwennen
- Clinic for Swine, Small Ruminants and Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hanover, Foundation, 30173, Hanover, Germany
| | - W Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hanover, Foundation, 30559, Hanover, Germany
| | - W Otten
- Institute of Behavioural Physiology, Research Institute for Farm Animal Biology (FBN), 18196, Dummerstorf, Germany
| | - M Wendt
- Clinic for Swine, Small Ruminants and Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hanover, Foundation, 30173, Hanover, Germany
| | - C Puff
- Department of Pathology, University of Veterinary Medicine Hanover, Foundation, 30559, Hanover, Germany
| | - J Krieter
- Institute of Animal Breeding and Husbandry, Kiel University, 24098, Kiel, Germany
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6
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Rohmann JL, Piccininni M, Ebinger M, Wendt M, Weber JE, Schwabauer E, Geisler F, Freitag E, Harmel P, Lorenz-Meyer I, Rohrpasser-Napierkowski I, Nolte CH, Nabavi DG, Schmehl I, Ekkernkamp A, Endres M, Audebert HJ. Effect of Mobile Stroke Unit Dispatch in all Patients with Acute Stroke or TIA. Ann Neurol 2023; 93:50-63. [PMID: 36309933 DOI: 10.1002/ana.26541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the effect of additional mobile stroke unit (MSU) dispatch on functional outcomes among the full spectrum of stroke patients, regardless of subtype or potential contraindications to reperfusion therapies. METHODS We used data from the nonrandomized Berlin-based B_PROUD study (02/2017 to 05/2019), in which MSUs were dispatched based solely on availability, and the linked B-SPATIAL stroke registry. All patients with final stroke or transient ischemic attack (TIA) diagnoses were eligible. The intervention under study was the additional dispatch of an MSU, an emergency physician-staffed ambulance equipped to provide prehospital imaging and thrombolytic treatment, compared to conventional ambulance alone. The primary outcome was the 3-month modified Rankin Scale (mRS) score, and the co-primary outcome was a 3-tiered disability scale. We identified confounders using directed acyclic graphs and obtained adjusted effect estimates using inverse probability of treatment weighting. RESULTS MSUs were dispatched to 1,125 patients (mean age: 74 years, 46.5% female), while for 1,141 patients only conventional ambulances were dispatched (75 years, 49.9% female). After confounding adjustment, MSU dispatch was associated with more favorable 3-month mRS scores (common odds ratio [cOR] = 0.82; 95% confidence interval [CI]: 0.71-0.94). No statistically significant association was found with the co-primary outcome (cOR = 0.86; 9% CI: 0.72-1.01) or 7-day mortality (OR = 0.94; 95% CI: 0.59-1.48). INTERPRETATION When considering the entire population of stroke/TIA patients, MSU dispatch improved 3-month functional outcomes without evidence of compromised safety. Our results are relevant for decision-makers since stroke subtype and treatment eligibility are unknown at time of dispatch. ANN NEUROL 2023;93:50-63.
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Affiliation(s)
- Jessica L Rohmann
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik für Neurologie, Medical Park Berlin (MPB) Humboldtmühle, Berlin, Germany
| | - Matthias Wendt
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Joachim E Weber
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eugen Schwabauer
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Frederik Geisler
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Freitag
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Harmel
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lorenz-Meyer
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christian H Nolte
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Darius G Nabavi
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ingo Schmehl
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Berlin, Germany
| | | | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,NeuroCure Cluster of Excellence, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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7
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Schoekel A, Etter M, Glaser L, Rothkirch A, Wendt M. Strain mapping of metallic cultural heritage objects with synchrotron microbeams. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322090076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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8
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Verra L, Zevi Della Porta G, Pucek J, Nechaeva T, Wyler S, Bergamaschi M, Senes E, Guran E, Moody JT, Kedves MÁ, Gschwendtner E, Muggli P, Agnello R, Ahdida CC, Goncalves MCA, Andrebe Y, Apsimon O, Apsimon R, Arnesano JM, Bachmann AM, Barrientos D, Batsch F, Bencini V, Blanchard P, Burrows PN, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke DA, Davut C, Demeter G, Dexter AC, Doebert S, Elverson FA, Farmer J, Fasoli A, Fedosseev V, Fonseca R, Furno I, Gorn A, Granados E, Granetzny M, Graubner T, Grulke O, Hafych V, Henderson J, Hüther M, Khudiakov V, Kim SY, Kraus F, Krupa M, Lefevre T, Liang L, Liu S, Lopes N, Lotov K, Martinez Calderon M, Mazzoni S, Medina Godoy D, Moon K, Morales Guzmán PI, Moreira M, Nowak E, Pakuza C, Panuganti H, Pardons A, Pepitone K, Perera A, Pukhov A, Ramjiawan RL, Rey S, Schmitz O, Silva F, Silva L, Stollberg C, Sublet A, Swain C, Topaloudis A, Torrado N, Tuev P, Velotti F, Verzilov V, Vieira J, Weidl M, Welsch C, Wendt M, Wing M, Wolfenden J, Woolley B, Xia G, Yarygova V, Zepp M. Controlled Growth of the Self-Modulation of a Relativistic Proton Bunch in Plasma. Phys Rev Lett 2022; 129:024802. [PMID: 35867433 DOI: 10.1103/physrevlett.129.024802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
A long, narrow, relativistic charged particle bunch propagating in plasma is subject to the self-modulation (SM) instability. We show that SM of a proton bunch can be seeded by the wakefields driven by a preceding electron bunch. SM timing reproducibility and control are at the level of a small fraction of the modulation period. With this seeding method, we independently control the amplitude of the seed wakefields with the charge of the electron bunch and the growth rate of SM with the charge of the proton bunch. Seeding leads to larger growth of the wakefields than in the instability case.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | | | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - O Apsimon
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - A-M Bachmann
- Max Planck Institute for Physics, 80805 Munich, Germany
| | | | - F Batsch
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - V Bencini
- CERN, 1211 Geneva 23, Switzerland
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - P N Burrows
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, 80805 Munich, Germany
| | | | | | - M Chung
- UNIST, Ulsan 44919, Republic of Korea
| | | | - C Davut
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Manchester, Manchester M13 9PL, United Kingdom
| | - G Demeter
- Wigner Research Centre for Physics, 1121 Budapest, Hungary
| | - A C Dexter
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | | | - J Farmer
- CERN, 1211 Geneva 23, Switzerland
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | - R Fonseca
- ISCTE-Instituto Universitéario de Lisboa, 1049-001 Lisbon, Portugal
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - A Gorn
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk , Russia
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - T Graubner
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - O Grulke
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
- Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - V Hafych
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - J Henderson
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Accelerator Science and Technology Centre, ASTeC, STFC Daresbury Laboratory, Warrington WA4 4AD, United Kingdom
| | - M Hüther
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - V Khudiakov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - S-Y Kim
- CERN, 1211 Geneva 23, Switzerland
- UNIST, Ulsan 44919, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - M Krupa
- CERN, 1211 Geneva 23, Switzerland
| | | | - L Liang
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Manchester, Manchester M13 9PL, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - K Lotov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk , Russia
| | | | | | | | - K Moon
- UNIST, Ulsan 44919, Republic of Korea
| | | | - M Moreira
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - E Nowak
- CERN, 1211 Geneva 23, Switzerland
| | - C Pakuza
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | | | | | - K Pepitone
- Angstrom Laboratory, Department of Physics and Astronomy, 752 37 Uppsala, Sweden
| | - A Perera
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - A Pukhov
- Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - R L Ramjiawan
- CERN, 1211 Geneva 23, Switzerland
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - S Rey
- CERN, 1211 Geneva 23, Switzerland
| | - O Schmitz
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - F Silva
- INESC-ID, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - L Silva
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - C Stollberg
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - A Sublet
- CERN, 1211 Geneva 23, Switzerland
| | - C Swain
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | | | - N Torrado
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - P Tuev
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk , Russia
| | | | | | - J Vieira
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - M Weidl
- Max Planck Institute for Plasma Physics, 80805 Munich, Germany
| | - C Welsch
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - M Wendt
- CERN, 1211 Geneva 23, Switzerland
| | - M Wing
- UCL, London WC1 6BT, United Kingdom
| | - J Wolfenden
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | | | - G Xia
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Manchester, Manchester M13 9PL, United Kingdom
| | - V Yarygova
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk , Russia
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin 53706, USA
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9
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Glazyrin K, Khandarkhaeva S, Fedotenko T, Dong W, Laniel D, Seiboth F, Schropp A, Garrevoet J, Brückner D, Falkenberg G, Kubec A, David C, Wendt M, Wenz S, Dubrovinsky L, Dubrovinskaia N, Liermann HP. Sub-micrometer focusing setup for high-pressure crystallography at the Extreme Conditions beamline at PETRA III. J Synchrotron Radiat 2022; 29:654-663. [PMID: 35510998 PMCID: PMC9070721 DOI: 10.1107/s1600577522002582] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Scientific tasks aimed at decoding and characterizing complex systems and processes at high pressures set new challenges for modern X-ray diffraction instrumentation in terms of X-ray flux, focal spot size and sample positioning. Presented here are new developments at the Extreme Conditions beamline (P02.2, PETRA III, DESY, Germany) that enable considerable improvements in data collection at very high pressures and small scattering volumes. In particular, the focusing of the X-ray beam to the sub-micrometer level is described, and control of the aberrations of the focusing compound refractive lenses is made possible with the implementation of a correcting phase plate. This device provides a significant enhancement of the signal-to-noise ratio by conditioning the beam shape profile at the focal spot. A new sample alignment system with a small sphere of confusion enables single-crystal data collection from grains of micrometer to sub-micrometer dimensions subjected to pressures as high as 200 GPa. The combination of the technical development of the optical path and the sample alignment system contributes to research and gives benefits on various levels, including rapid and accurate diffraction mapping of samples with sub-micrometer resolution at multimegabar pressures.
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Affiliation(s)
- K. Glazyrin
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - S. Khandarkhaeva
- Bayerisches Geoinstitut, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
- Material Physics and Technology at Extreme Conditions, Laboratory of Crystallography, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
| | - T. Fedotenko
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
- Material Physics and Technology at Extreme Conditions, Laboratory of Crystallography, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
| | - W. Dong
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - D. Laniel
- Material Physics and Technology at Extreme Conditions, Laboratory of Crystallography, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
| | - F. Seiboth
- Center for X-ray and Nano Science CXNS, Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - A. Schropp
- Center for X-ray and Nano Science CXNS, Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
- Helmholtz Imaging Platform, Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - J. Garrevoet
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - D. Brückner
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
- Department Physik, Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
- Ruhr-Universität Bochum, Universitätsstrasse 150, 44801 Bochum, Germany
| | - G. Falkenberg
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - A. Kubec
- Laboratory for Micro- and Nanotechnology, Paul Scherrer Institut, Forschungsstrasse 111, 5232 Villigen-PSI, Switzerland
| | - C. David
- Laboratory for Micro- and Nanotechnology, Paul Scherrer Institut, Forschungsstrasse 111, 5232 Villigen-PSI, Switzerland
| | - M. Wendt
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - S. Wenz
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - L. Dubrovinsky
- Bayerisches Geoinstitut, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
| | - N. Dubrovinskaia
- Material Physics and Technology at Extreme Conditions, Laboratory of Crystallography, University of Bayreuth, Universitätsstrasse 30, 95440 Bayreuth, Germany
- Department of Physics, Chemistry and Biology (IFM), Linköping University, Campus Valla, Fysikhuset F310, SE-581 83 Linköping, Sweden
| | - H.-P. Liermann
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
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10
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Greif G, Mrowietz C, Wendt M, Jung F, Hiebl B, Meyer-Sievers H. Differences in human and minipig platelet number, volume and activation induced by borosilicate glass beads in a modified chandler loop-system. Clin Hemorheol Microcirc 2021; 79:149-155. [PMID: 34487038 DOI: 10.3233/ch-219201] [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: 11/15/2022]
Abstract
The pig is the most widely used large animal model in Europe, with cardiovascular research being one of the main areas of application. Adequate refinement of interventional studies in this field, meeting the requirements of Russel and Burchs' 3 R concept, can only be performed if blood-contacting medical devices are hemocompatible. Because most medical devices for cardiovascular interventional procedures are developed for humans they are tested mostly for compatibility with human blood. The aim of this study was therefore to determine whether there are differences in behavior of porcine and human platelets when they come into contact with glass, which was used as an exemplary thrombogenic material. For this purpose changes of platelet count, platelet volume and platelet expression of the activation markers CD61, CD62P and CD63 were measured using a modified chandler loop-system simulating the fluidic effects of the blood flow. Minipig and human platelets showed significant differences in number and volume, but not in activation after 4-8 min exposure to glass.
