1
|
Schoene D, Hartmann C, Winzer S, Moustafa H, Günther A, Puetz V, Barlinn K. [Postoperative management following decompressive hemicraniectomy for malignant middle cerebral artery infarction-A German nationwide survey study]. Nervenarzt 2023; 94:934-943. [PMID: 37140605 PMCID: PMC10157548 DOI: 10.1007/s00115-023-01486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Malignant middle cerebral artery infarction is a potentially life-threatening disease. Decompressive hemicraniectomy constitutes an evidence-based treatment practice, especially in patients under 60 years of age; however, recommendations with respect to postoperative management and particularly duration of postoperative sedation lack standardization. OBJECTIVE This survey study aimed to analyze the current situation of patients with malignant middle cerebral artery infarction following hemicraniectomy in the neurointensive care setting. MATERIAL AND METHODS From 20 September 2021 to 31 October 2021, 43 members of the initiative of German neurointensive trial engagement (IGNITE) network were invited to participate in a standardized anonymous online survey. Descriptive data analysis was performed. RESULTS Out of 43 centers 29 (67.4%) participated in the survey, including 24 university hospitals. Of the hospitals 21 have their own neurological intensive care unit. While 23.1% favored a standardized approach regarding postoperative sedation, the majority utilized individual criteria (e.g., intracranial pressure increase, weaning parameters, complications) to assess the need and duration. The timing of targeted extubation varied widely between hospitals (≤ 24 h 19.2%, ≤ 3 days in 30.8%, ≤ 5 days in 19.2%, > 5 days in 15.4%). Early tracheotomy (≤ 7 days) is performed in 19.2% and 80.8% of the centers aim for tracheotomy within 14 days. Hyperosmolar treatment is used on a regular basis in 53.9% and 22 centers (84.6%) agreed to participate in a clinical trial addressing the duration of postoperative sedation and ventilation. CONCLUSION The results of this nationwide survey among neurointensive care units in Germany reflect a remarkable heterogeneity in the treatment practices of patients with malignant middle cerebral artery infarction undergoing hemicraniectomy, especially with respect to the duration of postoperative sedation and ventilation. A randomized trial in this matter seems warranted.
Collapse
Affiliation(s)
- D Schoene
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- Dresdner Neurovaskuläres Centrum, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
| | - C Hartmann
- Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - S Winzer
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Dresdner Neurovaskuläres Centrum, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - H Moustafa
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Dresdner Neurovaskuläres Centrum, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - A Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - V Puetz
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Dresdner Neurovaskuläres Centrum, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - K Barlinn
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Dresdner Neurovaskuläres Centrum, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| |
Collapse
|
2
|
Barker M, Günther A, Wurps H, Gebhardt A, Schönfeld N, Polsfuss S, Bauer TT. Ultrasound-guided lymph node biopsy in smear-negative children and adolescents with suspected TB. Int J Tuberc Lung Dis 2023; 27:164-165. [PMID: 36853115 DOI: 10.5588/ijtld.22.0364] [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: 01/26/2023] Open
Affiliation(s)
- M Barker
- Department of Paediatrics, Helios Klinikum Emil von Behring, Berlin, Germany
| | - A Günther
- Department of Paediatrics, Helios Klinikum Emil von Behring, Berlin, Germany
| | - H Wurps
- Department of Respiratory Medicine, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany
| | - A Gebhardt
- Department of Respiratory Medicine, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany
| | - N Schönfeld
- Department of Respiratory Medicine, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany
| | - S Polsfuss
- Institute for Microbiology, Immunology and Laboratory Medicine, Helios Klinikum Emil von Behring, Berlin, Germany
| | - T T Bauer
- Department of Respiratory Medicine, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany, German Central Committee for the Fight against Tuberculosis (DZK), Berlin, Germany
| |
Collapse
|
3
|
Herfurth K, Ruhe J, Kentouche K, Günther A, Brämer D, Eckardt N, Busch M, Wolf G. [Refractory thrombotic thrombocytopenic purpura]. Inn Med (Heidelb) 2022; 63:1307-1311. [PMID: 36194294 PMCID: PMC9531628 DOI: 10.1007/s00108-022-01408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) remains a serious illness with potentially life-threatening complications. The following case of a TTP patient describes a serious relapse with exacerbation in spite of adequately initiated therapy and highlights the necessity of interdisciplinary expertise in the treatment of the disease.
