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Westhoff M, Hardebusch T, Litterst P, Breithecker A, Haas M, Kuniss M, Neumann T, Guth S, Wiedenroth CB. Successful simultaneous stenting of a pulmonary artery and vein in pulmonary vascular stenosis due to silicosis. Case report and literature review. Front Cardiovasc Med 2023; 10:1108768. [PMID: 37229232 PMCID: PMC10203551 DOI: 10.3389/fcvm.2023.1108768] [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: 11/26/2022] [Accepted: 03/16/2023] [Indexed: 05/27/2023] Open
Abstract
A 58-year-old patient was admitted to the emergency department due to severe respiratory insufficiency. Anamnesis revealed that the patient had experienced increasing stress dyspnea for a few months. Upon imaging, an acute pulmonary embolism was excluded, but peribronchial and hilar soft tissue proliferation with compression of central parts of the pulmonary circulation was found. The patient had a history of silicosis. The histology report showed tumor-free lymph node particles with prominent anthracotic pigment and dust depositions without evidence of IgG4-associated disease. The patient was administered steroid therapy and underwent simultaneous stenting of the left interlobular pulmonary artery and the upper right pulmonary vein. As a result, a significant improvement in symptoms and physical performance was achieved. The diagnosis of inflammatory or, in particular, fibrosing mediastinal processes can be challenging and important clinical symptoms must be taken into account, especially if the pulmonary vasculature is involved. In such cases, the possibility of interventional procedures should be examined in addition to drug therapy options.
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Affiliation(s)
- M. Westhoff
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
- Universität Witten/Herdecke University, Witten, Germany
| | - T. Hardebusch
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - P. Litterst
- Department of Pulmonology, Klinik für Pneumologie, Schlaf und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer, Germany
| | - A. Breithecker
- Department of Radiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Haas
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M. Kuniss
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - T. Neumann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - S. Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - C. B. Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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2
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Kriechbaum SD, Birmes J, Wiedenroth CB, Gruen D, Vietheer J, Richter MJ, Guth S, Roller F, Liebetrau C, Hamm CW, Keller T, Rieth A. Exercise MR-proANP unmasks latent right heart failure in CTEPH. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic right heart failure is the major determinant of outcome in chronic thromboembolic pulmonary hypertension (CTEPH). Thus, its early detection is crucial for optimal patient management. Hemodynamic assessment with invasive right heart catheterization and the measurement of natriuretic peptides at rest are established diagnostic tools in this context. An elevated right atrial pressure (RAP) is a sensitive parameter of right right heart failure. Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a natriuretic peptide that reflects right atrial stress levels.
There is a growing recognition of exercise diagnostics in the assessment of right heart failure, particularly in patients with normal or borderline findings at rest. There are no data on the dynamics of MR-proANP in correlation to RAP during physical exercise.
Purpose
The present study was designed to investigate the dynamics of RAP and MR-proANP during physical exercise in patients with CTEPH and to determine whether these parameters might serve as a tool to measure exercise-dependent atrial stress as an indicator of right heart failure.
Methods
This observational cohort study included 100 CTEPH patients who underwent right heart catheterization during physical exercise (eRHC). Blood samples for MR-proANP measurement were taken prior, during, and after eRHC. MR-proANP levels were correlated to RAP levels at rest, at peak exercise (eRAP), and during recovery. RAP at rest ≤7 mmHg was defined as normal and eRAP >15 mmHg as suggestive of right heart failure.
Results
During eRHC mean RAP increased from 6±4 mmHg to 16±7 mmHg (p<0.001). MR-proANP levels and dynamics correlated with RAP at rest (rs=0.61; p<0.001; figure 1a) and at peak exercise (rs=0.66; p<0.001; Figure 1b). Furthermore, the relative percent increase in MR-proANP correlated with the relative percent increase in eRAP (rs=0.52; p<0.001; Figure 1c) Logistic regression analysis revealed the peak MR-proANP level (B=0.058; p=0.004) and the right atrial area (B=0.389; p<0.001) to be associated with eRAP dynamics. A peak MR-proANP level ≥139 pmol/L (AUC=0.81) and recovery level ≥159 pmol/L (AUC=0.82) predicted an eRAP >15 mmHg. Physical exercise unmasked RH failure in 39% of patients with normal RAP at rest; they were also characterized by a more distinct increase in MR-proANP levels (p=0.005) and higher peak (p<0.001) and recovery levels (p<0.001).
Conclusions
RAP and MR-proANP dynamics unmask manifest and latent right heart failure in CTEPH patients, which may be useful in estimating prognosis.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): SFB 1213 area CP-01 projectWilliam G. Kerckhoff-FoundationKerckhoff Heart Research Institute (KHFI)German Center for Cardiovascular Research (DZHK)
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Affiliation(s)
- S D Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - J Birmes
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - C B Wiedenroth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery , Bad Nauheim , Germany
| | - D Gruen
- University Hospital Giessen and Marburg, Medical Clinic I, Cardiology , Giessen , Germany
| | - J Vietheer
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - M J Richter
- University Hospital Giessen and Marburg, Medical Clinic II, Pneumology , Giessen , Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery , Bad Nauheim , Germany
| | - F Roller
- University Hospital Giessen and Marburg, Radiology , Giessen , Germany
| | - C Liebetrau
- CCB am Markus Hospital, Cardiology , Frankfurt am Main , Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - T Keller
- University Hospital Giessen and Marburg, Medical Clinic I, Cardiology , Giessen , Germany
| | - A Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
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3
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Kovacs Z, Guth S, Fistera D, Taube C, Wiedenroth CB. [Congenital Pulmonary Artery Stenoses as a Rare Cause of Pulmonary Hypertension]. Pneumologie 2021; 75:531-535. [PMID: 33684954 DOI: 10.1055/a-1362-4996] [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: 10/22/2022]
Abstract
Kongenitale Pulmonalarterienstenosen sind eine seltene Ursache der pulmonalen Hypertonie (PH). Die Erkrankung wird in ihrer Häufigkeit vermutlich unterschätzt, und sie sollte in der Abklärung einer PH bedacht werden.Die Vorstellung einer 43-jährigen Patientin erfolgte zur Therapieoptimierung und Evaluation einer möglichen Lungentransplantation mit der Arbeitsdiagnose kongenitale Pulmonalarterienstenosen.Die Patientin beklagte eine seit der frühen Kindheit bestehende Belastungsdyspnoe aktuell entsprechend WHO-FC-Klasse II-III.Die Krankengeschichte zeigte die Erstdiagnose einer primären pulmonalarteriellen Hypertonie (IPAH) vor 17 Jahren. Es erfolgte eine PH-spezifische Medikation in wechselnden Kombinationen. Im Rahmen eines Zentrumswechsels erfolgte eine Reevaluation, und bei Nachweis eines typischen Mismatch mit normaler Ventilation, jedoch keilförmig gestörter Perfusion in der Lungenszintigrafie wurde eine chronisch thromboembolische pulmonale Hypertonie (CTEPH) vermutet. Die Pulmonalis-Angiografie zeigte ausschließlich subsegmental gelegene Stenosierungen sowie Gefäßabbrüche mit korrespondierenden Minderperfusionen, passend zu einer CTEPH. Im Rahmen der ersten Intervention erfolgte aufgrund der ungewöhnlichen Morphologie der pulmonalarteriellen Läsionen eine Erweiterung der Diagnostik mittels optischer Kohärenztomografie (OCT). Bei der Patientin fand sich kein endoluminales Material, jedoch eine kräftige Gefäßwand. Damit wurde die Diagnose einer pumonalen Hypertonie bei kongenitalen Pulmonalarterienstenosen mit In-situ-Thrombosierung gestellt.