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Affiliation(s)
- G Greif
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behavior, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - C Mrowietz
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behavior, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - M Wendt
- Clinic for Swine and Small Ruminants, Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - F Jung
- Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - B Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behavior, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - H Meyer-Sievers
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behavior, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Batsch F, Muggli P, Agnello R, Ahdida CC, Amoedo Goncalves MC, Andrebe Y, Apsimon O, Apsimon R, Bachmann AM, Baistrukov MA, Blanchard P, Braunmüller F, Burrows PN, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke DA, Damerau H, Davut C, Demeter G, Deubner HL, Doebert S, Farmer J, Fasoli A, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Furno I, Garolfi L, Gessner S, Gorgisyan I, Gorn AA, Granados E, Granetzny M, Graubner T, Grulke O, Gschwendtner E, Hafych V, Helm A, Henderson JR, Hüther M, Kargapolov IY, Kim SY, Kraus F, Krupa M, Lefevre T, Liang L, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Medina Godoy D, Minakov VA, Moody JT, Moon K, Morales Guzmán PI, Moreira M, Nechaeva T, Nowak E, Pakuza C, Panuganti H, Pardons A, Perera A, Pucek J, Pukhov A, Ramjiawan RL, Rey S, Rieger K, Schmitz O, Senes E, Silva LO, Speroni R, Spitsyn RI, Stollberg C, Sublet A, Topaloudis A, Torrado N, Tuev PV, Turner M, Velotti F, Verra L, Verzilov VA, Vieira J, Vincke H, Welsch CP, Wendt M, Wing M, Wiwattananon P, Wolfenden J, Woolley B, Xia G, Zepp M, Zevi Della Porta G. Transition between Instability and Seeded Self-Modulation of a Relativistic Particle Bunch in Plasma. Phys Rev Lett 2021; 126:164802. [PMID: 33961468 DOI: 10.1103/physrevlett.126.164802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
We use a relativistic ionization front to provide various initial transverse wakefield amplitudes for the self-modulation of a long proton bunch in plasma. We show experimentally that, with sufficient initial amplitude [≥(4.1±0.4) MV/m], the phase of the modulation along the bunch is reproducible from event to event, with 3%-7% (of 2π) rms variations all along the bunch. The phase is not reproducible for lower initial amplitudes. We observe the transition between these two regimes. Phase reproducibility is essential for deterministic external injection of particles to be accelerated.
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Affiliation(s)
- F Batsch
- Max Planck Institute for Physics, Munich, Germany
| | - P Muggli
- Max Planck Institute for Physics, Munich, Germany
| | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | | | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - O Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - A-M Bachmann
- Max Planck Institute for Physics, Munich, Germany
| | - M A Baistrukov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - P N Burrows
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, Munich, Germany
| | - J Chappell
- University College London, London, United Kingdom
| | | | - M Chung
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - D A Cooke
- University College London, London, United Kingdom
| | | | - C Davut
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - G Demeter
- Wigner Research Center for Physics, Budapest, Hungary
| | - H L Deubner
- Philipps-Universität Marburg, Marburg, Germany
| | | | - J Farmer
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - R Fiorito
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - R A Fonseca
- ISCTE-Instituto Universitéario de Lisboa, Portugal
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - S Gessner
- CERN, Geneva, Switzerland
- SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | | | - A A Gorn
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin, USA
| | - T Graubner
- Philipps-Universität Marburg, Marburg, Germany
| | - O Grulke
- Max Planck Institute for Plasma Physics, Greifswald, Germany
- Technical University of Denmark, Lyngby, Denmark
| | | | - V Hafych
- Max Planck Institute for Physics, Munich, Germany
| | - A Helm
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - J R Henderson
- Cockcroft Institute, Daresbury, United Kingdom
- Accelerator Science and Technology Centre, ASTeC, STFC Daresbury Laboratory, Warrington, United Kingdom
| | - M Hüther
- Max Planck Institute for Physics, Munich, Germany
| | - I Yu Kargapolov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - S-Y Kim
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, Marburg, Germany
| | | | | | - L Liang
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - K V Lotov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - M Martyanov
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - V A Minakov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - J T Moody
- Max Planck Institute for Physics, Munich, Germany
| | - K Moon
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | | | - M Moreira
- CERN, Geneva, Switzerland
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - T Nechaeva
- Max Planck Institute for Physics, Munich, Germany
| | | | - C Pakuza
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | | | | | - A Perera
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - J Pucek
- Max Planck Institute for Physics, Munich, Germany
| | - A Pukhov
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - R L Ramjiawan
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - S Rey
- CERN, Geneva, Switzerland
| | - K Rieger
- Max Planck Institute for Physics, Munich, Germany
| | - O Schmitz
- University of Wisconsin, Madison, Wisconsin, USA
| | - E Senes
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - L O Silva
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - R I Spitsyn
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - C Stollberg
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | | | - N Torrado
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - P V Tuev
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - M Turner
- CERN, Geneva, Switzerland
- Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | | | - L Verra
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
- Technical University Munich, Munich, Germany
| | | | - J Vieira
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - C P Welsch
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | | | - M Wing
- University College London, London, United Kingdom
| | | | - J Wolfenden
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | | | - G Xia
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin, USA
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Wendt M, Kocur P, Lewandowski J, Waszak M. Effect of the Combined Therapy of the Muscle Energy Technique and Trigger Point Therapy on the Biophysical Parameters of the Trapezius Muscle: a Randomized Clinical Trial. Muscles Ligaments Tendons J 2021. [DOI: 10.32098/mltj.01.2021.05] [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: 11/05/2022]
Affiliation(s)
- M. Wendt
- Department of Biology and Anatomy, Poznan University of Physical Education, Poznan, Poland
| | - P. Kocur
- Department of Motor Organ Rehabilitation, Poznan University of Physical Education, Poznan, Poland
| | - J. Lewandowski
- Department of Motor Organ Rehabilitation, Poznan University of Physical Education, Poznan, Poland
| | - M. Waszak
- Department of Biology and Anatomy, Poznan University of Physical Education, Poznan, Poland
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Ebinger M, Siegerink B, Kunz A, Wendt M, Weber JE, Schwabauer E, Geisler F, Freitag E, Lange J, Behrens J, Erdur H, Ganeshan R, Liman T, Scheitz JF, Schlemm L, Harmel P, Zieschang K, Lorenz-Meyer I, Napierkowski I, Waldschmidt C, Nolte CH, Grittner U, Wiener E, Bohner G, Nabavi DG, Schmehl I, Ekkernkamp A, Jungehulsing GJ, Mackert BM, Hartmann A, Rohmann JL, Endres M, Audebert HJ. Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin. JAMA 2021; 325:454-466. [PMID: 33528537 PMCID: PMC7856548 DOI: 10.1001/jama.2020.26345] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [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: 01/27/2023]
Abstract
IMPORTANCE Effects of thrombolysis in acute ischemic stroke are time-dependent. Ambulances that can administer thrombolysis (mobile stroke units [MSUs]) before arriving at the hospital have been shown to reduce time to treatment. OBJECTIVE To determine whether dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS This prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, both a conventional ambulance and an MSU, when available, were dispatched. Functional outcomes of patients with final diagnosis of acute cerebral ischemia who were eligible for thrombolysis or thrombectomy were compared based on the initial dispatch (both MSU and conventional ambulance or conventional ambulance only). EXPOSURE Simultaneous dispatch of an MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities on board) and a conventional ambulance (n = 749) vs conventional ambulance alone (n = 794). MAIN OUTCOMES AND MEASURES The primary outcome was the distribution of modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. The coprimary outcome was a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available. Common odds ratios (ORs) were used to quantify the association between exposure and outcome; values less than 1.00 indicated a favorable shift in the mRS distribution and lower odds of higher levels of disability. RESULTS Of the 1543 patients (mean age, 74 years; 723 women [47%]) included in the adjusted primary analysis, 1337 (87%) had available mRS scores (primary outcome) and 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome). Patients with an MSU dispatched had lower median mRS scores at month 3 (1; interquartile range [IQR], 0-3) than did patients without an MSU dispatched (2; IQR, 0-3; common OR for worse mRS, 0.71; 95% CI, 0.58-0.86; P < .001). Similarly, patients with an MSU dispatched had lower 3-month coprimary disability scores: 586 patients (80.3%) had none to moderate disability; 92 (12.6%) had severe disability; and 52 (7.1%) had died vs patients without an MSU dispatched: 605 (78.0%) had none to moderate disability; 103 (13.3%) had severe disability; and 68 (8.8%) had died (common OR for worse functional outcome, 0.73, 95% CI, 0.54-0.99; P = .04). CONCLUSIONS AND RELEVANCE In this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global disability at 3 months. Clinical trials in other regions are warranted.
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Affiliation(s)
- Martin Ebinger
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
| | - Alexander Kunz
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Wendt
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Joachim E. Weber
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
| | - Eugen Schwabauer
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Frederik Geisler
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Erik Freitag
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Julia Lange
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Janina Behrens
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Hebun Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ramanan Ganeshan
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Thomas Liman
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Jan F. Scheitz
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ludwig Schlemm
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Peter Harmel
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Katja Zieschang
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Irina Lorenz-Meyer
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ira Napierkowski
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Carolin Waldschmidt
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie–Stroke Unit–Zentrum für Epilepsie; Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Christian H. Nolte
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
| | - Ulrike Grittner
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany
| | - Edzard Wiener
- Institut für Neuroradiologie, Charité–Universitätsmedizin Berlin, Germany
| | - Georg Bohner
- Institut für Neuroradiologie, Charité–Universitätsmedizin Berlin, Germany
| | - Darius G. Nabavi
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ingo Schmehl
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Axel Ekkernkamp
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | | | - Bruno-Marcel Mackert
- Klinik für Neurologie mit Stroke Unit, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Jessica L. Rohmann
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Institute of Public Health, Charité–Universitätsmedizin Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
- NeuroCure Cluster of Excellence, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Germany
| | - Heinrich J. Audebert
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
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Geisler F, Wesirow M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Audebert HJ. Probability assessment of intracerebral hemorrhage in prehospital emergency patients. Neurol Res Pract 2021; 3:1. [PMID: 33499926 PMCID: PMC7786495 DOI: 10.1186/s42466-020-00100-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routing of patients with intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) to the most appropriate hospital is challenging for emergency medical services particularly when specific treatment options are only provided by specialized hospitals and determination of the exact diagnosis is difficult. We aimed to develop a prehospital score - called prehospital-intracerebral hemorrhage score (ph-ICH score) - to assist in discriminating between both conditions. METHODS The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen's d and receiver-operating-characteristics. RESULTS We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p < 0.01). Receiver-operating-characteristics showed fair and good accuracy with an area under the curve of 0.71 for the derivation and 0.81 for the validation cohort. CONCLUSIONS The ph-ICH score can assist medical personnel in the field to assess the likelihood of ICH and AIS in emergency patients.