Collapse
Affiliation(s)
- K Herfurth
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - J Ruhe
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - K Kentouche
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - A Günther
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - D Brämer
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - N Eckardt
- Institut für Interventionelle und Diagnostische Radiologie, Abt. Neuroradiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - M Busch
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - G Wolf
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| |
Collapse
|
4
|
Kirsten D, de Vries U, Costabel U, Koschel D, Bonella F, Günther A, Behr J, Claussen M, Schwarz S, Prasse A, Kreuter M. [Linguistic Validation of the "German Lung Fibrosis Health Related Quality of Life Questionnaire"]. Pneumologie 2021; 75:753-760. [PMID: 34428830 DOI: 10.1055/a-1334-2745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Health status and quality of life are impaired in patients with idiopathic pulmonary fibrosis (IPF) and idiopathic non-specific interstitial fibrosis (iNSIP). In Germany exists only the K-BILD questionnaire for patients with ILD 1 in a professional translation by Kreuter et al. 2 This questionnaire focuses on the main problems in patients with progressive lung fibrosis in a limited manner. Therefore a new quality of life questionnaire for patients with idiopathic pulmonary fibrosis was developed and linguistically validated. METHODS The linguistic validation of our questionnaire was carried out in a multistage process in collaboration with the developer of the questionnaire and bilingual, professional translators. Review by the developers and back translations as well as clinical assessment by IPF- and iNSIP-patients ensured that the translated questionnaire reflected the intention of the original English version of our questionnaire.Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). RESULTS The new questionnaire concerning the health status was composed in English and German language. The questions cover five scales (sensitivity, selectivity and symptoms like breathlessness and cough and a visual analog scale on general health status) with 23 items. CONCLUSIONS The results show that the FFB maps the special needs of the patients with IPF and iNSIP well and can support clinical and scientific questions and can be helpful in monitoring the clinical course.
Collapse
Affiliation(s)
| | - U de Vries
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - U Costabel
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | | | - F Bonella
- Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | - A Günther
- Medizinische Klinik Universität Gießen
| | - J Behr
- Medzinische Klinik und Poliklinik V, LMU Klinikum, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | | | - S Schwarz
- Asklepios Klinikum Harburg, Lungenabteilung
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Deutsches Zentrum für Lungenforschung, Heidelberg
| |
Collapse
|
5
|
Barlinn J, Winzer S, Worthmann H, Urbanek C, Häusler KG, Günther A, Erdur H, Görtler M, Busetto L, Wojciechowski C, Schmitt J, Shah Y, Büchele B, Sokolowski P, Kraya T, Merkelbach S, Rosengarten B, Stangenberg-Gliss K, Weber J, Schlachetzki F, Abu-Mugheisib M, Petersen M, Schwartz A, Palm F, Jowaed A, Volbers B, Zickler P, Remi J, Bardutzky J, Bösel J, Audebert HJ, Hubert GJ, Gumbinger C. [Telemedicine in stroke-pertinent to stroke care in Germany]. Nervenarzt 2021; 92:593-601. [PMID: 34046722 PMCID: PMC8184549 DOI: 10.1007/s00115-021-01137-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution. METHODS The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks. RESULTS Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states. CONCLUSION Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.
Collapse
Affiliation(s)
- J Barlinn
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - S Winzer
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - H Worthmann
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Urbanek
- Klinik für Neurologie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland
| | - K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - H Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Görtler
- Klinik für Neurologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - L Busetto
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Wojciechowski
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Y Shah
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - B Büchele
- Klinik für Neurologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - P Sokolowski
- Klinik für Neurologie und neurologische Intensivmedizin, Fachkrankenhaus Hubertusburg, Hubertusburg, Deutschland
| | - T Kraya
- Klinik für Neurologie, Klinikum St.Georg Leipzig, Leipzig, Deutschland
| | - S Merkelbach
- Klinik für Neurologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland
| | - B Rosengarten
- Klinik für Neurologie, Klinikum Chemnitz, Chemnitz, Deutschland
| | - K Stangenberg-Gliss
- Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - J Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Schlachetzki
- Klinik für Neurologie, Universität Regensburg, Regensburg, Deutschland
| | - M Abu-Mugheisib
- Klinik für Neurologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - M Petersen
- Klinik für Neurologie, Klinikum Osnabrück, Osnabrück, Deutschland
| | - A Schwartz
- Klinik für Neurologie, Klinikum Region Hannover, Hannover, Deutschland
| | - F Palm
- Klinik für Neurologie, Helios Klinikum Schleswig, Schleswig, Deutschland
| | - A Jowaed
- Klinik für Neurologie, Westküstenkliniken Heide, Heide, Deutschland
| | - B Volbers
- Klinik für Neurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Zickler
- Klinik für Neurologie und Klinische Neurophysiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Remi
- Klinik für Neurologie, Klinikum der LMU München-Großhadern, München, Deutschland
| | - J Bardutzky
- Klinik für Neurologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Bösel
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - H J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G J Hubert
- Klinik für Neurologie, München-Klinik Harlaching, München, Deutschland