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Affiliation(s)
- Z Kovacs
- Ruhrlandklinik, Abt. Pneumologie, Universitätsmedizin Essen, Universität Duisburg-Essen
| | - S Guth
- Kerckhoff-Klinik, Abt. Thoraxchirurgie, Bad Nauheim
| | - D Fistera
- Ruhrlandklinik, Abt. Pneumologie, Universitätsmedizin Essen, Universität Duisburg-Essen
| | - C Taube
- Ruhrlandklinik, Abt. Pneumologie, Universitätsmedizin Essen, Universität Duisburg-Essen
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Cho A, Mraz J, Weijler A, Guth S, Muraközy G, Just U, Knobler R, Spittler A, Hoetzenecker K, Jaksch P, Wekerle T. Comprehensive Immunophenotypic Monitoring in a Prospective Randomized Controlled Trial of Prophylactic Use of Extracorporeal Photopheresis (ECP) in Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.730] [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: 11/30/2022] Open
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5
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Liebetrau C, Kriechbaum S, Rieth A, Ghofrani HA, Haas M, Rolf A, Hamm CW, Guth S, Mayer E, Wiedenroth CB. 4283Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Balloon pulmonary angioplasty (BPA) is an evolving treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The main indicator for success is improvement in pulmonary hemodynamics, but outcome data are heterogeneous.
Purpose
The aim of the present study was to evaluate pulmonary hemodynamics not only at rest, but also during exercise before and 6 months after BPA.
Methods
We report a prospective series of 64 consecutive patients with inoperable CTEPH who were treated interventionally with BPA. All patients underwent standardized assessment prior to the first BPA and 6 months after the last intervention. Assessment included WHO FC, Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), 6-minute walking distance (6MWD), serum levels of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), and exercise RHC.
Results
The mean number of sessions per patient was 5.6 (± 1.3) and the mean number of pulmonary segments targeted in all interventions was 11 (± 3). BPA treatment led to improvements in pulmonary hemodynamics and exercise capacity (6MWD: 416±94 m vs. 463±96 m; p<0.0001) except for CO and CI during RHC at rest; these parameters showed improvements only during exercise RHC. MPAP at rest showed a reduction from 41±9 to 31±9 mmHg (p<0.0001) and PVR at rest decreased from 6.8±2.3 WU to 4.3±1.9 WU (p<0.0001). Further decreases were observed for systolic pulmonary arterial pressure, TPG, PVR, and TPR. Cardiac output (7.0±2.0 L/min vs. 8.3±2.0 L/min; p<0.0001) and cardiac index during exercise RHC (3.8±1.1 L/min/m2 vs. 4.4±1.1 L/min/m2; p<0.0001) improved significantly. Median NT-proBNP concentrations decreased from 741 ng/L (IQR 192–1425 ng/L) to 139 ng/L (IQR 60–266 ng/L) during BPA treatment (p<0.0001). Results from the CAMPHOR questionnaire showed significant improvements in symptoms (11±5.8 vs. 5.5±4.9, p<0.0001), activity limitations (9.2±5.6 vs. 5.2±4.5, p<0.0001), and quality of life (6.4±5.7 vs. 3.5±3.7, p<0.0001).
Conclusion
Significant improvements in pulmonary hemodynamics at rest and during exercise were observed 6 months after BPA. Exercise right heart catheterization offers a more discriminating evaluation of the changes in pulmonary hemodynamics after BPA.
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Affiliation(s)
- C Liebetrau
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - S Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - H A Ghofrani
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - M Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - E Mayer
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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Kriechbaum SD, Peters K, Ajnwojner R, Wolter JS, Haas M, Roller F, Keller T, Rolf A, Hamm CW, Mayer E, Guth S, Liebetrau C. P2774Galectin-3, GDF-15, and ST2 in noninvasive assessment of myocardial remodelling in chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary artery obstruction leads to impaired pulmonary hemodynamics and secondary right heart failure, which is highly predictive of outcome. Thus, the extent of myocardial -especially right heart- remodelling is an indicator of disease severity.
Purpose
The aim of the present study was to assess growth differentiation factor-15 (GDF-15), galectin-3, and suppression of tumorigenicity 2 (ST2) as non-invasive biomarkers of myocardial remodelling in patients suffering from CTEPH.
Methods
We analysed the serum levels of GDF-15, galectin-3 and ST2 in a cohort of 64 CTEPH patients and in a control group of 25 patients without cardiovascular disease. The biomarker levels were further correlated with clinical, laboratory, and hemodynamic data, including 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (meanPAP), pulmonary vascular resistance (PVR), and right atrial pressure (RAP).