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Affiliation(s)
- Frederik Geisler
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Medschid Wesirow
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Martin Ebinger
- Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Alexander Kunz
- Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Michal Rozanski
- Department of Neurology, Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Joachim E Weber
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Benjamin Winter
- Department of Neurology, St. Josefs-Krankenhaus, Potsdam, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany
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Abstract
Background Mobile stroke units (MSUs), equipped with an integrated computed tomography scanner, can shorten time to thrombolytic treatment and may improve outcome in patients with acute ischemic stroke. Original (German) MSUs are staffed by neurologists trained as emergency physicians, but patient assessment and treatment decisions by a remote neurologist may offer an alternative to neurologists aboard MSU. Methods and Results Remote neurologists examined and assessed emergency patients treated aboard the MSU in Berlin, Germany. Audiovisual quality was rated by the remote neurologist from 1 (excellent) to 6 (insufficient), and duration of video examinations was assessed. We analyzed interrater reliability of diagnoses, scores on the National Institutes of Health Stroke Scale and treatment decisions (intravenous thrombolysis) between the MSU neurologist and the remote neurologist. We included 90 of 103 emergency assessments (13 patients were excluded because of either failed connection, technical problems, clinical worsening during teleconsultation, or missing data in documentation) in this study. The remote neurologist rated audiovisual quality with a median grade for audio quality of 3 (satisfactory) and for video quality of 2 (good). Mean time for completion of teleconsultations was about 19±5 minutes. The interrater reliabilities between the onboard and remote neurologist were high for diagnoses (Cohen's κ=0.86), National Institutes of Health Stroke Scale sum scores (intraclass correlation coefficient, 0.87) and treatment decisions (16 treatment decisions agreed versus 2 disagreed; Cohen's κ=0.93). Conclusions Remote assessment and treatment decisions of emergency patients are technically feasible with satisfactory audiovisual quality. Agreement on diagnoses, neurological examinations, and treatment decisions between onboard and remote neurologists was high. See Editorial by Derry et al
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Affiliation(s)
- Frederik Geisler
- 1 Department of Neurology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - Alexander Kunz
- 1 Department of Neurology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany.,6 Department of Neurology Medical Park Berlin Humboldtmühle Berlin Germany
| | - Benjamin Winter
- 2 Department of Neurology St. Josefs-Krankenhaus Potsdam-Sanssouci Potsdam Germany
| | - Michal Rozanski
- 3 Department of Neurology Vivantes Auguste-Viktoria-Klinikum Berlin Germany
| | | | - Joachim E Weber
- 1 Department of Neurology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - Matthias Wendt
- 5 Department of Neurology Unfallkrankenhaus Berlin Germany
| | - Katja Zieschang
- 1 Department of Neurology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - Martin Ebinger
- 6 Department of Neurology Medical Park Berlin Humboldtmühle Berlin Germany
| | - Heinrich J Audebert
- 1 Department of Neurology Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany.,7 Center for Stroke Research Berlin (CSB) Charité-Universitätsmedizin Berlin Germany
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Gschwendtner E, Turner M, Adli E, Ahuja A, Apsimon O, Apsimon R, Bachmann AM, Batsch F, Bracco C, Braunmüller F, Burger S, Burt G, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke D, Damerau H, Deubner LH, Dexter A, Doebert S, Farmer J, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Garolfi L, Gessner S, Goddard B, Gorgisyan I, Gorn AA, Granados E, Grulke O, Hartin A, Helm A, Henderson JR, Hüther M, Ibison M, Jolly S, Keeble F, Kelisani MD, Kim SY, Kraus F, Krupa M, Lefevre T, Li Y, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Minakov VA, Molendijk JC, Moody JT, Moreira M, Muggli P, Panuganti H, Pardons A, Peña Asmus F, Perera A, Petrenko A, Pukhov A, Rey S, Sherwood P, Silva LO, Sosedkin AP, Tuev PV, Velotti F, Verra L, Verzilov VA, Vieira J, Welsch CP, Wendt M, Williamson B, Wing M, Woolley B, Xia G. Correction to 'Proton-driven plasma wakefield acceleration in AWAKE'. Philos Trans A Math Phys Eng Sci 2020; 378:20190539. [PMID: 31865874 PMCID: PMC6939239 DOI: 10.1098/rsta.2019.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Gschwendtner E, Turner M, Adli E, Ahuja A, Apsimon O, Apsimon R, Bachmann AM, Batsch F, Bracco C, Braunmüller F, Burger S, Burt G, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke D, Damerau H, Deubner LH, Dexter A, Doebert S, Farmer J, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Garolfi L, Gessner S, Goddard B, Gorgisyan I, Gorn AA, Granados E, Grulke O, Hartin A, Helm A, Henderson JR, Hüther M, Ibison M, Jolly S, Keeble F, Kelisani MD, Kim SY, Kraus F, Krupa M, Lefevre T, Li Y, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Minakov VA, Molendijk JC, Moody JT, Moreira M, Muggli P, Panuganti H, Pardons A, Peña Asmus F, Perera A, Petrenko A, Pukhov A, Rey S, Sherwood P, Silva LO, Sosedkin AP, Tuev PV, Velotti F, Verra L, Verzilov VA, Vieira J, Welsch CP, Wendt M, Williamson B, Wing M, Woolley B, Xia G. Proton-driven plasma wakefield acceleration in AWAKE. Philos Trans A Math Phys Eng Sci 2019; 377:20180418. [PMID: 31230571 PMCID: PMC6602911 DOI: 10.1098/rsta.2018.0418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
In this article, we briefly summarize the experiments performed during the first run of the Advanced Wakefield Experiment, AWAKE, at CERN (European Organization for Nuclear Research). The final goal of AWAKE Run 1 (2013-2018) was to demonstrate that 10-20 MeV electrons can be accelerated to GeV energies in a plasma wakefield driven by a highly relativistic self-modulated proton bunch. We describe the experiment, outline the measurement concept and present first results. Last, we outline our plans for the future. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.
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Affiliation(s)
| | | | - E. Adli
- University of Oslo, Oslo, Norway
| | | | - O. Apsimon
- University of Manchester, Manchester, UK
- Cockcroft Institute, Daresbury, UK
| | - R. Apsimon
- University of Manchester, Manchester, UK
- Cockcroft Institute, Daresbury, UK
| | - A.-M. Bachmann
- CERN, Geneva, Switzerland
- Max Planck Institute for Physics, Munich, Germany
- Technical University Munich, Munich, Germany
| | - F. Batsch
- CERN, Geneva, Switzerland
- Max Planck Institute for Physics, Munich, Germany
- Technical University Munich, Munich, Germany
| | | | | | | | - G. Burt
- Cockcroft Institute, Daresbury, UK
- Lancaster University, Lancaster, UK
| | - B. Buttenschön
- Max Planck Institute for Plasma Physics, Greifswald, Germany
| | - A. Caldwell
- Max Planck Institute for Physics, Munich, Germany
| | | | | | | | | | | | | | - A. Dexter
- Cockcroft Institute, Daresbury, UK
- Lancaster University, Lancaster, UK
| | | | - J. Farmer
- Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | | | - R. Fiorito
- Cockcroft Institute, Daresbury, UK
- University of Liverpool, Liverpool, UK
| | - R. A. Fonseca
- ISCTE - Instituto Universitéario de Lisboa, Portugal
| | | | | | | | | | | | - A. A. Gorn
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | | | - O. Grulke
- Max Planck Institute for Plasma Physics, Greifswald, Germany
- Technical University of Denmark, Lyngby, Denmark
| | | | - A. Helm
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - J. R. Henderson
- Cockcroft Institute, Daresbury, UK
- Lancaster University, Lancaster, UK
| | - M. Hüther
- Max Planck Institute for Physics, Munich, Germany
| | - M. Ibison
- Cockcroft Institute, Daresbury, UK
- University of Liverpool, Liverpool, UK
| | | | | | | | | | - F. Kraus
- Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Y. Li
- University of Manchester, Manchester, UK
- Cockcroft Institute, Daresbury, UK
| | - S. Liu
- TRIUMF, Vancouver, Canada
| | - N. Lopes
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - K. V. Lotov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - M. Martyanov
- Max Planck Institute for Physics, Munich, Germany
| | | | - V. A. Minakov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | | | - J. T. Moody
- Max Planck Institute for Physics, Munich, Germany
| | - M. Moreira
- CERN, Geneva, Switzerland
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - P. Muggli
- CERN, Geneva, Switzerland
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - F. Peña Asmus
- Max Planck Institute for Physics, Munich, Germany
- Technical University Munich, Munich, Germany
| | - A. Perera
- Cockcroft Institute, Daresbury, UK
- University of Liverpool, Liverpool, UK
| | - A. Petrenko
- CERN, Geneva, Switzerland
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - A. Pukhov
- Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - S. Rey
- CERN, Geneva, Switzerland
| | | | - L. O. Silva
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - A. P. Sosedkin
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - P. V. Tuev
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | | | - L. Verra
- CERN, Geneva, Switzerland
- University of Milan, Milan, Italy
| | | | - J. Vieira
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - C. P. Welsch
- Cockcroft Institute, Daresbury, UK
- University of Liverpool, Liverpool, UK
| | | | - B. Williamson
- University of Manchester, Manchester, UK
- Cockcroft Institute, Daresbury, UK
| | | | | | - G. Xia
- University of Manchester, Manchester, UK
- Cockcroft Institute, Daresbury, UK
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18
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Jenei Z, Liermann HP, Husband R, Méndez ASJ, Pennicard D, Marquardt H, O'Bannon EF, Pakhomova A, Konopkova Z, Glazyrin K, Wendt M, Wenz S, McBride EE, Morgenroth W, Winkler B, Rothkirch A, Hanfland M, Evans WJ. New dynamic diamond anvil cells for tera-pascal per second fast compression x-ray diffraction experiments. Rev Sci Instrum 2019; 90:065114. [PMID: 31255042 DOI: 10.1063/1.5098993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Abstract
Fast compression experiments performed using dynamic diamond anvil cells (dDACs) employing piezoactuators offer the opportunity to study compression-rate dependent phenomena. In this paper, we describe an experimental setup which allows us to perform time-resolved x-ray diffraction during the fast compression of materials using improved dDACs. The combination of the high flux available using a 25.6 keV x-ray beam focused with a linear array of compound refractive lenses and the two fast GaAs LAMBDA detectors available at the Extreme Conditions Beamline (P02.2) at PETRA III enables the collection of x-ray diffraction patterns at an effective repetition rate of up to 4 kHz. Compression rates of up to 160 TPa/s have been achieved during the compression of gold in a 2.5 ms fast compression using improved dDAC configurations with more powerful piezoactuators. The application of this setup to low-Z compounds at lower compression rates is described, and the high temporal resolution of the setup is demonstrated. The possibility of applying finely tuned pressure profiles opens opportunities for future research, such as using oscillations of the piezoactuator to mimic propagation of seismic waves in the Earth.