| | - C Gumbinger
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
6
|
Diab M, Hamadanchi A, Franz M, Struve A, Färber G, Sponholz C, Löffler B, Pletz MW, Schulze PC, Günther A, Doenst T. The Impact of Establishing a Regional Infective Endocarditis (IE) Network on Decreasing Diagnostic Latency and Perioperative IE-Related Complications. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725759] [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: 10/21/2022]
|
7
|
Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geißler K, Gläser S, Handzhhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. [German Guideline for Idiopathic Pulmonary Fibrosis]. Pneumologie 2020; 74:e1-e2. [PMID: 32422671 DOI: 10.1055/a-1179-2905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - A Günther
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, sowie Agaplesion Pneumologische Klinik Waldhof-Elgershausen, Greifenstein, University of Giessen Marburg Lung Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - J Dinkel
- Klinik für Radiologie, Klinikum der Universität München, LMU, und Asklepios Fachkliniken München Gauting, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - L Fink
- Institut für Pathologie und Zytologie, ÜGP Wetzlar, Mitglied des Deutschen Zentrums für Lungenforschung, Wetzlar
| | - T Geiser
- Universitätsklinik für Pneumologie, Universitätsspital, Universität Bern, Bern
| | - K Geißler
- Patientenvertretung Lungenfibrose e. V., Essen
| | - S Gläser
- Vivantes Klinikum Neukölln und Spandau Berlin, Klinik für Innere Medizin - Pneumologie und Infektiologie sowie und Universitätsmedizin Greifswald, Greifswald
| | - S Handzhhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems an der Donau, Österreich
| | - D Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thoraxchirurgie und Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung, Heidelberg
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - P Markart
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, University of Giessen Marburg Lung Center, sowie Campus Fulda Universitätsmedizin Marburg, Med. Klinik V; Mitglied des Deutschen Zentrums für Lungenforschung, Fulda
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Clinical Research Center Fraunhofer Institut ITEM, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - J C Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - H Sitter
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Medizinische Fakultät, Albert Ludwigs Universität, Freiburg
| | - U Costabel
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| |
Collapse
|
8
|
Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geißler K, Gläser S, Handzhhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. [German Guideline for Idiopathic Pulmonary Fibrosis]. Pneumologie 2020; 74:263-293. [PMID: 32227328 DOI: 10.1055/a-1120-3531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since publication of the international IPF guideline in the year 2011 and Update 2018 several studies and technical advances occurred, which made a new assessment of the diagnostic process mandatory. In view of the antifibrotic drugs which have been approved for the treatment of IPF patients, the goal of this guideline is to foster early, confident and effective diagnosis of IPF. The guideline focusses on the typical clinical setting of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardised questionnaires, serologic testing and cellular analysis of bronchoalveolar lavage. High resolution computed tomography remains crucial in the diagnostic work-up. If it is necessary to obtain specimen for histology transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom bronchoscopic diagnosis did not provide the information needed. Despite considerable progress, IPF remains a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
Collapse
Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - A Günther
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, sowie Agaplesion Pneumologische Klinik Waldhof-Elgershausen, Greifenstein, University of Giessen Marburg Lung Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - J Dinkel
- Klinik für Radiologie, Klinikum der Universität München, LMU, und Asklepios Fachkliniken München Gauting, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - L Fink
- Institut für Pathologie und Zytologie, ÜGP Wetzlar, Mitglied des Deutschen Zentrums für Lungenforschung, Wetzlar
| | - T Geiser
- Universitätsklinik für Pneumologie, Universitätsspital, Universität Bern, Bern
| | - K Geißler
- Patientenvertretung Lungenfibrose e. V., Essen
| | - S Gläser
- Vivantes Klinikum Neukölln und Spandau Berlin, Klinik für Innere Medizin - Pneumologie und Infektiologie sowie und Universitätsmedizin Greifswald, Greifswald
| | - S Handzhhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems an der Donau, Österreich
| | - D Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thoraxchirurgie und Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung, Heidelberg
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - P Markart
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, University of Giessen Marburg Lung Center, sowie Campus Fulda Universitätsmedizin Marburg, Med. Klinik V; Mitglied des Deutschen Zentrums für Lungenforschung, Fulda
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Clinical Research Center Fraunhofer Institut ITEM, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - J C Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - H Sitter
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Medizinische Fakultät, Albert Ludwigs Universität, Freiburg
| | - U Costabel
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| |
Collapse
|
9
|
Sturmheit T, Konczalla L, Temovski TS, Günther A, Brauneck F, Li J, Perez D, Jücker M, Thastrup J, Fiedler W, Wellbrock J, Kupper J, Block A. Pre-therapeutic Evaluation of Patient-Specific Responses to Immune-Checkpoint Inhibition in Colorectal Cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz450.002] [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: 11/12/2022] Open
|
10
|