Results
The biomarker levels in the control group were: galectin-3: 3.5 ng/l (IQR 2.7–4.0), GDF-15: 92.6 pg/ml (IQR 78.5–129.1), and ST2: 48.65 ng/l (IQR 35.5–57.0). CTEPH patients had higher levels of GDF-15 (196.7 pg/ml; IQR 128.4–302.8; p<0.001) and ST2 (52.6 ng/l; IQR 44.5–71.9; p=0.05) but not galectin-3 (3.4 ng/l; IQR 2.7–4.3; p=0.84). In the CTEPH cohort, patients with a meanPAP >35 mmHg (GDF-15: p=0.01; ST2: p=0.04) and patients with a PVR >500 dyn sec cm–5 (GDF-15: p=0.004; ST2: p=0.002) had significantly increased biomarker levels. For the detection of a meanPAP >35mmHg, ROC analysis revealed an AUC of 0.71 for GDF-15 and 0.67 for ST2. The level of GDF-15 correlated with the level of NT-proBNP (rrs=0.69; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=−0.47; p≤0.001). The level of ST2 correlated with the level of NT-proBNP (rrs=0.67; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=-0.31; p=0.02).
Conclusion
Our results demonstrate that GDF-15 and ST2, non-invasive biomarkers of myocardial remodelling, are significantly elevated in patients suffering from CTEPH. The correlation of biomarker levels with established outcome predictors suggests a use as indicators of disease severity.
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Affiliation(s)
- S D Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - K Peters
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - R Ajnwojner
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - J S Wolter
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - M Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - F Roller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - E Mayer
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
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Hüser S, Guth S, Joost HG, Soukup ST, Köhrle J, Kreienbrock L, Diel P, Lachenmeier DW, Eisenbrand G, Vollmer G, Nöthlings U, Marko D, Mally A, Grune T, Lehmann L, Steinberg P, Kulling SE. Effects of isoflavones on breast tissue and the thyroid hormone system in humans: a comprehensive safety evaluation. Arch Toxicol 2018; 92:2703-2748. [PMID: 30132047 PMCID: PMC6132702 DOI: 10.1007/s00204-018-2279-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Isoflavones are secondary plant constituents of certain foods and feeds such as soy, linseeds, and red clover. Furthermore, isoflavone-containing preparations are marketed as food supplements and so-called dietary food for special medical purposes to alleviate health complaints of peri- and postmenopausal women. Based on the bioactivity of isoflavones, especially their hormonal properties, there is an ongoing discussion regarding their potential adverse effects on human health. This review evaluates and summarises the evidence from interventional and observational studies addressing potential unintended effects of isoflavones on the female breast in healthy women as well as in breast cancer patients and on the thyroid hormone system. In addition, evidence from animal and in vitro studies considered relevant in this context was taken into account along with their strengths and limitations. Key factors influencing the biological effects of isoflavones, e.g., bioavailability, plasma and tissue concentrations, metabolism, temporality (pre- vs. postmenopausal women), and duration of isoflavone exposure, were also addressed. Final conclusions on the safety of isoflavones are guided by the aim of precautionary consumer protection.
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Affiliation(s)
- S Hüser
- Institute for Food Toxicology, Senate Commission on Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
| | - S Guth
- Institute for Food Toxicology, Senate Commission on Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
| | - H G Joost
- Department of Experimental Diabetology, German Institute of Human Nutrition (DIfE), Nuthetal, Germany
| | - S T Soukup
- Department of Safety and Quality of Fruit and Vegetables, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Haid-und-Neu-Str. 9, 76131, Karlsruhe, Germany
| | - J Köhrle
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, CVK, Berlin, Germany
| | - L Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hannover, Germany
| | - P Diel
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - D W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt Karlsruhe, Karlsruhe, Germany
| | - G Eisenbrand
- Division of Food Chemistry and Toxicology, Molecular Nutrition, Department of Chemistry, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - G Vollmer
- Department of Biology, Molecular Cell Physiology and Endocrinology, Technische Universität Dresden, Dresden, Germany
| | - U Nöthlings
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany
| | - D Marko
- Department of Food Chemistry and Toxicology, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - A Mally
- Department of Toxicology, University of Würzburg, Würzburg, Germany
| | - T Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition (DIfE), Nuthetal, Germany
| | - L Lehmann
- Department of Food Chemistry, Institute for Pharmacy and Food Chemistry, University of Würzburg, Würzburg, Germany
| | - P Steinberg
- Institute for Food Toxicology, University of Veterinary Medicine Hannover, Hannover, Germany
- Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Haid-und-Neu-Str. 9, 76131, Karlsruhe, Germany
| | - S E Kulling
- Department of Safety and Quality of Fruit and Vegetables, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Haid-und-Neu-Str. 9, 76131, Karlsruhe, Germany.
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Krieg VJ, Hobohm L, Liebetrau C, Guth S, Koelmel S, Keller K, Kresoja KP, Konstantinides S, Mayer E, Wiedenroth CB, Lankeit M. P6342Risk assessment according to the 2015 ESC guidelines risk prediction model of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V J Krieg
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - L Hobohm
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - C Liebetrau
- Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - S Koelmel
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - K Keller
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - K P Kresoja
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
| | | | - E Mayer
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - C B Wiedenroth
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
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Krieg V, Hobohm L, Liebetrau C, Guth S, Koelmel S, Pohl K, Troidl C, Essmann L, Rossmann H, Konstantinides S, Mayer E, Wiedenroth C, Lankeit M. P1343Risk factors for chronic thromboembolic pulmonary hypertension - importance of thyroid disease and treatment. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lankeit M, Koelmel S, Krieg V, Hobohm L, Liebetrau C, Konstantinides S, Mayer E, Wiedenroth C, Guth S. P4002Outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension - a German single centre two-year experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Wiedenroth C, Breithecker A, Liebetrau C, Haas M, Guth S, Mayer E. Interventionelle Behandlung der inoperablen chronisch thromboembolischen pulmonalen Hypertonie (CTEPH): pulmonale Ballonangioplastie (BPA). Pneumologie 2017. [DOI: 10.1055/s-0037-1598267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Wiedenroth
- Abteilung für Thoraxchirurgie, Kerckhoff-Klinik, Bad Nauheim
| | - A Breithecker
- Abteilung für Radiologie, Gesundheitszentrum Wetterau, Bad Nauheim
| | - C Liebetrau
- Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim
| | - M Haas
- Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim
| | - S Guth
- Abteilung für Thoraxchirurgie, Kerckhoff-Klinik, Bad Nauheim
| | - E Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff-Klinik, Bad Nauheim
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Wilkens H, Konstantinides S, Lang I, Bunck AC, Gerges M, Gerhardt F, Grgic A, Grohé C, Guth S, Held M, Hinrichs J, Hoeper MM, Klepetko W, Kramm T, Krüger U, Lankeit M, Meyer BC, Olsson KM, Schäfers HJ, Schmidt M, Seyfarth HJ, Ulrich S, Wiedenroth CB, Mayer E. [Chronic thromboembolic pulmonary hypertension: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S62-S69. [PMID: 27760452 DOI: 10.1055/s-0042-114529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In every patient with PH of unknown cause CTEPH should be excluded. The primary treatment option is surgical pulmonary endarterectomy (PEA) in a specialized multidisciplinary CTEPH center. Inoperable patients or patients with persistent or recurrent CTEPH after PEA are candidates for targeted drug therapy. For balloon pulmonary angioplasty (BPA), there is currently only limited experience. This option - as PEA - is reserved to specialized centers with expertise for this treatment method. In addition, a brief overview is given on pulmonary artery sarcoma, since its surgical treatment is often analogous to PEA. The recommendations of this working group are summarized in the present paper.