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Affiliation(s)
- Zs Jenei
- High Pressure Physics Group, Lawrence Livermore National Laboratory, 7000 East Avenue, L-041, Livermore, California 94550, USA
| | - H P Liermann
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - R Husband
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - A S J Méndez
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - D Pennicard
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - H Marquardt
- Department of Earth Sciences, University of Oxford, South Parks Road, OX1 3AN Oxford, United Kingdom
| | - E F O'Bannon
- High Pressure Physics Group, Lawrence Livermore National Laboratory, 7000 East Avenue, L-041, Livermore, California 94550, USA
| | - A Pakhomova
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - Z Konopkova
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - K Glazyrin
- High Pressure Physics Group, Lawrence Livermore National Laboratory, 7000 East Avenue, L-041, Livermore, California 94550, USA
| | - M Wendt
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - S Wenz
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - E E McBride
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - W Morgenroth
- Arbeitsgruppe Kristallographie, Department of Geoscience, University of Frankfurt, 60438 Frankfurt, Germany
| | - B Winkler
- Arbeitsgruppe Kristallographie, Department of Geoscience, University of Frankfurt, 60438 Frankfurt, Germany
| | - A Rothkirch
- Photon Science, DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - M Hanfland
- ESRF, The European Synchrotron, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - W J Evans
- High Pressure Physics Group, Lawrence Livermore National Laboratory, 7000 East Avenue, L-041, Livermore, California 94550, USA
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19
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Winter B, Wendt M, Waldschmidt C, Rozanski M, Kunz A, Geisler F, Grittner U, Kaczmarek S, Ebinger M, Audebert HJ. 4G versus 3G-enabled telemedicine in prehospital acute stroke care. Int J Stroke 2019; 14:620-629. [DOI: 10.1177/1747493019830303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Time to reperfusion treatment is closely related to outcome in ischemic stroke. Prehospital stroke work-up in CT-equipped mobile stroke units is effective in reducing time to thrombolytic treatment. Current evidence predominantly comes from mobile stroke units staffed with neurologists but telemedicine-guided management may be acceptable for providing neurological expertise in ambulances. With unsatisfactory experiences in third-generation (3G)-based approaches, fourth-generation (4G) networks may provide adequate audio-visual quality but systematic comparisons of technological parameters and decision-making are lacking. Methods Trained actors presented stroke symptoms and paramedics assisted the remotely guided extended National Institutes of Health Stroke Scale (eNIHSS) assessment on the mobile stroke unit in Berlin, Germany. We compared technical parameters of 4G and 3G connections, assessed audio-visual quality of examination, and analyzed reliability of neurological assessment and treatment decisions made by the remote neurologist versus the mobile stroke unit neurologist. Results 4G and 3G connections were evaluated in 40 scenarios each. Connectivity was not available in 17% of 4G- and 15% of 3G-attempts with 6% simultaneous unavailability of both networks. The remote examiners graded audio and video quality in 4G better than in 3G with slightly shorter assessment duration in 4G (mean: 9 (SD:5) vs. mean 11 (SD:3) min, p = 0.10). Reliability of the eNIHSS sum scores was high with intraclass correlation coefficients of 0.99 (95% CI: 0.987–1.00) for 4G and 0.98 (95% CI: 0.96–0.99) for 3G. None of the remote treatment decisions differed from onsite decisions. Conclusions 4G mobile communications provided higher quality of video-examination and allowed reliable remote assessment of stroke symptoms but coverage was still incomplete in both networks.
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Affiliation(s)
- B Winter
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, St. Josefs-Krankenhaus Potsdam-Sanssouci, Potsdam, Germany
| | - M Wendt
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- Unfallkrankenhaus Berlin, Berlin, Germany
| | - C Waldschmidt
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - M Rozanski
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - A Kunz
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - F Geisler
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - U Grittner
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - M Ebinger
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - HJ Audebert
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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20
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Kunz A, Nolte CH, Erdur H, Fiebach JB, Geisler F, Rozanski M, Scheitz JF, Villringer K, Waldschmidt C, Weber JE, Wendt M, Winter B, Zieschang K, Grittner U, Kaczmarek S, Endres M, Ebinger M, Audebert HJ. Effects of Ultraearly Intravenous Thrombolysis on Outcomes in Ischemic Stroke: The STEMO (Stroke Emergency Mobile) Group. Circulation 2019; 135:1765-1767. [PMID: 28461420 DOI: 10.1161/circulationaha.117.027693] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander Kunz
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Christian H Nolte
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Hebun Erdur
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Jochen B Fiebach
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Frederik Geisler
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Michal Rozanski
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Jan F Scheitz
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Kersten Villringer
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Carolin Waldschmidt
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Joachim E Weber
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Matthias Wendt
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Benjamin Winter
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Katja Zieschang
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Ulrike Grittner
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Sabina Kaczmarek
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Matthias Endres
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Martin Ebinger
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres)
| | - Heinrich J Audebert
- From Klinik und Hochschulambulanz für Neurologie (A.K., C.H.N., H.E., J.B.F., F.G., M.R., J.F.S., K.V., C.W., J.E.W., M.W., B.W., K.Z., M. Endres, M. Ebinger, H.J.A.), Center for Stroke Research Berlin (A.K., C.H.N., J.B.F., M.R., K.V., U.G., M. Endres, M. Ebinger, H.J.A.), German Center for Cardiovascular Research (DZHK), Berlin Partner Site (M. Endres), and German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site (M. Endres), Charité-Universitätsmedizin Berlin, Germany; Berliner Feuerwehr, Germany (S.K.); and Berlin Institute of Health, Germany (M. Endres).
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21
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Wisotzki L, Bacon R, Brinchmann J, Cantalupo S, Richter P, Schaye J, Schmidt KB, Urrutia T, Weilbacher PM, Akhlaghi M, Bouché N, Contini T, Guiderdoni B, Herenz EC, Inami H, Kerutt J, Leclercq F, Marino RA, Maseda M, Monreal-Ibero A, Nanayakkara T, Richard J, Saust R, Steinmetz M, Wendt M. Author Correction: Nearly all the sky is covered by Lyman-α emission around high-redshift galaxies. Nature 2018; 563:E31. [PMID: 30377312 DOI: 10.1038/s41586-018-0664-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Change history: In this Letter, author M. Akhlaghi should be associated with affiliation (2) rather than (3). This error has been corrected online.
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Affiliation(s)
- L Wisotzki
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany.
| | - R Bacon
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - J Brinchmann
- Leiden Observatory, Leiden University, Leiden, The Netherlands.,Instituto de Astrofísica e Ciências do Espaço, Universidade do Porto, CAUP, Porto, Portugal
| | - S Cantalupo
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - P Richter
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam, Germany
| | - J Schaye
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - K B Schmidt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - T Urrutia
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - P M Weilbacher
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Akhlaghi
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - N Bouché
- Institut de Recherche en Astrophysique et Planétologie (IRAP), Université de Toulouse, CNRS, Toulouse, France
| | - T Contini
- Institut de Recherche en Astrophysique et Planétologie (IRAP), Université de Toulouse, CNRS, Toulouse, France
| | - B Guiderdoni
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - E C Herenz
- Department of Astronomy, Stockholm University, AlbaNova University Centre, Stockholm, Sweden
| | - H Inami
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - J Kerutt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - F Leclercq
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - R A Marino
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - M Maseda
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - A Monreal-Ibero
- Instituto de Astrofísica de Canarias (IAC), La Laguna, Tenerife, Spain.,Universidad de La Laguna, Departamento Astrofísica, La Laguna, Tenerife, Spain
| | - T Nanayakkara
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - J Richard
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - R Saust
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Steinmetz
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Wendt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany.,Institut für Physik und Astronomie, Universität Potsdam, Potsdam, Germany
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22
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Geisler F, Ali SF, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Schwamm LH, Audebert HJ. Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients. Int J Stroke 2018; 14:400-408. [DOI: 10.1177/1747493018806194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany. We investigated whether the TM-score (comprising six parameters), Face Arm Speech Time test, and individual patient characteristics were able to differentiate cerebrovascular disease from stroke mimic patients. Results We included 423 patients (299 (70.7%) cerebrovascular disease and 124 (29.3%) stroke mimic) in the final analysis. A TM-score > 30 indicated a high probability of a cerebrovascular disease and a score ≤15 of a stroke mimic. The TM-score performed well to identify stroke mimics (area under the curve of 0.74 under receiver-operating characteristic curve analysis). The cerebrovascular disease patients were older (74.8 vs. 69.8 years, p = 0.001), had more often severe strokes (NIHSS > 14 25.8% vs. 11.3%, p = 0.001), presented more often with weakness of the face (70.9% vs. 42.7%, p = 0.001) or arm (60.9% vs. 33.9%, p = 0.001), dysarthria (59.5% vs. 40.3%, p < 0.001), history of atrial fibrillation (38.1% vs. 21.0%, p = 0.001), arterial hypertension (78.9% vs. 53.2%, p < 0.001), and less often with seizure (0.7% vs. 21.0%, p < 0.001). Conclusions The TM-score and certain patient characteristics can help paramedics and emergency physicians in the field to identify stroke mimic patients and select the most appropriate hospital destination.
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Affiliation(s)
- Frederik Geisler
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Syed F Ali
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Martin Ebinger
- Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Alexander Kunz
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michal Rozanski
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Waldschmidt
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim E Weber
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Benjamin Winter
- Department of Neurology, St. Josefs-Krankenhaus, Potsdam-Sanssouci, Germany
| | - Lee H Schwamm
- Department of Neurology, MGH Stroke Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Heinrich J Audebert
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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23
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Tsivgoulis G, Geisler F, Katsanos AH, Kõrv J, Kunz A, Mikulik R, Rozanski M, Wendt M, Audebert HJ. Ultraearly Intravenous Thrombolysis for Acute Ischemic Stroke in Mobile Stroke Unit and Hospital Settings. Stroke 2018; 49:1996-1999. [DOI: 10.1161/strokeaha.118.021536] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Georgios Tsivgoulis
- From the Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Frederik Geisler
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (F.G., A.K., M.R., H.J.A.)
| | - Aristeidis H. Katsanos
- From the Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.)
- Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.)
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.)
| | - Alexander Kunz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (F.G., A.K., M.R., H.J.A.)
| | - Robert Mikulik
- Neurology Department and International Clinical Research Center, St. Anne’s Hospital, Brno, Czech Republic (R.M.)
- Medical Faculty of Masaryk University, Brno, Czech Republic (R.M.)
| | - Michal Rozanski
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (F.G., A.K., M.R., H.J.A.)
| | - Matthias Wendt
- Department of Neurology, Unfallkrankenhaus Berlin, Germany (M.W.)
| | - Heinrich J. Audebert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany (F.G., A.K., M.R., H.J.A.)
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.)
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24
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Winterberg B, Ramme K, Tenschert W, Winterberg G, Rolf N, Wendt M, Teerling K, Lison A, Zumkley H. Hemofiltration in Myoglobinuric Acute Renal Failure. Int J Artif Organs 2018. [DOI: 10.1177/039139889001300211] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The frequency of myoglobinuric renal failure is estimated between 8 and 20%. Despite early onset of therapy often the use of renal substitution by hemodialysis or hemofiltration is required. This study of the clinical course of nine patients with myoglobinuric acute renal failure reveals continuous arterio-venous hemofiltration (CAVH) to have an effective clearance for myoglobin. Thus, the time until recovery of renal function as well as the frequency of secondary complications in rhabdomyolysis induced acute renal failure can be distinctly reduced.