Günther A, Schubert J, Witte OW, Brämer D. [Intensive care aspects of autoimmune encephalitis]. Med Klin Intensivmed Notfmed 2019; 114:620-627. [PMID: 31456008 DOI: 10.1007/s00063-019-0604-5] [Citation(s) in RCA: 2] [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: 02/08/2019] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 01/15/2023]
Abstract
Autoimmune encephalitis is a rare, rapidly progressive and potentially severe inflammatory brain disease, usually mediated by autoantibodies. Frequently, the affected patients go through various phases of the disease with prodromi, neuropsychological abnormalities, severe neurological and autonomic disorders and usually long reconvalescence. In up to 85% of patients intensive care treatment is necessary, especially in the group of anti-NMDA receptor encephalitis (NMDA-RE). Typical problems during ICU stay include: severe qualitative and quantitative disturbances of consciousness, autonomic dysfunction, epileptic seizures/epileptic status, treatment-refractory movement disorders, as well as ventilation and weaning problems requiring tracheotomy. But also ethical conflicts and general ICU complications such as sepsis, the need for resuscitation, as well as surgical and psychiatric complications occur. The outcome is highly heterogeneous with a range from complete recovery to the most severe, persistent disorders of consciousness with extensive care and death. Mortality data also vary at between 12% and 40%. Patients requiring mechanical ventilation and tracheostomy and with sepsis and autonomic dysfunction are prone to worse outcomes. A large part of the presented data refers to a recently published multicenter, Germany-wide retrospective cohort study and brought into the context of existing literature.
Collapse
Affiliation(s)
- A Günther
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - J Schubert
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - O W Witte
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - D Brämer
- Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| |
Collapse
|
11
|
Heiligenhaus A, Minden K, Tappeiner C, Baus H, Bertram B, Deuter C, Foeldvari I, Föll D, Frosch M, Ganser G, Gaubitz M, Günther A, Heinz C, Horneff G, Huemer C, Kopp I, Lommatzsch C, Lutz T, Michels H, Neß T, Neudorf U, Pleyer U, Schneider M, Schulze-Koops H, Thurau S, Zierhut M, Lehmann HW. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 49:43-55. [PMID: 30595409 DOI: 10.1016/j.semarthrit.2018.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. CONCLUSIONS An interdisciplinary, evidence-based treatment guideline for JIAU is presented.
Collapse
Affiliation(s)
- A Heiligenhaus
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany.
| | - K Minden
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Tappeiner
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H Baus
- The Participation of the Following Bodies: Parents' Group for Children with Uveitis and their Families, Germany
| | - B Bertram
- Professional Association of Ophthalmologists (BVA), Germany
| | - C Deuter
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - I Foeldvari
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - D Föll
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Frosch
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - G Ganser
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Gaubitz
- German Society of Rheumatology (DGRh), Germany
| | - A Günther
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Heinz
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - G Horneff
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Huemer
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - I Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Germany
| | - C Lommatzsch
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - T Lutz
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - H Michels
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - T Neß
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - U Neudorf
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - U Pleyer
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Schneider
- German Society of Rheumatology (DGRh), Germany
| | | | - S Thurau
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Zierhut
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H W Lehmann
- The Society for Paediatric Rheumatology (GKJR), Germany
| |
Collapse
|
12
|
Kletzl H, Czech C, Cleary Y, Sturm S, Günther A, Baranello G, Mercuri E, Servais L, Day J, Deconinck N, Klein A, Darras B, Masson R, Kirschner J, Goemans N, Pera M, Chiriboga C, Fischer D, Gorni K, Khwaja O. SMA THERAPIES II AND BIOMARKERS. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.307] [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: 11/16/2022]
|
13
|
Günther A, Weisner N, Richter C. Vaginale Untersuchung bei Geburt im Rettungsdienst. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Röska B, Park SH, Behal D, Hess KU, Günther A, Benka G, Pfleiderer C, Hoelzel M, Kimura T. Determination of the hydrogen-bond network and the ferrimagnetic structure of a rockbridgeite-type compound, [Formula: see text]. J Phys Condens Matter 2018; 30:235401. [PMID: 29701605 DOI: 10.1088/1361-648x/aac0cd] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Applying neutron powder diffraction, four unique hydrogen positions were determined in a rockbridgeite-type compound, [Formula: see text] [Formula: see text]. Its honeycomb-like H-bond network running without interruption along the crystallographic [Formula: see text] axis resembles those in alkali sulphatic and arsenatic oxyhydroxides. They provide the so-called dynamically disordered H-bond network over which protons are superconducting in a vehicle mechanism. This is indicated by dramatic increases of dielectric constant and loss factor at room temperature. The relevance of static and dynamic disorder of OH and HOH groups are explained in terms of a high number of structural defects at octahedral chains alternatingly half-occupied by [Formula: see text] cations. The structure is built up by unusual octahedral doublet, triplet, and quartet clusters of aliovalent 3d transition metal cations, predicting complicate magnetic ordering and interaction. The ferrimagnetic structure below the Curie temperature [Formula: see text]-83 K could be determined from the structure analysis with neutron diffraction data at 25 K.