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Schneeweis C, Magedanz A, Guth S, Voigtländer T. Pulmonary artery sarcoma mimicking pulmonary embolism. Clin Res Cardiol 2016; 105:962-963. [PMID: 27351705 DOI: 10.1007/s00392-016-1007-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - A Magedanz
- Cardioangiologisches Centrum Bethanien (CCB), 60389, Frankfurt, Germany
| | - S Guth
- Department of Thoracic Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - T Voigtländer
- Cardioangiologisches Centrum Bethanien (CCB), 60389, Frankfurt, Germany
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Kramm T, Guth S, Wiedenroth CB, Ghofrani HA, Mayer E. [Treatment of acute and chronic right ventricular failure]. Med Klin Intensivmed Notfmed 2016; 111:463-80. [PMID: 27241776 DOI: 10.1007/s00063-016-0181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/17/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
Abstract
Acute or chronic right ventricular failure is an often misdiagnosed cause of cardiopulmonary insufficiency. In addition to clinical symptoms or laboratory testing, echocardiography and invasive hemodynamic measurement by means of right-heart catheterization are essential for diagnosis and treatment control. In case of acute right ventricular failure, adequate symptomatic treatment of the life-threatening situation is important. Main issues are maintenance of coronary artery perfusion pressure and myocardial oxygen delivery as well as reduction of right ventricular afterload. In persistent right ventricular failure extracorporeal or intracorporeal assist devices are increasingly used as bridging or destination therapy. On a long-term basis, the targeted therapy of the underlying disease is crucial.
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Affiliation(s)
- T Kramm
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland.
| | - S Guth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
| | - C B Wiedenroth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
| | - H A Ghofrani
- Abteilung für allgemeine Pneumologie, Kerckhoff-Klinik gGmbH, Bad Nauheim, Deutschland.,Medizinische Klinik II, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
| | - E Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik gGmbH, Benekestr. 2‑8, 61231, Bad Nauheim, Deutschland
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Wiedenroth CB, Liebetrau C, Breithecker A, Haas M, Guth S, Krombach G, Mayer E. Hybrid-Eingriffe zur Behandlung von hoch-Risiko-Patienten mit chronisch thromboembolischer pulmonaler Hypertonie (CTEPH). Pneumologie 2016. [DOI: 10.1055/s-0036-1583502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wiedenroth CB, Breithecker A, Haas M, Guth S, Ghofrani A, Mayer E, Liebetrau C. Pulmonale Ballonangioplastie (BPA) zur Behandlung von Patienten mit inoperabler chronisch thromboembolischer pulmonaler Hypertonie (CTEPH). Pneumologie 2016. [DOI: 10.1055/s-0036-1583506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Avramov-Zamurovic S, Nelson C, Guth S, Korotkova O. Flatness parameter influence on scintillation reduction for multi-Gaussian Schell-model beams propagating in turbulent air. Appl Opt 2016; 55:3442-3446. [PMID: 27140353 DOI: 10.1364/ao.55.003442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Reduction in the scintillation index of multi-Gaussian Schell-model beams propagating in turbulent air is demonstrated as a function of two source parameters: the r.m.s. coherence width and the summation index. The beams were generated with the help of a nematic phase-only, reflective spatial light modulator at a cycling rate of 333 frames per second and recorded after propagating through a weakly turbulent air channel over a distance of 70 m. Experimental results are in good agreement with theory.
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Guth S, Windler E, Leise U, Bamberger CM. Ultrasound Diagnosis of Hepatic Steatosis as a Surrogate for Atherosclerosis. Ultrasound Int Open 2016; 2:E27-31. [PMID: 27689164 DOI: 10.1055/s-0035-1569419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/13/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- S Guth
- Medical Prevention Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - E Windler
- Präventive Medizin, University Hospital Hamburg-Eppendorf, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - U Leise
- Medical Prevention Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - C M Bamberger
- Medical Prevention Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Wittkämper G, Gall H, Reichenberger F, Seeger W, Ghofrani A, Mayer E, Guth S, Wiedenroth C, Richter MJ. Inspiratorische Kapazität bei operabler chronisch thromboembolischer pulmonaler Hypertonie vor pulmonaler Endarteriektomie: eine prospektive Beobachtungsstudie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wiedenroth C, Liebetrau C, Breithecker A, Guth S, Krombach G, Mayer E. Hybrid-Eingriffe zur Behandlung von hoch-Risiko-Patienten mit chronisch thromboembolischer pulmonaler Hypertonie. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wiedenroth CB, Richter MJ, Guth S, Zaatar M, Fink L, Mayer E, Beqiri S. Thymolipom – eine seltene Ursache für Fieber. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wilkens H, Lang I, Blankenburg T, Grohé C, Guth S, Held M, Klepetko W, Konstantinides S, Kramm T, Krüger U, Lankeit M, Schäfers HJ, Seyfarth HJ, Mayer E. [Chronic thromboembolic pulmonary hypertension--a position paper]. Dtsch Med Wochenschr 2014; 139 Suppl 4:S155-65. [PMID: 25084310 DOI: 10.1055/s-0034-1370220] [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: 10/25/2022]
Abstract
This position paper summarises current developments in chronic thromboembolic pulmonary hypertension (CTEPH) including diagnostic approaches and treatment options. Based on the guidelines of the task force of CTEPH experts at the 5th World Symposium on Pulmonary Hypertension in Nice 2013. Open questions arising during the treatment of patients with CTEPH are addressed. Patients with suspected CTEPH should undergo echocardiography and cardiopulmonary exercise testing. A ventilation/perfusion scan is the recommended imaging test for screening in the diagnostic algorithm for the evaluation of CTEPH. CTEPH-patients should be discussed in an expert center with an interdisciplinary team and an experienced PEA surgeon to decide the further treatment. Pulmonary endarterectomy (PEA) is the treatment of choice for patients with CTEPH. Medical therapy with PH-targeted medications for inoperable CTEPH and residual disease after PEA should only be initiated if evaluation reveals that the patient is no candidate for a PEA. Current data suggest that CTEPH patients treated with PEA have a better long-term survival rate and quality of life than patients treated with medical therapy.