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Affiliation(s)
- B. Winterberg
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - K. Ramme
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - W. Tenschert
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - G. Winterberg
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - N. Rolf
- Klinik für Anästhesiologie und Operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - M. Wendt
- Klinik für Anästhesiologie und Operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - K. Teerling
- Medizinische Klinik und Poliklinik C, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - A.E. Lison
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
| | - H. Zumkley
- Medizinische Poliklinik, Westfälische Wilhelms-Universität Münster, Münster - F.R.G
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25
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Nolte CH, Ebinger M, Scheitz JF, Kunz A, Erdur H, Geisler F, Braemswig TB, Rozanski M, Weber JE, Wendt M, Zieschang K, Fiebach JB, Villringer K, Grittner U, Kaczmarek S, Endres M, Audebert HJ. Effects of Prehospital Thrombolysis in Stroke Patients With Prestroke Dependency. Stroke 2018; 49:646-651. [DOI: 10.1161/strokeaha.117.019060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily –independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency.
Methods—
This observational, retrospective analysis included all patients with acute ischemic stroke depending on assistance before stroke who received intravenous thrombolysis either on the Stroke Emergency Mobile (STEMO) or through conventional in-hospital care (CC) in a tertiary stroke center (Charité, Campus Benjamin Franklin, Berlin) during routine care. Prespecified outcomes were modified Rankin Scale scores of 0 to 3 and survival at 3 months, as well as symptomatic intracranial hemorrhage. Outcomes were adjusted in multivariable logistic regression.
Results—
Between February 2011 and March 2015, 122 of 427 patients (28%) treated on STEMO and 142 of 505 patients (28%) treated via CC needed assistance before stroke. Median onset-to-treatment times were 97 (interquartile range, 69–159; STEMO) and 135 (interquartile range, 98–184; CC;
P
<0.001) minutes. After 3 months, modified Rankin Scale scores of 0 to 3 was observed in 48 STEMO patients (39%) versus 35 CC patients (25%;
P
=0.01) and 86 (70%, STEMO) versus 85 (60%, CC) patients were alive (
P
=0.07). After adjustment, STEMO care was favorable with respect to modified Rankin Scale scores of 0 to 3 (odds ratio, 1.99; 95% confidence interval, 1.02–3.87;
P
=0.042) with a nonsignificant result for survival (odds ratio, 1.73; 95% confidence interval, 0.95–3.16;
P
=0.07). Symptomatic intracranial hemorrhage occurred in 5 STEMO versus 12 CC patients (4.2% versus 8.5%;
P
=0.167).
Conclusions—
The results of this study suggest that earlier, prehospital (as compared with in-hospital) start of intravenous thrombolysis in acute ischemic stroke may translate into better clinical outcome in patients with prestroke dependency.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02358772.
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Affiliation(s)
- Christian H. Nolte
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Martin Ebinger
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Jan F. Scheitz
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Alexander Kunz
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Hebun Erdur
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Frederik Geisler
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Tim Bastian Braemswig
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Michal Rozanski
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Joachim E. Weber
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Matthias Wendt
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Katja Zieschang
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Jochen B. Fiebach
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Kersten Villringer
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Ulrike Grittner
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Sabina Kaczmarek
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Matthias Endres
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
| | - Heinrich J. Audebert
- From the Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité – Universitätsmedizin
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Wendt M, Mahnke LK, Näther C, van Leusen J, Kögerler P, Bensch W. Ordnung muss sein: heteroelement order and disorder in polyoxovanadates. Dalton Trans 2018; 47:6672-6674. [DOI: 10.1039/c8dt00715b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Three new mixed antimonato–germanato polyoxovanadates exhibit different degrees of order of their unique crystallographic heterometal atom positions.
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Affiliation(s)
- M. Wendt
- Institut für Anorganische Chemie
- Christian-Albrechts-Universität zu Kiel
- 24118 Kiel
- Germany
| | - L. K. Mahnke
- Institut für Anorganische Chemie
- Christian-Albrechts-Universität zu Kiel
- 24118 Kiel
- Germany
| | - C. Näther
- Institut für Anorganische Chemie
- Christian-Albrechts-Universität zu Kiel
- 24118 Kiel
- Germany
| | - J. van Leusen
- Institut für Anorganische Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - P. Kögerler
- Institut für Anorganische Chemie
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - W. Bensch
- Institut für Anorganische Chemie
- Christian-Albrechts-Universität zu Kiel
- 24118 Kiel
- Germany
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Wendt M, Polzin P, van Leusen J, Näther C, Kögerler P, Bensch W. In situ ligand exchange-mediated 0D/1D transformation of a polyoxovanadate. Dalton Trans 2017; 46:1618-1623. [DOI: 10.1039/c6dt04412c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The antimonato-polyoxovanadate {NiII(en)3}3[VIV15SbIII6O42(H2O)]·ca.15H2O was utilized as a synthon for the solvothermal in situ generation of the new compound {NiII(phen)3}2[{NiII(en)2}VIV15SbIII6O42(H2O)]·19H2O, a rearrangement induced by ligand metathesis.
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Affiliation(s)
- M. Wendt
- Institute of Inorganic Chemistry
- Christian-Albrechts University of Kiel
- 24118 Kiel
- Germany
| | - P. Polzin
- Institute of Inorganic Chemistry
- Christian-Albrechts University of Kiel
- 24118 Kiel
- Germany
| | - J. van Leusen
- Institute of Inorganic Chemistry
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - C. Näther
- Institute of Inorganic Chemistry
- Christian-Albrechts University of Kiel
- 24118 Kiel
- Germany
| | - P. Kögerler
- Institute of Inorganic Chemistry
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - W. Bensch
- Institute of Inorganic Chemistry
- Christian-Albrechts University of Kiel
- 24118 Kiel
- Germany
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Hansmann D, Postel A, Bächlein C, Fischer N, Alawi M, Grundhoff A, Derking S, Tenhündfeld J, Pfankuche V, Herder V, Wendt M, Becher P, Baumgärtner W. Detection of a New Pestivirus in the Central Nervous System of Piglets with Congenital Tremors. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.009] [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: 11/17/2022]
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Rozanski M, Waldschmidt C, Kunz A, Grittner U, Ebinger M, Wendt M, Winter B, Bollweg K, Villringer K, Fiebach JB, Audebert HJ. Glial Fibrillary Acidic Protein for Prehospital Diagnosis of Intracerebral Hemorrhage. Cerebrovasc Dis 2016; 43:76-81. [PMID: 27951536 DOI: 10.1159/000453460] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting. METHODS We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO). STEMO is a stroke ambulance staffed by a specialized team including a neurologist and equipped with a computed tomography scanner plus a point-of-care laboratory. The STEMO ambulance is integrated in the emergency medical system of Berlin, Germany. Following prehospital stroke diagnosis, blood was drawn and subsequently analysed using research assays from Roche diagnostics. The clinical accuracy of plasma GFAP was tested using a cut-off value of 0.29 ng/ml. RESULTS Blood samples of 74 patients were analysed. Twenty-five patients had ICH (mean age 69 ± 11 years, median National Institutes of Health Stroke Scale (NIHSS) 15) and 49 IS (mean age 75 ± 10 years, median NIHSS 6). Nine ICH (0 IS patients) had GFAP-levels above 0.29 ng/ml. The sensitivity and specificity of GFAP for differentiating between ICH and AIS were 36.0 and 100%. The sensitivity for ICH volume >15 ml was 61.5%. ICH patients without GFAP elevation had significantly smaller hemorrhage volumes (median 4.5 vs. 37.6 ml, p = 0.004) and were less likely to deteriorate (19 vs. 56%, p = 0.087). CONCLUSIONS GFAP levels >0.29 ng/ml were seen only in ICH, thus confirming the diagnosis of ICH during prehospital care. However, sensitivity is low particularly in smaller hemorrhages.
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Affiliation(s)
- Michal Rozanski
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
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Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Zieschang K, Fiebach JB, Villringer K, Erdur H, Scheitz JF, Tütüncü S, Bollweg K, Grittner U, Kaczmarek S, Endres M, Nolte CH, Audebert HJ. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol 2016; 15:1035-43. [DOI: 10.1016/s1474-4422(16)30129-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/02/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
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Koch PM, Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Zieschang K, Bollweg K, Kaczmarek S, Endres M, Audebert HJ. Influence of Distance to Scene on Time to Thrombolysis in a Specialized Stroke Ambulance. Stroke 2016; 47:2136-40. [DOI: 10.1161/strokeaha.116.013057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Specialized computed tomography–equipped stroke ambulances shorten time to intravenous thrombolysis in acute ischemic stroke by starting treatment before hospital arrival. Because of longer travel-time-to-scene, time benefits of this concept are expected to diminish with longer distances from base station to scene.
Methods—
We used data from the Prehospital Acute Neurological Treatment and Optimization of Medical Cares in Stroke (PHANTOM-S) trial comparing time intervals between patients for whom a specialized stroke ambulance (stroke emergency mobile) was deployed and patients with conventional emergency medical service. Expected times from base station to scene had been calculated beforehand using computer algorithms informed by emergency medical service routine data. Four different deployment zones with–75% probability–expected arrival within 4, 8, 12, and 16 minutes and total population coverage of ≈1.3 million inhabitants were categorized for stroke emergency mobile deployment. We analyzed times from alarm-to-arrival at scene, to start of intravenous thrombolysis and from onset-to-intravenous thrombolysis.
Results—
Corresponding to the size of the respective catchment zone, the number of patients cared increased with distance (zone 1: n=30, zone 2: n=127, zone 3: n=156, and zone 4: n=217). Although time to stroke emergency mobile arrival increased with distance (mean: 8.0, 12.5, 15.4, and 18.4 minutes in zones 1–4), time from alarm-to-intravenous thrombolysis (mean: 41.8 versus 76.5; 50.2 versus 79.1; 54.5 versus 76.6; and 59.3 versus 78.0 minutes, respectively; all
P
<0.01) remained shorter in the stroke emergency mobile group across all zones.
Conclusions—
In a metropolitan area such as Berlin, time benefits justify a specialized stroke ambulance service up to a mean travel time of 18 minutes from base station.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01382862.
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Affiliation(s)
- Peter M. Koch
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Alexander Kunz
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Martin Ebinger
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Frederik Geisler
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Michal Rozanski
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Carolin Waldschmidt
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Joachim E. Weber
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Matthias Wendt
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Benjamin Winter
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Katja Zieschang
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Kerstin Bollweg
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Sabina Kaczmarek
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Matthias Endres
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
| | - Heinrich J. Audebert
- From the Klinik und Hochschulambulanz für Neurologie (P.M.K., A.K., M.E., F.G., M.R., C.W., J.E.W., M.W., B.W., K.Z., M.E., H.J.A.), Center for Stroke Research Berlin (A.K., M.E., M.R., K.B., M.E., H.J.A.), German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin (M.E.), and German Center for Cardiovascular Research (DZHK), Partner Site Berlin (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Fire Brigade, Berlin, Germany (S.K.); and Berlin Institute of Health (BIH)
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Lehmann C, Feyerherd F, Feyerherd T, Fogliata M, Gründling M, Usichenko TI, Meissner K, Wendt M, Pavlovic D. Ketamine does not affect intestinal microcirculation in pentobarbital-anaesthetized rats during experimental endotoxaemia. Lab Anim 2016; 41:55-62. [PMID: 17234050 DOI: 10.1258/002367707779399491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/18/2022]
Abstract
The objective of the study was to evaluate the effects of ketamine on intestinal microcirculation in pentobarbital-anaesthetized rats during experimental endotoxaemia. A prospective, randomized, controlled study was carried out using 32 male Lewis rats. The animals were divided into four groups ( n = 8 each). All animals were initially anaesthetized with 60 mg/kg pentobarbital (i.p.). Group 1 served as a control (18.5 mg/kg/h pentobarbital i.v.). Groups 2 and 4 received an endotoxin intravenous infusion of 15 mg/kg lipopolysaccharide (LPS) from Escherichia coli. Groups 3 and 4 also received 10 mg/kg/h ketamine (i.v.). After 2 h of observation, the animals were examined for intestinal functional capillary density (FCD) and leukocyte adherence to the venular endothelium by means of intravital fluorescence microscopy (IVM). Subsequent to this examination, blood samples were collected to determine release of the cytokines tumour necrosis factor (TNF)- α, interleukin (IL)-1 β, IL-6 and IL-10. Endotoxaemia tended to decrease intestinal FCD (mucosa: −10.1%, muscularis longitudinalis: −2%, muscularis circularis: −9.8%) and significantly increase leukocyte adherence within submucosal venules (collecting venules: +133%, postcapillary venules: +207%; P<0.05). TNF- α, IL-1 β, IL-6 and IL-10 levels were significantly elevated following endotoxin challenge. The addition of ketamine to pentobarbital anaesthesia did not significantly affect FCD, leukocyte behaviour or cytokine levels. In conclusion, intravenous pentobarbital anaesthesia with the additional administration of ketamine did not cause alterations within the microcirculation or changes in cytokine release during endotoxaemia. In rats, the combination of pentobarbital and ketamine is suitable for use during the study of intestinal microcirculation in experimental endotoxaemia.