Collapse
Affiliation(s)
- B Röska
- Department of Geo- and Environmental Sciences, Section of Crystallography, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Polke M, Behr J, Kabitz H, Neurohr C, Leuschner G, Prasse A, Bonella F, Koschel D, Günther A, Wälscher J, Herth FJF, Kreuter M. Status zur Diagnostik und Therapie der akuten Exazerbation der idiopathischen Lungenfibrose in Deutschland – ein weites Feld! Pneumologie 2018. [DOI: 10.1055/s-0037-1619401] [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: 10/28/2022]
Affiliation(s)
- M Polke
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - J Behr
- Klinik für Pneumologie, Asklepios Fachklinik München-Gauting; Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - H Kabitz
- II. Medizinische Klinik, Pneumologie, Kardiologie, Internistische Intensivmedizin, Klinikum Konstanz
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Bonella
- Schwerpunkt Interstitielle und Seltene Lungenkrankheiten, Ruhrlandklinik, Universitätsmedizin Essen
| | - D Koschel
- Zentrum für Pneumologie, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig GmbH
| | - A Günther
- Med. Klinik II, Klinische Forschergruppe 'Lungenfibrose', Universitätsklinikum Gießen und Marburg; Lungenfachklinik Waldhof-Elgershausen, Greifenstein; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - J Wälscher
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| |
Collapse
|
16
|
Karwal M, Ruppert C, Seeger W, Günther A, Korfei M. Charakterisierung der therapeutischen Effizienz von Histondeacetylase (HDAC)-Inhibitoren hinsichtlich der Modulierung von pro-koagulatorischen und fibrinolytischen Signalwegen in Lungenfibroblasten von Patienten mit idiopathischer pulmonaler Fibrose (IPF). Pneumologie 2018. [DOI: 10.1055/s-0037-1619427] [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: 10/28/2022]
Affiliation(s)
- M Karwal
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (BFS), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - C Ruppert
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (BFS), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - W Seeger
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (BFS), Excellence Cluster Cardio-Pulmonary System (ECCPS), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (Dzl); Max-Planck-Institut für Herz- und Lungenforschung
| | - A Günther
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (BFS), Excellence Cluster Cardio-Pulmonary System (ECCPS), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL); Agaplesion Pneumologische Klinik Waldhof-Elgershausen; European IPF Network and European IPF Registry
| | - M Korfei
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (BFS), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| |
Collapse
|
17
|
Ruppert C, Korfei M, Henneke I, Seeger W, Günther A. Rolle des Hepatozytenwachstumsfaktor (HGF) in der gesunden und geschädigten Lunge. Pneumologie 2018. [DOI: 10.1055/s-0037-1619432] [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: 10/28/2022]
Affiliation(s)
- C Ruppert
- Medizinische Klinik II, Universities of Gießen & Marburg Lung Center (UGMLC), Justus-Liebig Universität Gießen, Deutsches Zentrum für Lungenforschung (DZL)
| | - M Korfei
- Medizinische Klinik II, Universities of Gießen & Marburg Lung Center (UGMLC), Justus-Liebig Universität Gießen, Deutsches Zentrum für Lungenforschung (DZL)
| | - I Henneke
- Medizinische Klinik II, Universities of Gießen & Marburg Lung Center (UGMLC), Justus-Liebig Universität Gießen, Deutsches Zentrum für Lungenforschung (DZL)
| | - W Seeger
- Medizinische Klinik II, Universities of Gießen & Marburg Lung Center (UGMLC), Justus-Liebig Universität Gießen, Deutsches Zentrum für Lungenforschung (DZL)
| | - A Günther
- Medizinische Klinik II, Universities of Gießen & Marburg Lung Center (UGMLC), Justus-Liebig Universität Gießen, Deutsches Zentrum für Lungenforschung (DZL); Agaplesion Lungenklinik Waldhof Elgershausen, Greifenstein
| |
Collapse
|
18
|
Kreuter M, Herth FJF, Wacker M, Witt S, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederholf C, Skowasch D, Stolpe C, Joest M, Veitshans S, Leidl R, Hellmann A, Pfeifer M, Behr J, Kauschka D, Mall M, Günther A, Markart P. Diagnostik und Therapie von Patienten mit interstitiellen Lungenerkrankungen in Deutschland – das EXCITING ILD Register. Pneumologie 2018. [DOI: 10.1055/s-0037-1619191] [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: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg
| | - M Wacker
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - S Witt