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Affiliation(s)
- H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - I Lang
- Klinik für Innere Medizin II, Abt. Kardiologie, Medizinische Universität Wien
| | - T Blankenburg
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch
| | - S Guth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
| | - M Held
- Missionsärztliche Klinik Würzburg, Abteilung Innere Medizin, Würzburg
| | - W Klepetko
- Klinische Abteilung für Thoraxchirurgie, Medizinische Universität Wien
| | - S Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz
| | - T Kramm
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
| | - U Krüger
- Klinik für Kardiologie und Angiologie, Herzzentrum Duisburg
| | - M Lankeit
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz
| | - H J Schäfers
- Klinik für Thorax-Herz-Gefäßchirurgie, Universitätsklinikum des Saarlandes, Homburg
| | - H J Seyfarth
- Abteilung Pneumologie (Department für Innere Medizin, Neurologie und Dermatologie), Universitätsklinikum Leipzig
| | - E Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
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Wilkens H, Lang I, Blankenburg T, Grohé C, Guth S, Held M, Klepetko W, Konstantinides S, Kramm T, Krüger U, Lankeit M, Schäfers HJ, Seyfarth HJ, Mayer E. [Chronic thromboembolic pulmonary hypertension--a position paper]. Dtsch Med Wochenschr 2014; 139:2204-6. [PMID: 25084309 DOI: 10.1055/s-0034-1370219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - I Lang
- Klinik für Innere Medizin II, Abt. Kardiologie, Medizinische Universität Wien
| | - T Blankenburg
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch
| | - S Guth
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
| | - M Held
- Missionsärztliche Klinik Würzburg, Abteilung Innere Medizin, Würzburg
| | - W Klepetko
- Klinische Abteilung für Thoraxchirurgie, Medizinische Universität Wien
| | - S Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz
| | - T Kramm
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
| | - U Krüger
- Klinik für Kardiologie und Angiologie, Herzzentrum Duisburg
| | - M Lankeit
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz
| | - H J Schäfers
- Klinik für Thorax-Herz-Gefäßchirurgie, Universitätsklinikum des Saarlandes, Homburg
| | - H J Seyfarth
- Abteilung Pneumologie (Department für Innere Medizin, Neurologie und Dermatologie), Universitätsklinikum Leipzig
| | - E Mayer
- Abteilung für Thoraxchirurgie, Kerckhoff Klinik, Bad Nauheim
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Guth S, Kramm T, Wiedenroth C, Mayer E. Pulmonale Endarteriektomie bei chronisch-thrombembolischer pulmonaler Hypertonie. Z Herz- Thorax- Gefäßchir 2014. [DOI: 10.1007/s00398-014-1071-1] [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: 10/25/2022]
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25
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Stille P, Richter MJ, Wiedenroth C, Zaatar M, Guth S, Voswinckel R, Ghofrani A, Mayer E. Hypoxämie im 6 Minuten Gehtest bei Patienten mit chronisch thromboembolischer pulmonaler Hypertonie. Pneumologie 2014. [DOI: 10.1055/s-0034-1367925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Richter MJ, Wiedenroth C, Zaatar M, Guth S, Mayer E, Beqiri S, Ghofrani A, Voswinckel R, Siemons T, Mitrovic V, Fink L, Bauer C. Ein seltener Fall einer in Arizona (USA) häufigen Erkrankung. Pneumologie 2014. [DOI: 10.1055/s-0034-1367855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Kramm T, Guth S, Mayer E. Pulmonale Embolektomie. Z Herz- Thorax- Gefäßchir 2014. [DOI: 10.1007/s00398-013-1067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Guth S, Kramer F, Schulz A, Wiedenroth C, Kramm T, Mayer E. Identifizierung von Biomarkern bei Chronisch Thromboembolischer Pulmonaler Hypertonie (CTEPH) und deren Verlauf nach Pulmonaler Endarteriektomie (PEA). Pneumologie 2013. [DOI: 10.1055/s-0033-1344854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. Guth
- Kerckhoff-Klinik, Bad Nauheim
| | - F. Kramer
- Global Biomarker, Bayer Pharma AG, Wuppertal
| | - A. Schulz
- Global Drug Discovery Statistics, Bayer Pharma AG, Berlin
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Pena Pinado F, Ehlken N, Nagel C, Fischer C, Tiede H, Rosenkranz S, Seyfarth HJ, Mayer E, Halank M, Guth S, Grünig E. Angststörungen und Depression bei Patienten mit pulmonal arterieller Hypertonie und chronisch thromboembolischer pulmonaler Hypertonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1334605] [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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Guth S, Leise U, Gocke C, Herborn CU, Galach A, Bamberger CM. [Ultrasound versus MRI in preventive examinations - a retrospective analysis of 833 patients]. Ultraschall Med 2012; 33:E202-E209. [PMID: 23175274 DOI: 10.1055/s-0032-1330284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The benefit of ultrasound in comparison with full-body MRI during a medical checkup in preventive health care was examined with regard to the detection of cardiovascular risk factors, metabolic syndrome, malignant tumors and further relevant findings. MATERIALS AND METHODS 833 consecutive patients (266 f/567 m, age: 19 - 93 y, mean age: 56.6 y) underwent both ultrasound (extracranial carotid arteries, thyroid, abdominal ultrasound and echocardiography) and whole-body MRI (whole-body MR angiography, head, thorax, abdomen and virtual colonoscopy). For ultrasound examinations, DEGUM level III devices were used (Siemens Acuson Antares, Siemens G60, Siemens, Erlangen). MRI examinations were performed using a 1.5 Tesla MRI device (Siemens Avanto, Siemens, Erlangen). All patients were reviewed retrospectively based on the written reports. RESULTS Ultrasound was much more sensitive in detecting early atherosclerotic changes than MRI angiography. In 33 % of the patients, manifestations of atherosclerosis were found. Thoracic (3) and abdominal aortic and mesenteric artery aneurysms (3) were diagnosed by both methods. Hepatic steatosis as an important risk factor of metabolic syndrome was only found by ultrasound in 20.4 % of our patients. Malignant tumors were rare in this population (1.4 %): all abdominal tumors except one renal oncocytoma were found using both methods. MRI and ultrasound were equally sensitive with respect to the detection of small liver foci. As expected, MRI was less sensitive than ultrasound in the diagnosis of thyroid nodes. For intracranial diagnoses, malignant intrathoracic findings and colonic polyps, ultrasound is not the method of choice. CONCLUSION For the detection of lifestyle-dependent diseases such as atherosclerosis and metabolic syndrome, ultrasound examination was more sensitive than MRI, and the same was true for the early detection of thyroid diseases. For the detection of malignant abdominal tumors, both methods were equally sensitive. Whole-body MRI can additionally detect pathological changes in the head, lungs and colon.