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Affiliation(s)
- Ch Lehmann
- Klinik für Anästhesiologie und Intensivmedizin, Ernst-Moritz-Arndt-Universität Greifswald, 17475 Greifswald, F-Loeffler-Str 23, Germany.
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Hecker M, Fitzner B, Wendt M, Lorenz P, Flechtner K, Steinbeck F, Schröder I, Thiesen HJ, Zettl UK. High-Density Peptide Microarray Analysis of IgG Autoantibody Reactivities in Serum and Cerebrospinal Fluid of Multiple Sclerosis Patients. Mol Cell Proteomics 2016; 15:1360-80. [PMID: 26831522 DOI: 10.1074/mcp.m115.051664] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/06/2022] Open
Abstract
Intrathecal immunoglobulin G (IgG) synthesis and oligoclonal IgG bands in cerebrospinal fluid (CSF) are hallmarks of multiple sclerosis (MS), but the antigen specificities remain enigmatic. Our study is the first investigating the autoantibody repertoire in paired serum and CSF samples from patients with relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and other neurological diseases by the use of high-density peptide microarrays. Protein sequences of 45 presumed MS autoantigens (e.g.MOG, MBP, and MAG) were represented on the microarrays by overlapping 15mer peptides. IgG reactivities were screened against a total of 3991 peptides, including also selected viral epitopes. The measured antibody reactivities were highly individual but correlated for matched serum and CSF samples. We found 54 peptides to be recognized significantly more often by serum or CSF antibodies from MS patients compared with controls (pvalues <0.05). The results for RRMS and PPMS clearly overlapped. However, PPMS patients presented a broader peptide-antibody signature. The highest signals were detected for a peptide mapping to a region of the Epstein-Barr virus protein EBNA1 (amino acids 392-411), which is homologous to the N-terminal part of human crystallin alpha-B. Our data confirmed several known MS-associated antigens and epitopes, and they delivered additional potential linear epitopes, which await further validation. The peripheral and intrathecal humoral immune response in MS is polyspecific and includes antibodies that are also found in serum of patients with other diseases. Further studies are required to assess the pathogenic relevance of autoreactive and anti-EBNA1 antibodies as well as their combinatorial value as biomarkers for MS.
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Affiliation(s)
- Michael Hecker
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany; §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany;
| | - Brit Fitzner
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany; §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany
| | - Matthias Wendt
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Peter Lorenz
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany
| | - Kristin Flechtner
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany
| | - Felix Steinbeck
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany; ‖Gesellschaft für Individualisierte Medizin mbH (IndyMED), Lessingstr. 17, 18055 Rostock, Germany
| | - Ina Schröder
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Hans-Jürgen Thiesen
- §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany; ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany; ‖Gesellschaft für Individualisierte Medizin mbH (IndyMED), Lessingstr. 17, 18055 Rostock, Germany
| | - Uwe Klaus Zettl
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
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Kunz AK, Nolte C, Fiebach JB, Geisler F, Rozanski M, Scheitz JF, Villringer K, Waldschmidt C, Weber J, Wendt M, Winter B, Zieschang K, Grittner U, Kaczmarek S, Endres M, Ebinger M, Audebert HJ. Abstract 179: Functional Outcomes of Pre-hospital Stroke Thrombolysis Compared to Conventional Care; the Stroke Emergency Mobile (STEMO) Project. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Specialized CT-equipped stroke ambulances can shorten time to intravenous thrombolysis (IVT) in acute ischemic stroke. Although efficacy of thrombolytic treatment is known to be time-sensitive, effects of pre-hospital thrombolysis on functional outcomes have not yet been evaluated.
Methods:
We compared outcomes of all consecutive stroke patients who received thrombolysis during the same period cared for either by the Berlin Stroke Emergency Mobile (STEMO) or within conventional care (normal ambulance and in-hospital thrombolysis). Treatment and outcomes were documented in prospective registries. Patients who lived at home without assistance prior to their stroke were included. Primary outcome was modified Rankin Scale (mRS) ≤1 at 3 month. Secondary outcome was 3-month mortality. Outcomes were adjusted in multivariable regression for demographics, co-morbidities and stroke severity.
Results:
From Feb. 5, 2011 to Mar 5, 2015, 427 patients were treated on STEMO and 513 in conventional care. 303 (mean age: 71y, female gender: 48%, median NIHSS: 7) and 357 (mean age: 70y, female gender: 36%, median NIHSS: 7) of them had lived at home without assistance pre-stroke, respectively. Mean onset to treatment time was 34 minutes shorter in STEMO care (96±60 vs. 130±56min). The primary outcome of mRS≤1 was observed in 167 (55%) and 168 (47%) patients (p=0.039); 17 (6%) vs 38 (11%) had died (p=0.02), respectively. Adjusted odds ratios were favorable for STEMO care: OR 1.56 (95%-CI: 1.11-2.20; p=0.01) for mRS≤1 and OR 0.50 (95%-CI: 0.26-0.98; p=0.04) for death.
Conclusions:
The data suggest that earlier start of IVT by specialized prehospital stroke care leads to improved outcome.
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Affiliation(s)
- Alexander Kunz Kunz
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Nolte
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Neuroradiology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Geisler
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michal Rozanski
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Neuroradiology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Waldschmidt
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Weber
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Wendt
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Winter
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Zieschang
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthias Endres
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Ebinger
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
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Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Winter B, Koch PM, Nolte CH, Hertel S, Ziera T, Audebert HJ. Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics. Stroke 2015; 46:2426-31. [PMID: 26251255 DOI: 10.1161/strokeaha.115.009877] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Copeptin levels are increased in patients diagnosed with stroke and other vascular diseases. Copeptin elevation is associated with adverse outcome, predicts re-events in patients with transient ischemic attack and is used in ruling-out acute myocardial infarction. We evaluated whether copeptin can also be used as a diagnostic marker in the prehospital stroke setting. METHODS We prospectively examined patients with suspected stroke on the Stroke Emergency Mobile-an ambulance that is equipped with computed tomography and point-of-care laboratory. A blood sample was taken from patients immediately after arrival. We analyzed copeptin levels in patients with final hospital-based diagnosis of stroke or stroke mimics as well as in vascular or nonvascular patients. In addition, we examined the associations of symptom onset with copeptin levels and the prognostic value of copeptin in patients with stroke. RESULTS Blood samples of 561 patients were analyzed. No significant differences were seen neither between cerebrovascular (n=383) and other neurological (stroke mimic; n=90) patients (P=0.15) nor between vascular (n=391) and nonvascular patients (n=170; P=0.57). We could not detect a relationship between copeptin levels and time from onset to blood draw. Three-month survival status was available in 159 patients with ischemic stroke. Copeptin levels in nonsurviving patients (n=8: median [interquartile range], 27.4 [20.2-54.7] pmol/L) were significantly higher than in surviving patients (n=151: median [interquartile range], 11.7 [5.2-30.9] pmol/L; P=0.024). CONCLUSIONS In the prehospital setting, copeptin is neither appropriate to discriminate between stroke and stroke mimic patients nor between vascular and nonvascular patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01382862. The Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients study (PHANTOM-S) was registered (NCT01382862). This sub-study was observational and not registered separately, therefore.
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Affiliation(s)
- Matthias Wendt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.).
| | - Martin Ebinger
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Alexander Kunz
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Michal Rozanski
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Carolin Waldschmidt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Joachim E Weber
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Benjamin Winter
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Peter M Koch
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Christian H Nolte
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Sabine Hertel
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Tim Ziera
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
| | - Heinrich J Audebert
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., C.H.N., H.J.A.) and Center for Stroke Research Berlin (M.E., M.R., H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany; and Department for Clinical Diagnostics, Thermo Fisher Scientific (BRAHMS GmbH), Hennigsdorf, Germany (S.H., T.Z.)
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Strauch-Sürken L, Wendt M. [Comparison of novel infrared heating plates and conventional warm water plates for piglets' creep areas in farrowing pens]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2015; 43:207-15. [PMID: 26166364 DOI: 10.15653/tpg-150068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE On a conventionally managed piglet-producing farm, novel infrared (IR) heating plates for piglets in the farrowing pens were tested for their suitability and compared with common warm-water (WW) heating plates. MATERIAL AND METHODS In total, 134 litters (summer n = 82, winter n = 52) were investigated, which were housed on IR or WW heating plates, respectively, with or without an extra cover plate (groups 1-4). To determine the influence of the different heat sources, the wound healing after castration and tail docking, the umbilical regression and the weight gain of the piglets were investigated. Additionally, the lying behavior of the piglets and the position of the sows' udder at the time of farrowing were examined with regard to the heating plates. Furthermore, the energy consumption and costs were compared. RESULTS The piglets housed on IR heating plates displayed better wound healing after castration and tail docking than the piglets housed on WW plates. The best results were obtained in piglets kept on IR heating plates with an extra cover plate. In addition, significant benefits were demonstrated for the usage of IR heating plates regarding umbilical regression. The piglets kept on IR heating plates had a slightly better weight gain in summer, whereas there were no differences between groups during winter. The lying behavior in the creep areas was similar in all groups. In general, with increasing age the percentage of time piglets spent in the lying position on the plates decreased. The percentage of time lying on the plates was higher in winter than in summer. At farrowing, 74.6% of all investigated sows directed their udder towards the heating plates. With the IR heating plates, this behavior occurred significantly more often. The energy consumption (kWh) per litter was significantly lower for the IR heating plates (electric power) both in winter and summer in comparison with the WW plates (gas). The energy costs were comparable in summer, but were higher for the IR heating plates in winter. CONCLUSION AND CLINICAL RELEVANCE IR radiation of heating plates has a positive influence on wound healing after castration and tail docking as well as on umbilical regression. In addition, the lying behavior of sows at farrowing is influenced by the IR radiation. Despite the lower energy consumption of the IR heating plates, the most profitable system has to be determined individually for each farm.