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | | | - L Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen
| | | | - A Esselmann
- Outpatient Center for Pulmonology, Warendorf
| | | | - D Skowasch
- Medical Clinic II, University Hospital Bonn
| | - C Stolpe
- Outpatient Center for Pulmonology, Ibbenbüren
| | - M Joest
- Malteser Center for Pulmonology and Allergology, Bonn
| | - S Veitshans
- Outpatient Center for Pulmonology, Böblingen
| | - R Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - A Hellmann
- Outpatient Center for Pulmonology, Augsburg
| | - M Pfeifer
- Klinik Donaustauf und Universitätsklinikum Regensburg
| | | | | | - M Mall
- Translational Pulmonology, University of Heidelberg, Germany, Member of the German Center for Lung Research (TLRC)
| | - A Günther
- Universitätsklinikum Gießen und Marburg
| | - P Markart
- Medical Clinic II, University Hospital Gießen, Universities of Gießen and Marburg Lung Centre (Ugmlc), Member and Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg
| |
Collapse
|
19
|
Korfei M, Stelmaszek D, Skwarna S, Chillappagari S, Bach A, MacKenzie B, Ruppert C, Mahavadi P, Klepetko W, Fink L, Seeger W, Savai Pullamsetti S, Krämer OH, Günther A. In vitro-Vergleich der antifibrotischen Effizienz des pan-HDAC-Inhibitors LBH589 mit dem IPF-Medikament Pirfenidon in Lungenfibroblasten von Patienten mit IPF. Pneumologie 2018. [DOI: 10.1055/s-0037-1619243] [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: 10/28/2022]
Affiliation(s)
- M Korfei
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - D Stelmaszek
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - S Skwarna
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - S Chillappagari
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - A Bach
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - B MacKenzie
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - C Ruppert
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - P Mahavadi
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL)
| | - W Klepetko
- Abteilung für Thoraxchirurgie, Allgemeines Krankenhaus der Stadt Wien; European Ipf Network and European Ipf Registry
| | - L Fink
- Institut für Pathologie und Zytologie, Member of the German Center for Lung Research (DZL)
| | - W Seeger
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Member of the German Center for Lung Research (DZL); Excellence Cluster Cardio-Pulmonary System (ECCPS); Max-Planck-Institut für Herz- und Lungenforschung, Gießen
| | - S Savai Pullamsetti
- Max-Planck-Institut für Herz- und Lungenforschung, Member of the German Center for Lung Research (DZL); Excellence Cluster Cardio-Pulmonary System (Eccps)
| | - OH Krämer
- Institut für Toxikologie, Universitätsmedizin Mainz
| | - A Günther
- Medizinische Klinik II und Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen, Excellence Cluster Cardio-Pulmonary System (Eccps), Member of the German Center for Lung Research (DZL); European Ipf Network and European Ipf Registry; Agaplesion Pneumologische Klinik Waldhof-Elgershausen
| |
Collapse
|
20
|
Günther K, Seeger W, Günther A, Korfei M. Untersuchung uncharakterisierter SP-A2 Varianten hinsichtlich der Induktion von Endoplasmatischem Retikulum (ER)-Stress bei der idiopathischen pulmonalen Fibrose (IPF). Pneumologie 2018. [DOI: 10.1055/s-0037-1619297] [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: 10/28/2022]
Affiliation(s)
- K Günther
- Biomedizinisches Forschungszentrum Seltersberg (BFS); Universität Gießen und Marburg Lungen Zentrum (Ugmlc) und Mitglied des DZL
| | - W Seeger
- Biomedizinisches Forschungszentrum Seltersberg (BFS); Universität Gießen und Marburg Lungen Zentrum (UGMLC) und Mitglied des DZL; Excellence Cluster Cardio-Pulmonary Systems (ECCPS)
| | - A Günther
- Biomedizinisches Forschungszentrum Seltersberg (BFS) und Agaplesion Pneumologische Klinik Waldhof-Elgershausen; Universität Gießen und Marburg Lungen Zentrum (UGMLC) und Mitglied des DZL; Excellence Cluster Cardio-Pulmonary Systems (ECCPS)
| | - M Korfei
- Biomedizinisches Forschungszentrum Seltersberg (BFS); Universität Gießen und Marburg Lungen Zentrum (Ugmlc) und Mitglied des DZL
| |
Collapse
|
21
|
Klingner CM, Herdtle S, Brodoehl S, Hohenstein C, Wild T, Behringer W, Witte OW, Günther A. Akuter Schlaganfall – Aufgabe für Notarzt oder Rettungsassistent? Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0398-z] [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: 11/29/2022]
|
22
|