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Prange F, Herb J, Ehlken N, Ghofrani HA, Halank M, Seyfarth HJ, Nagel C, Guth S, Mayer E, Grünig E. Effekt von Atem- und Bewegungstherapie bei Patienten mit inoperabler chronisch thrombembolischer pulmonaler Hypertonie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Herb J, Prange F, Ehlken N, Nagel C, Grünig E, Mayer E, Guth S. Re-Remodeling des rechten Herzens nach pulmonaler Endarteriektomie bei Patienten mit chronisch thromboembolischer pulmonaler Hypertonie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Guth S, Mayer E. Pulmonale Endarteriektomie: Ergebnisse des europäischen CTEPH-Registers. Pneumologie 2011. [DOI: 10.1055/s-0030-1256799] [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: 10/15/2022]
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Wilkens H, Lang I, Behr J, Berghaus T, Grohe C, Guth S, Hoeper MM, Kramm T, Krüger U, Langer F, Schäfers HJ, Schmidt M, Seyfarth HJ, Wahlers T, Worth H, Mayer E. [Chronic thromboembolic pulmonary hypertension: recommendations of the Cologne Consensus Conference 2010]. Dtsch Med Wochenschr 2010; 135 Suppl 3:S125-30. [PMID: 20862621 DOI: 10.1055/s-0030-1263319] [Citation(s) in RCA: 4] [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: 10/19/2022]
Abstract
In the 2009 European Guidelines on pulmonary hypertension one section covers aspects of pathophysiology, diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). The practical implementation of the guidelines for this disease is of crucial importance, because CTEPH is a form of pulmonary hypertension which can be surgically cured. It is, however, frequently diagnosed late in the course of disease and often treated not correctly. In the European Guidelines CTEPH is addressed relatively briefly, although it is a common form of PH which is often overlooked. Any patient with unexplained PH should be evaluated for the presence of CTEPH. A ventilation/perfusion lung scan is recommended as the first step to exclude CTEPH. If the ventilation/perfusion lung scan or multislice CT angiography reveals perfusions defects suggesting the diagnosis of CTEPH, the patient should be referred to a centre with expertise in the medical and surgical management of these patients. After diagnosis of CTEPH the case has to be reviewed by an experienced surgeon in a PEA centre for assessment of operability. The recommendations of the European guidelines are summarized in the current manuscript with additional comments regarding diagnosis and treatment according to most recent evidence.
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Affiliation(s)
- H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg.
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Gorgus E, Lohr C, Raquet N, Guth S, Schrenk D. Limettin and furocoumarins in beverages containing citrus juices or extracts. Food Chem Toxicol 2009; 48:93-8. [PMID: 19770019 DOI: 10.1016/j.fct.2009.09.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 08/11/2009] [Accepted: 09/11/2009] [Indexed: 11/29/2022]
Abstract
Phototoxic and photo-genotoxic furocoumarins occur, e.g., in citrus species, parsnip, parsley, celery, and figs. They exhibit phototoxic and photo-genotoxic properties in combination with UV radiation, while less is known about the phototoxicity of the coumarin derivative limettin mainly found in limes and lemons. Risk assessment of dietary furocoumarins is based on a threshold approach and on estimates of 1.2-1.45 mg for the average daily exposure for adults via the diet in several countries. In these estimates, the major contribution to overall daily exposure has been attributed to citrus-flavored non-alcoholic beverages, in spite of a lack of analytical data for those products. Therefore, we analyzed a number of furocoumarins in a variety of citrus-containing beverages and included limettin in the pattern of analyzed constituents. Our findings provide strong evidence that grapefruit juice and not citrus-flavored non-alcoholic beverages is the major source of furocoumarin exposure in a Western diet. Based on these findings it can be assumed that the average dietary exposure to furocoumarins is about 3-fold lower than previously estimated, i.e. in the range of 548 and 2237 microg/day for the average and high consumer, respectively. The coumarin derivative limettin was mainly found in lime products.