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Affiliation(s)
| | - M Wendt
- Prof. Dr. Michael Wendt, Klinik für kleine Klauentiere, Stiftung Tierärztliche Hochschule, Bischofsholer Damm 15, 30173 Hannover, E-Mail:
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Liermann HP, Konôpková Z, Morgenroth W, Glazyrin K, Bednarčik J, McBride EE, Petitgirard S, Delitz JT, Wendt M, Bican Y, Ehnes A, Schwark I, Rothkirch A, Tischer M, Heuer J, Schulte-Schrepping H, Kracht T, Franz H. The Extreme Conditions Beamline P02.2 and the Extreme Conditions Science Infrastructure at PETRA III. J Synchrotron Radiat 2015; 22:908-24. [PMID: 26134794 PMCID: PMC4489534 DOI: 10.1107/s1600577515005937] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/24/2015] [Indexed: 05/18/2023]
Abstract
A detailed description is presented of the Extreme Conditions Beamline P02.2 for micro X-ray diffraction studies of matter at simultaneous high pressure and high/low temperatures at PETRA III, in Hamburg, Germany. This includes performance of the X-ray optics and instrumental resolution as well as an overview of the different sample environments available for high-pressure studies in the diamond anvil cell. Particularly emphasized are the high-brilliance and high-energy X-ray diffraction capabilities of the beamline in conjunction with the use of fast area detectors to conduct time-resolved compression studies in the millisecond time regime. Finally, the current capability of the Extreme Conditions Science Infrastructure to support high-pressure research at the Extreme Conditions Beamline and other PETRA III beamlines is described.
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Affiliation(s)
- H.-P. Liermann
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
- Correspondence e-mail:
| | - Z. Konôpková
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - W. Morgenroth
- Department of Crystallography, University of Frankfurt, Frankfurt, Germany
| | - K. Glazyrin
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - J. Bednarčik
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - E. E. McBride
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - S. Petitgirard
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
- Bayrisches Geoinstitut, University of Bayreuth, Bayreuth, Germany
| | - J. T. Delitz
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - M. Wendt
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - Y. Bican
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - A. Ehnes
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - I. Schwark
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - A. Rothkirch
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - M. Tischer
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - J. Heuer
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | | | - T. Kracht
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - H. Franz
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
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Wichelhaus A, Wendt M, Mielsch N, Gradl G, Mittlmeier T. [Manifestation of Dupuytren nodules following fracture of the distal radius]. HANDCHIR MIKROCHIR P 2015; 47:38-43. [PMID: 25671757 DOI: 10.1055/s-0034-1398660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the incidence of post-traumatic development of Dupuytren nodules in distal radius fractures treated operatively. PATIENTS AND METHODS In 2 prospective randomised studies for operative treatment of distal radius fractures, the formation of Dupuytren nodules was registered. One of the exclusion criteria was a pre-existing Dupuytren's disease at the date of trauma. In addition to the notification of the development of Dupuytren nodules, signs of a complex regional pain syndrome were registered as well as the wrist function, level of pain and grip strength. The Castaing and the Gartland and Werley scores were assessed. The clinical outcomes of patients with and without Dupuytren nodules were compared. 239 of 275 (87%) of the patients could be examined 1 year after the operation, consisting of 32 men and 207 women with a median age of 64.2 years. The patients with Dupuytren nodules were re-evaluated after 16-60 months (median 41.8) for progression of the disease. RESULTS 21 patients (8.7%) developed changes of the palmar aponeurosis. In 20 patients nodules were stated, one patient showed a cord at the fourth ray of the injured hand. 19 out of 21 patients were female (90.5%). At re-evaluation after 41.8 months (16-60) progression could not be noted nor could similar changes be seen on the contralateral side. Patients with Dupuytren nodules were not handicapped in their hand function. 3 patients (14.3%) revealed a positive family history for Dupuytren's disease. Abuse of alcohol or diabetes was not present in any of the patients with Dupuytren nodules, 7 (33%) were smokers. CONCLUSION The occurrence of Dupyutren nodules can be triggered by a trauma or operation. It may be speculated that these nodules are an entity of their own as no progression of the contracture could be seen during the follow-up period.
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Affiliation(s)
- Alice Wichelhaus
- Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Rostock
| | - M Wendt
- Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Rostock
| | - N Mielsch
- Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Rostock
| | - G Gradl
- Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Rostock
| | - T Mittlmeier
- Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Rostock
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Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Winter B, Koch PM, Freitag E, Reich J, Schremmer D, Audebert HJ. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study. Stroke 2015; 46:740-5. [PMID: 25634000 DOI: 10.1161/strokeaha.114.008159] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke. METHODS STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome. RESULTS From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%; P<0.01%) patients in STEMO care. In patients with ischemic stroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610; P<0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care (P<0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%; P=0.096). CONCLUSIONS The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01382862.
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Affiliation(s)
- Matthias Wendt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.).
| | - Martin Ebinger
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Alexander Kunz
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Michal Rozanski
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Carolin Waldschmidt
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Joachim E Weber
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Benjamin Winter
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Peter M Koch
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Erik Freitag
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Jenrik Reich
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Daniel Schremmer
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
| | - Heinrich J Audebert
- From the Department of Neurology (M.W., M.E., A.K., M.R., C.W., J.E.W., B.W., P.M.K., E.F., J.R., H.J.A.), Center for Stroke Research Berlin (M.E., M.R., B.W., H.J.A.), Charité-Universitätsmedizin, Berlin, Germany; and Berliner Feuerwehr, Berlin, Germany (D.S.)
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Ebinger M, Kunz A, Wendt M, Rozanski M, Winter B, Waldschmidt C, Weber J, Villringer K, Fiebach JB, Audebert HJ. Effects of Golden Hour Thrombolysis. JAMA Neurol 2015; 72:25-30. [DOI: 10.1001/jamaneurol.2014.3188] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Ebinger
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Kunz
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Wendt
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Michal Rozanski
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Winter
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Waldschmidt
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Weber
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B. Fiebach
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J. Audebert
- Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany2Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, Kunz A, Koch P, Kellner PA, Gierhake D, Villringer K, Fiebach JB, Grittner U, Hartmann A, Mackert BM, Endres M, Audebert HJ. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014; 311:1622-31. [PMID: 24756512 DOI: 10.1001/jama.2014.2850] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [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: 11/14/2022]
Abstract
IMPORTANCE Time to thrombolysis is crucial for outcome in acute ischemic stroke. OBJECTIVE To determine if starting thrombolysis in a specialized ambulance reduces delays. DESIGN, SETTING, AND PARTICIPANTS In the Prehospital Acute Neurological Treatment and Optimization of Medical care in Stroke Study (PHANTOM-S), conducted in Berlin, Germany, we randomly assigned weeks with and without availability of the Stroke Emergency Mobile (STEMO) from May 1, 2011, to January 31, 2013. Berlin has an established stroke care infrastructure with 14 stroke units. We included 6182 adult patients (STEMO weeks: 44.3% male, mean [SD] age, 73.9 [15.0] y; control weeks: 45.2% male, mean [SD] age, 74.3 [14.9] y) for whom a stroke dispatch was activated. INTERVENTIONS The intervention comprised an ambulance (STEMO) equipped with a CT scanner, point-of-care laboratory, and telemedicine connection; a stroke identification algorithm at dispatcher level; and a prehospital stroke team. Thrombolysis was started before transport to hospital if ischemic stroke was confirmed and contraindications excluded. MAIN OUTCOMES AND MEASURES Primary outcome was alarm-to-thrombolysis time. Secondary outcomes included thrombolysis rate, secondary intracerebral hemorrhage after thrombolysis, and 7-day mortality. RESULTS Time reduction was assessed in all patients with a stroke dispatch from the entire catchment area in STEMO weeks (3213 patients) vs control weeks (2969 patients) and in patients in whom STEMO was available and deployed (1804 patients) vs control weeks (2969 patients). Compared with thrombolysis during control weeks, there was a reduction of 15 minutes (95% CI, 11-19) in alarm-to-treatment times in the catchment area during STEMO weeks (76.3 min; 95% CI, 73.2-79.3 vs 61.4 min; 95% CI, 58.7-64.0; P < .001). Among patients for whom STEMO was deployed, mean alarm-to-treatment time (51.8 min; 95% CI, 49.0-54.6) was shorter by 25 minutes (95% CI, 20-29; P < .001) than during control weeks. Thrombolysis rates in ischemic stroke were 29% (310/1070) during STEMO weeks and 33% (200/614) after STEMO deployment vs 21% (220/1041) during control weeks (differences, 8%; 95% CI, 4%-12%; P < .001, and 12%, 95% CI, 7%-16%; P < .001, respectively). STEMO deployment incurred no increased risk for intracerebral hemorrhage (STEMO deployment: 7/200; conventional care: 22/323; adjusted odds ratio [OR], 0.42, 95% CI, 0.18-1.03; P = .06) or 7-day mortality (9/199 vs 15/323; adjusted OR, 0.76; 95% CI, 0.31-1.82; P = .53). CONCLUSIONS AND RELEVANCE Compared with usual care, the use of ambulance-based thrombolysis resulted in decreased time to treatment without an increase in adverse events. Further studies are needed to assess the effects on clinical outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01382862.
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Affiliation(s)
- Martin Ebinger
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Benjamin Winter
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Matthias Wendt
- Department of Neurology, Charité-Universitätsmedizin Berlin
| | | | | | - Michal Rozanski
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Alexander Kunz
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Peter Koch
- Department of Neurology, Charité-Universitätsmedizin Berlin
| | | | - Daniel Gierhake
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Kersten Villringer
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
| | - Ulrike Grittner
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin4Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin
| | | | | | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin7ExcellenceCluster NeuroCure, Charité-Universitätsmedizin Berlin8German Center for Neurodegenerative Diseases (DZNE), Be
| | - Heinrich J Audebert
- Department of Neurology, Charité-Universitätsmedizin Berlin2Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin
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Ebinger M, Wendt M, Rozanski M, Winter B, Waldschmidt C, Weber J, Villringer K, Fiebach J, Kunz A, Audebert HJ. Abstract 104: Golden Hour-Thrombolysis by Starting Treatment Before Hospital Arrival the Pre-Hospital Acute Neurological Treatment and Optimization of Medical Care in Stroke Study (PHANTOM-S). Stroke 2014. [DOI: 10.1161/str.45.suppl_1.104] [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: 11/16/2022]
Abstract
Objective:
The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if onset-to-treatment time (OTT) is < 60 minutes, the so called Golden-Hour. Starting thrombolysis in a specialized ambulance with a CT-scanner plus point-of-care laboratory reduced time from emergency call to treatment in the prospective controlled PHANTOM-S study. We evaluated the rate and effectiveness of Golden-Hour thrombolysis.
Methods:
The stroke emergency mobile (STEMO) is staffed with a neurologist trained in emergency medicine, a paramedic and a technician. The effects of the STEMO implementation were evaluated in a prospective study comparing weeks with and without STEMO-availability. STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (in operation or maintenance), patients received conventional care. OTT-intervals were dichotomized in either ≤60 (Golden-Hour) or > 60 minutes as well as categorized in 10-minute intervals from 0 to 270 minutes for graphical description.
Results:
Overall, thrombolysis rates in ischemic stroke were 33% (200/614) when STEMO was deployed and 22% (330/1497) in conventional care (p<0.001). The proportion of Golden-Hour treatments (from all thrombolysis) was 6-fold higher after STEMO deployment (31.0%; n= 62 versus 4.9%; n=16; p<0.01). Compared to patients with longer OTT patients with Golden-Hour thrombolysis had no higher risks for 7- or 90-day mortality (adjusted ORs: 0.38, 95%-CI: 0.09-1.70 and 0.69, 95%-CI: 0.32-1.53) but were more likely to be discharged at home (adjusted OR: 1.93 95%CI: 1.09-3.41; p=0.024).
Conclusion:
STEMO increased the percentage of patients treated within the Golden-Hour. This entailed no risk to patients’ safety and was associated with better short-term outcome.