Krauss E, Zoelitz J, Wagner J, Barretto G, Degen M, Seeger W, Günther A. The use of electronic nose technology for the detection of lung cancer: analysis of exhaled volatile compounds by Aeonose®. Pneumologie 2018. [DOI: 10.1055/s-0037-1619179] [Citation(s) in RCA: 1] [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: 10/28/2022]
Affiliation(s)
- E Krauss
- European IPF Registry & Biobank (eurIPFreg), Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Gießen
| | - J Zoelitz
- European IPF Registry & Biobank (eurIPFreg), Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Gießen
| | - J Wagner
- European IPF Registry & Biobank (eurIPFreg), Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Gießen
| | | | - M Degen
- Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein
| | - W Seeger
- European IPF Registry & Biobank (eurIPFreg), Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Gießen
| | - A Günther
- European IPF Registry & Biobank (eurIPFreg), Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Gießen; Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein
| |
Collapse
|
23
|
Abstract
SummaryElevated procoagulant and suppressed fibrinolytic activities are regularly encountered in different forms of clinical and experimental fibrosis of the lungs and the kidneys. Although primarily serving to provide a provisional matrix of repair largely consisting of fibrin and fibronectin, the involved procoagulant serine proteases and protease inhibitors may also exert distinct cellular downstream signaling events modifying the fibrotic reponse.In this review, evidence for an impaired regulation of coagulation and fibrinolysis factors in clinical and experimental lung and renal fibrosis is provided and the role of PAR (protease activated receptor) induced profibrotic and HGF (hepatocyte growth factor) elicited antifibrotic cellular events is worked out. In view of experiments obtained in animal models of lung and renal fibrosis, the potential therapeutic usefulness of anticoagulant or profibrinolytic strategies is discussed.
Collapse
|
24
|
Günther A, Mosavi P, Ruppert C, Heinemann S, Temmesfeld B, Velcovsky HG, Morr H, Grimminger F, Walmrath D, Seeger W. Enhanced Tissue Factor Pathway Activity and Fibrin Turnover in the Alveolar Compartment of Patients with Interstitial Lung Disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613933] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryBronchoalveolar lavage fluids (BALF) from patients with hyper- sensitivity pneumonitis (HP; n = 35), idiopathic pulmonary fibrosis (IPF, n = 41) and sarcoidosis (SARC, n = 48) were investigated for alterations in the alveolar hemostatic balance. Healthy individuals (n = 21) served as Controls. Procoagulant activity (PCA), tissue factor (TF) activity and F VII activity were assessed by means of specific recalcification assays. The overall fibrinolytic activity (FA) was measured using the 125I-labeled fibrin plate assay. Fibrinopeptide A (FP-A), D-Dimer, plasminogen activators (PA) of the urokinase (u-PA) or tissue type (t-PA), PA-Inhibitor I (PAI-1) and α2-antiplasmin (α2-AP) were determined by ELISA technique. As compared to Controls, all groups with interstitial lung disease (ILD) displayed an increase in BALF PCA by approximately one order of magnitude, and this was ascribed to enhanced TF activity by >98%. Accordingly, F VII-activity was increased in all ILD groups, and elevated FP-A levels were noted. There was no significant difference in procoagulant activi- ties between the different ILD entities, but the increase in TF was significantly correlated with deterioration of lung compliance. Overall fibrinolytic activity did not significantly differ between ILD entities and Controls, although some reduction in IPF subjects was observed. Nevertheless, changes in the profile of the different pro- and anti- fibrinolytic compounds were noted. U-PA, but not t-PA levels were significantly reduced in all ILD groups. α2-AP was markedly elevated throughout, whereas PAI-1 levels were lowered. As a balance of enhanced procoagulant and sustained overall fibrinolytic activity, lavage D-dimer levels were elevated by more than one order of magnitude in all ILD patients. We conclude that the predominant alteration in alveolar hemostatic balance in all groups of ILD patients is an enhancement in TF factor pathway activity. Concomitantly, various compounds of the (anti-)fibrinolytic pathways present with altered concentrations, but the overall BALF fibrinolytic activity is largely unchanged. The net enhancement of fibrin turnover is significantly correlated with the decrease in lung compliance.