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Affiliation(s)
- E Gorgus
- Food Chemistry and Toxicology, University of Kaiserslautern, Erwin-Schroedinger-Strasse 52, D-67663 Kaiserslautern, Germany
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Abstract
BACKGROUND The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7.5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. A study employing more sensitive 13 MHz scanners has not been conducted so far. MATERIALS AND METHODS Six hundred and thirty-five consecutive patients (33% female, 67% male, mean 56.7 years) presenting for a preventive health check up underwent ultrasound screening of the thyroid gland (Siemens Acuson Antares, 13 MHz-linear scanner, B-mode and Power mode) and measurement of the basal TSH (thyroid stimulating hormone) value. Size and degree of vascularization of the thyroid gland and of nodules were determined and analysed retrospectively. RESULTS In 432 of 635 patients, thyroid nodules could be detected with an increasing incidence with age, in 338 without goiter. Mean thyroid size was 12.3 mL for women and 20.5 mL for men correlating strongly with body weight. Fifty-three percentage of the nodules were smaller than 5 mm. Incidence of thyroid dysfunction was only 4%. No cancerous lesions could be found. CONCLUSIONS Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning. Our study underlines the clinical significance of iodine deficiency and should renew the discussion on routine iodine supplementation.
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Affiliation(s)
- S Guth
- Medical Prevention Center, Center of Internal Medicine, Hamburg-Eppendorf University Medical Center, Falkenried 88, Hamburg, Germany.
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37
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Gangi A, Dietemann J, Guth S, Steib J, Roy C. Computed Tomography (CT) and Flouroscopy-guided Vertebroplasty: Results and Complications in 187 Patients. Semin Intervent Radiol 2008. [DOI: 10.1055/s-0028-1082199] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Aberle J, Kilic E, Guth S, Gille J, Liebl L, Guthoff AE. An unusual cause of acute lower gastrointestinal bleeding. Acta Gastroenterol Belg 2006; 69:221-3. [PMID: 16929620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 45 year old male patient was referred to hospital after syncope during defaecation. Rapid peranal blood loss occurred shortly after admission. Gastroscopy and coloscopy performed as first line diagnostic measures failed to detect the source of haemorrhage. Ultrasound (US) revealed a hypoechoic and hypervascularized tumor mass in the right lower abdomen. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparatomy. Collectively US should be among the first line diagnostic procedures in younger patients presenting with lower gastrointestinal haemorrhage.
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Affiliation(s)
- J Aberle
- Zentrum für Innere Medizin, Medizinische Klinik 3, Hamburg.
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39
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Wolf D, Guth S, Kemény M, Eisenbrand G. Aufgaben und Funktionen der ?Senatskommission zur Beurteilung der gesundheitlichen Unbedenklichkeit von Lebensmitteln? der Deutschen Forschungsgemeinschaft. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:857-61. [PMID: 15378173 DOI: 10.1007/s00103-004-0902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) advises authorities and the government on food safety. The risk assessment of foodstuffs, including novel and functional foods, covers the evaluation of food ingredients and additives as well as the evaluation of novel processing methods. In carrying out this task the Commission expresses its opinion primarily on those aspects which are concerned with the safety assessment. In addition, questions relating to the technological need and to nutritional or physiological benefits are also considered. The topics considered may originate from enquiries of the Ministry for Consumer Protection, Nutrition and Agriculture (BMVEL). Other topics may be selected by the Commission on its own initiative, if they are considered to be of particular importance for consumer protection. Within the context of this activity the SKLM also organises symposia and expert discussions, their outcome subsequently being published as resolutions, conclusions or opinions.
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Affiliation(s)
- D Wolf
- Fachrichtung Lebensmittelchemie und Umwelttoxikologie, Technische Universität Kaiserslautern, Kaiserslautern
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40
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Guth S, Pr�fer D, Kramm T, Peivandi A, Oelert H, Mayer E. Inhalation of aerosolized iloprost protects against severe ischemia-reperfusion injury in isolated perfused rabbit lungs. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Werth WA, Kuroczynski W, Guth S, von Bardeleben RS, Oelert H. Klappenerhaltende Resektion eines Fibroelastoms. Zeitschrift f�r Herz-, Thorax- und Gef��chirurgie 2002. [DOI: 10.1007/s003980200003] [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: 12/01/2022]
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42
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Böhme A, Ruhnke M, Karthaus M, Einsele H, Guth S, Heussel G, Heussel CP, Junghanss C, Kern WV, Kubin T, Sezer O, Silling G, Südhoff T, Szelényi H, Ullmann AJ. [Treatment of fungal infections in hematology and oncology. Guidelines of the Working Party on Infections in Hematology and Oncology (AGIHO) of the German Society for Hematology and Oncology (DGHO)]. Dtsch Med Wochenschr 2001; 126:1440-7. [PMID: 11743682 DOI: 10.1055/s-2001-18975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Böhme
- Med. Klin. III, J. W. Goethe-Universität Frankfurt.
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43
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Abstract
The splicing factor U2AF is required for the recruitment of U2 small nuclear RNP to pre-mRNAs in higher eukaryotes. The 65-kDa subunit of U2AF (U2AF(65)) binds to the polypyrimidine (Py) tract preceding the 3' splice site, while the 35-kDa subunit (U2AF(35)) contacts the conserved AG dinucleotide at the 3' end of the intron. It has been shown that the interaction between U2AF(35) and the 3' splice site AG can stabilize U2AF(65) binding to weak Py tracts characteristic of so-called AG-dependent pre-mRNAs. U2AF(35) has also been implicated in arginine-serine (RS) domain-mediated bridging interactions with splicing factors of the SR protein family bound to exonic splicing enhancers (ESE), and these interactions can also stabilize U2AF(65) binding. Complementation of the splicing activity of nuclear extracts depleted of U2AF by chromatography in oligo(dT)-cellulose requires, for some pre-mRNAs, only the presence of U2AF(65). In contrast, splicing of a mouse immunoglobulin M (IgM) M1-M2 pre-mRNA requires both U2AF subunits. In this report we have investigated the sequence elements (e.g., Py tract strength, 3' splice site AG, ESE) responsible for the U2AF(35) dependence of IgM. The results indicate that (i) the IgM substrate is an AG-dependent pre-mRNA, (ii) U2AF(35) dependence correlates with AG dependence, and (iii) the identity of the first nucleotide of exon 2 is important for U2AF(35) function. In contrast, RS domain-mediated interactions with SR proteins bound to the ESE appear to be dispensable, because the purine-rich ESE present in exon M2 is not essential for U2AF(35) activity and because a truncation mutant of U2AF(35) consisting only of the pseudo-RNA recognition motif domain and lacking the RS domain is active in our complementation assays. While some of the effects of U2AF(35) can be explained in terms of enhanced U2AF(65) binding, other activities of U2AF(35) do not correlate with increased cross-linking of U2AF(65) to the Py tract. Collectively, the results argue that interaction of U2AF(35) with a consensus 3' splice site triggers events in spliceosome assembly in addition to stabilizing U2AF(65) binding, thus revealing a dual function for U2AF(35) in pre-mRNA splicing.