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Affiliation(s)
- Martin Ebinger
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Wendt
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michal Rozanski
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Winter
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Waldschmidt
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Weber
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Villringer
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Fiebach
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Kunz
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Neurology, Cntr for Stroke Rsch, Charité Universitätsmedizin Berlin, Berlin, Germany
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White GR, Ainsworth R, Akagi T, Alabau-Gonzalvo J, Angal-Kalinin D, Araki S, Aryshev A, Bai S, Bambade P, Bett DR, Blair G, Blanch C, Blanco O, Blaskovic-Kraljevic N, Bolzon B, Boogert S, Burrows PN, Christian G, Corner L, Davis MR, Faus-Golfe A, Fukuda M, Gao J, García-Morales H, Geffroy N, Hayano H, Heo AY, Hildreth M, Honda Y, Huang JY, Hwang WH, Iwashita Y, Jang S, Jeremie A, Kamiya Y, Karataev P, Kim ES, Kim HS, Kim SH, Kim YI, Komamiya S, Kubo K, Kume T, Kuroda S, Lam B, Lekomtsev K, Liu S, Lyapin A, Marin E, Masuzawa M, McCormick D, Naito T, Nelson J, Nevay LJ, Okugi T, Omori T, Oroku M, Park H, Park YJ, Perry C, Pfingstner J, Phinney N, Rawankar A, Renier Y, Resta-López J, Ross M, Sanuki T, Schulte D, Seryi A, Shevelev M, Shimizu H, Snuverink J, Spencer C, Suehara T, Sugahara R, Takahashi T, Tanaka R, Tauchi T, Terunuma N, Tomás R, Urakawa J, Wang D, Warden M, Wendt M, Wolski A, Woodley M, Yamaguchi Y, Yamanaka T, Yan J, Yokoya K, Zimmermann F. Experimental validation of a novel compact focusing scheme for future energy-frontier linear lepton colliders. Phys Rev Lett 2014; 112:034802. [PMID: 24484144 DOI: 10.1103/physrevlett.112.034802] [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] [Received: 09/10/2013] [Indexed: 06/03/2023]
Abstract
A novel scheme for the focusing of high-energy leptons in future linear colliders was proposed in 2001 [P. Raimondi and A. Seryi, Phys. Rev. Lett. 86, 3779 (2001)]. This scheme has many advantageous properties over previously studied focusing schemes, including being significantly shorter for a given energy and having a significantly better energy bandwidth. Experimental results from the ATF2 accelerator at KEK are presented that validate the operating principle of such a scheme by demonstrating the demagnification of a 1.3 GeV electron beam down to below 65 nm in height using an energy-scaled version of the compact focusing optics designed for the ILC collider.
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Affiliation(s)
- G R White
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - R Ainsworth
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - T Akagi
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - J Alabau-Gonzalvo
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - D Angal-Kalinin
- CLRC: Daresbury Laboratory, Daresbury, Warrington, Cheshire WA4 4AD, United Kingdom
| | - S Araki
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - A Aryshev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Bai
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - P Bambade
- LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - D R Bett
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - G Blair
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom and Science and Technology Facilities Council, Polaris House, North Star Avenue, Swindon SN2 1SZ, United Kingdom
| | - C Blanch
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - O Blanco
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - N Blaskovic-Kraljevic
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - B Bolzon
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and CLRC: Daresbury Laboratory, Daresbury, Warrington, Cheshire WA4 4AD, United Kingdom and Department of Physics, Oliver Lodge Laboratory, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - S Boogert
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - P N Burrows
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - G Christian
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M R Davis
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A Faus-Golfe
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - M Fukuda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Gao
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - H García-Morales
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and Universitat Politécnica de Catalunya, BarcelonaTech, C. Jordi Girona, 31. 08034 Barcelona, Spain
| | - N Geffroy
- LAPP-Universite de Savoie-CNRS/IN2P3, Annecy-le-Vieux, France
| | - H Hayano
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - A Y Heo
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - M Hildreth
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Y Honda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Y Huang
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - W H Hwang
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - Y Iwashita
- Institute for Chemical Research (ICR), Nuclear Science Research Facility, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan
| | - S Jang
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - A Jeremie
- LAPP-Universite de Savoie-CNRS/IN2P3, Annecy-le-Vieux, France
| | - Y Kamiya
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - P Karataev
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - E S Kim
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - H S Kim
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - S H Kim
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - Y I Kim
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - S Komamiya
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - K Kubo
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Kume
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Kuroda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - B Lam
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - K Lekomtsev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Liu
- LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - A Lyapin
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - E Marin
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - M Masuzawa
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - D McCormick
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Naito
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Nelson
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - L J Nevay
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom and John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - T Okugi
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Omori
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - M Oroku
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - H Park
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - Y J Park
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - C Perry
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Pfingstner
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - N Phinney
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - A Rawankar
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - Y Renier
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - J Resta-López
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - M Ross
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Sanuki
- Tohoku University, 28 Kawauchi, Aoba-ku, Sendai, 980-8576 Japan
| | - D Schulte
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - A Seryi
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M Shevelev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - H Shimizu
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Snuverink
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - C Spencer
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Suehara
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - R Sugahara
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Takahashi
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - R Tanaka
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - T Tauchi
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - N Terunuma
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - R Tomás
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - J Urakawa
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - D Wang
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - M Warden
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M Wendt
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - A Wolski
- Department of Physics, Oliver Lodge Laboratory, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - M Woodley
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - Y Yamaguchi
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - T Yamanaka
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - J Yan
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - K Yokoya
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - F Zimmermann
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
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Ebinger M, Lindenlaub S, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Kellner PA, Kaczmarek S, Endres M, Audebert HJ. Prehospital thrombolysis: a manual from Berlin. J Vis Exp 2013:e50534. [PMID: 24300505 PMCID: PMC4112646 DOI: 10.3791/50534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient's medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse). Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.
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Affiliation(s)
- Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin
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Usichenko T, Julich A, Wendt M. ‘ Yes, we can ' utilize the Hawthorne effect to improve postoperative analgesia. Br J Anaesth 2013; 110:659. [DOI: 10.1093/bja/aet040] [Citation(s) in RCA: 5] [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] [Indexed: 11/14/2022] Open
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Wendt M, Borjesson O, Avik A, Bratt J, Qureshi A, Gunnarsson I, Bruchfeld A. Pentraxin-3 and soluble tumor necrosis factor-like weak inducer of apoptosis (s-Tweak) in anti-neutrophil antibody associated vasculitis (AAV). Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.250] [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: 10/27/2022] Open
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Wendt M, Tütüncü S, Fiebach JB, Scheitz JF, Audebert HJ, Nolte CH. Preclusion of ischemic stroke patients from intravenous tissue plasminogen activator treatment for mild symptoms should not be based on low National Institutes of Health Stroke Scale Scores. J Stroke Cerebrovasc Dis 2013; 22:550-3. [PMID: 23433783 DOI: 10.1016/j.jstrokecerebrovasdis.2013.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Intravenous tissue plasminogen activator (IV tPA) improves neurologic outcome after stroke, but is not recommended for patients with minor neurologic deficits commonly classified by a lower cutoff on the National Institutes of Health Stroke Scale (NIHSS). Because not all stroke signs are captured on the NIHSS, the use of a strict cutoff may exclude functionally impaired stroke patients from IV tPA treatment. METHODS We described functional impairment, safety, and clinical outcome in patients derived from our hospital thrombolysis database who had stroke that was considered disabling despite a neurologic deficit that was considered mild. We used 2 cutoffs: NIHSS score ≤ 4 and ≤ 3. Functional impairment was assessed with the modified Rankin Scale (mRS). RESULTS Between 2008 and 2011, a total of 670 acute ischemic stroke patients received IV tPA in our institution. 107 (16%) of these patients presented with a NIHSS score ≤ 4; 65 (10%) patients presented with a NIHSS score ≤ 3. All of these patients were considered functionally impaired (mRS score ≥ 2). The most frequent symptoms were language impairment (two-thirds), distal (hand) paresis (one-third), and gait disorder in both groups. Symptomatic intracerebral hemorrhage occurred in 1 patient with a NIHSS score of 4 (1%). Despite IV tPA therapy, 26% had a nonfavorable outcome (mRS score 0-1) after 3 months, and 52% had persisting symptoms in both groups. CONCLUSIONS Language impairment, distal (hand) paresis, and gait disorder are common disabling deficits in patients with low NIHSS scores. Judgment of whether a stroke is disabling should not be based on the NIHSS score but on the assessment of the individual neurologic deficits and their impact on functional impairment.
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Affiliation(s)
- Matthias Wendt
- Department of Neurology, University of Berlin, Charite, Germany.
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Weber JE, Ebinger M, Rozanski M, Waldschmidt C, Wendt M, Winter B, Kellner P, Baumann A, Fiebach JB, Villringer K, Kaczmarek S, Endres M, Audebert HJ. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study. Neurology 2012; 80:163-8. [PMID: 23223534 DOI: 10.1212/wnl.0b013e31827b90e5] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time. METHODS The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system. It was deployed by the dispatch center whenever a specific emergency call algorithm indicated an acute stroke situation. Study-specific procedures were restricted to patients able to give informed consent. We report feasibility, safety, and duration of procedures regarding prehospital tPA administration. RESULTS From February 8 to April 30, 2011, 152 subjects were treated in STEMO. Informed consent was given by 77 patients. Forty-five (58%) had an acute ischemic stroke and 23 (51%) of these patients received tPA. The mean call-to-needle time was 62 minutes compared with 98 minutes in 50 consecutive patients treated in 2010. Two (9%) of the tPA-treated patients had a symptomatic intracranial hemorrhage and 1 of these patients (4%) died in hospital. Technical failures encountered were 1 CT dysfunction and 2 delayed CT image transmissions. CONCLUSIONS The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.
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Affiliation(s)
- Joachim E Weber
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany
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Leverson J, Souers A, Boghaert E, Phillips D, Park C, Wendt M, Fairbrother W, Humerickhouse R, Roberts A, Elmore S. 69 ABT-199, a Selective Small Molecule Inhibitor of Bcl-2, Exhibits Efficacy in Bcl-2 Dependent Malignancies While Sparing Platelets. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71867-1] [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: 10/27/2022]
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Usichenko TI, Röttenbacher I, Kohlmann T, Jülich A, Lange J, Mustea A, Engel G, Wendt M. Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study. Br J Anaesth 2012; 110:87-95. [PMID: 23048069 PMCID: PMC3520148 DOI: 10.1093/bja/aes352] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background An organizational approach is proposed as an immediate solution for improving
postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness
of a quality management system (QMS), based on procedure-specific, multimodal analgesic
protocols, modified to meet the individual patients’ requirements. Methods Patients from the orthopaedic, gynaecological, visceral, and trauma surgery departments
of the university hospital were involved in two prospective surveys. Survey 1 was
performed at baseline and survey 2 was performed after the implementation of QMS within
an interval of 1 year. The patients were asked to report pain intensity on the visual
rating scale, incidence of analgesia-related side-effects, and incidence of pain
interference with the items of life quality and their satisfaction with the treatment of
POP. Results Patients from Survey 2 (n=251) reported 25–30%
less pain than those from Survey 1 (n=269)
(P<0.0001). Nausea was reported by 40% of the patients
from Survey 1 vs 17% from Survey 2, vomiting by 25
vs 11% and fatigue by 76% in Survey 1
vs 30% in Survey 2 (P<0.0001). Life
quality and patients’ satisfaction improved in Survey 2 vs
Survey 1 (P<0.001). Conclusions The implementation of QMS allowed the reduction in POP intensity with a simultaneous
decrease in analgesia-related side-effects. This has led to an increased quality of life
and patient satisfaction.
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Affiliation(s)
- T I Usichenko
- Department of Anaesthesiology and Intensive Care Medicine, University Medicine of Greifswald, Greifswald, Germany.
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