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Affiliation(s)
- S Guth
- Gene Expression Programme, European Molecular Biology Laboratory, 69117 Heidelberg, Germany
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44
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Affiliation(s)
- S Guth
- Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Hospital, Langenbeckstr. 1, D-55101 Mainz, Germany.
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45
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Guth S, Valcárcel J. Kinetic role for mammalian SF1/BBP in spliceosome assembly and function after polypyrimidine tract recognition by U2AF. J Biol Chem 2000; 275:38059-66. [PMID: 10954700 DOI: 10.1074/jbc.m001483200] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Two sequences important for pre-mRNA splicing precede the 3' end of introns in higher eukaryotes, the branch point (BP) and the polypyrimidine (Py) tract. Initial recognition of these signals involves cooperative binding of the splicing factor SF1/mammalian branch point binding protein (mBBP) to the BP and of U2AF(65) to the Py tract. Both factors are required for recruitment of the U2 small nuclear ribonucleoprotein particle (U2 snRNP) to the BP in reactions reconstituted from purified components. In contrast, extensive depletion of ST1/BBP in Saccharomyces cerevisiae does not compromise spliceosome assembly or splicing significantly. As BP sequences are less conserved in mammals, these discrepancies could reflect more stringent requirements for SF1/BBP in this system. We report here that extensive depletion of SF1/mBBP from nuclear extracts of HeLa cells results in only modest reduction of their activity in spliceosome assembly and splicing. Some of these effects reflect differences in the kinetics of U2 snRNP binding. Although U2AF(65) binding was reduced in the depleted extracts, the defects caused by SF1/mBBP depletion could not be fully restored by an increase in occupancy of the Py tract by exogenously added U2AF(65), arguing for a role of SF1/mBBP in U2 snRNP recruitment distinct from promoting U2AF(65) binding.
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Affiliation(s)
- S Guth
- Gene Expression Programme, European Molecular Biology Laboratory, Meyerhofstrasse 1, D-69117 Heidelberg, Germany
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46
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Roy C, Tuchmann C, Guth S, Saussine C. [Vesical diseases: accuracy of imaging modalities]. J Radiol 2000; 81:1099-111. [PMID: 10995498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Vesical disorders are numerous. For tumoral processes, the role of imaging modalities is limited to the loco-regional extension. In certain rare cases of benign tumors, precise diagnosis can be evocated. Nowadays, urinary insufficiency is explored by dynamic MRI. It provides a complete assessment of the whole muscular and visceral compartments of the pelvic cavity.
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Affiliation(s)
- C Roy
- Service de Radiologie B, Hôpital Civil, Strasbourg, France.
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47
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Roy C, Tuchmann C, Guth S, Lang H, Saussine C, Jacqmin D. [Helical CT of urinary tract: clinical applications]. J Radiol 2000; 81:1071-81. [PMID: 10995494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Helical CT is the most useful imaging modality to evaluate kidney diseases. Different imaging protocols are used to assess the correct diagnosis in each clinical situation. The nephrographic phase (between 90 and 100 s of delay after injection) is more accurate than the cortical phase (between 30 and 40 s of delay) to depict and characterise small renal masses. Multiplanar and 3D reconstruction are useful to plan partial kidney surgery or percutaneous surgery of lithiasis. In emergency, spiral CT, if available, is suitable to assess renal colic. Spiral CT is the best modality to evaluate traumatic kidney.
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Affiliation(s)
- C Roy
- Service de Radiologie B, Chirurgie A - Hôpital Civil, Strasbourg, France.
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48
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Roy C, Tuchmann C, Guth S, Saussine C. [Quiz. Vesicle diseases: accuracy of imaging modalities]. J Radiol 2000; 81:1112-3. [PMID: 10995499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- C Roy
- Service de Radiologie B, Hôpital Civil, Strasbourg, France.
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49
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Roy C, Tuchmann C, Guth S, Lang H, Saussine C, Jacqmin D. [Quiz. Helical CT of urinary tract: clinical applications]. J Radiol 2000; 81:1082-3. [PMID: 10995495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- C Roy
- Service de Radiologie B, Chirurgie A--Hôpital Civil, Strasbourg, France.
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50
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Guth S, Dinkelmann S, Domack U, Pötzschke H, Barnikol WK. A model of stepwise isovolaemic blood exchange in anaesthetised, spontaneously breathing rats to evaluate the oxygen transport efficiency of artificial oxygen carriers. Artif Cells Blood Substit Immobil Biotechnol 2000; 28:113-27. [PMID: 10728580 DOI: 10.3109/10731190009118575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our research pursues the production of hypo-oncotic artificial oxygen carriers, based on artificial covalently cross-linked hyperpolymeric mammalian haemoglobins. To evaluate their in vivo efficiency in oxygen delivery to the tissue we developed a small animal model of stepwise isovolaemic blood exchange in anaesthetised, spontaneously breathing rats. With the aid of a two-way respiratory micro valve for small animals the overall oxygen uptake by the tissue of the animal can be determined. Measurements of oxygen contents in arterial and mixed venous blood and of some further blood parameters together with known oxygen-binding characteristics of artificial and native oxygen carriers, permits the determination of the way the two oxygen carriers contribute to the overall oxygen uptake. These so-called partial oxygen net to transport rates (i.e. partial oxygen uptakes), related to the corresponding intravascular mass flow of the transporters, are characteristic measures of the efficiency of the oxygen transporter, the so-called oxygen transport quality. Other biological indicators for an adequate oxygen supply are oxygen-dependent changes of ventilation, cardiac output, heart rate, and systemic vascular resistance. The performance of artificial oxygen carriers is elucidated by a comparison with experimental results from the analogous treatment of rats with non oxygen-transporting plasma expanders.
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Affiliation(s)
- S Guth
- Klinik für Herz-, Thorax- und Gefasschirurgie, Johannes Gutenberg-Universität, Mainz
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