Abbreviations: α2-AP – α2-antiplasmin; ARDS – acute respiratory distress syndrome; BAL – bronchoalveolar lavage; BALF – BAL fluids; BSA – bovine serum albumin; FEV1 – forced expired volume within 1 s; FP-A – fibrinopeptide A; FVC – forced vital capacity; ILD – interstitial lung disease; IPF – idiopathic pulmonary fibrosis; HP – hypersensitivity pneumonitis; PAI-1 – plasminogen-activator-inhibitor-1; PBS – phosphate buffered saline; PCA – procoagulant activity; PL – phospholipid; PPQ – phospholipid-proteinquotient; SARC – sarcoidosis; t-PA – tissue-type plasminogen activator; u-PA – urokinase-type plasminogen activator
Collapse
|
25
|
Künstler ECS, Finke K, Günther A, Klingner C, Witte O, Bublak P. Motor-cognitive dual-task performance: effects of a concurrent motor task on distinct components of visual processing capacity. Psychol Res 2017; 82:177-185. [PMID: 29196834 PMCID: PMC5816117 DOI: 10.1007/s00426-017-0951-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 11/22/2017] [Indexed: 11/26/2022]
Abstract
Dual tasking, or the simultaneous execution of two continuous tasks, is frequently associated with a performance decline that can be explained within a capacity sharing framework. In this study, we assessed the effects of a concurrent motor task on the efficiency of visual information uptake based on the 'theory of visual attention' (TVA). TVA provides parameter estimates reflecting distinct components of visual processing capacity: perceptual threshold, visual processing speed, and visual short-term memory (VSTM) storage capacity. Moreover, goodness-of-fit values and bootstrapping estimates were derived to test whether the TVA-model is validly applicable also under dual task conditions, and whether the robustness of parameter estimates is comparable in single- and dual-task conditions. 24 subjects of middle to higher age performed a continuous tapping task, and a visual processing task (whole report of briefly presented letter arrays) under both single- and dual-task conditions. Results suggest a decline of both visual processing capacity and VSTM storage capacity under dual-task conditions, while the perceptual threshold remained unaffected by a concurrent motor task. In addition, goodness-of-fit values and bootstrapping estimates support the notion that participants processed the visual task in a qualitatively comparable, although quantitatively less efficient way under dual-task conditions. The results support a capacity sharing account of motor-cognitive dual tasking and suggest that even performing a relatively simple motor task relies on central attentional capacity that is necessary for efficient visual information uptake.
Collapse
Affiliation(s)
- E C S Künstler
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - K Finke
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Günther
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Klingner
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - O Witte
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - P Bublak
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
26
|
Baumbach P, Götz T, Günther A, Weiss T, Meissner W. Chronic intensive care-related pain: Exploratory analysis on predictors and influence on health-related quality of life. Eur J Pain 2017; 22:402-413. [PMID: 29105897 DOI: 10.1002/ejp.1129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is growing evidence for the development of chronic pain after intensive care. Nonetheless, there is only limited knowledge about factors leading to chronic intensive care-related pain (CIRP). Thus, the primary objective was the identification of predictors of CIRP. Moreover, we aimed to assess the impact of CIRP on patients' health-related quality of Life (HRQOL). METHODS Comprehensive information on patients' pain before ICU admission and present pain was collected longitudinally by means of the German Pain Questionnaire 6 and 12 months after ICU discharge (ICUDC ). In addition, a subsample of patients underwent Quantitative Sensory Testing (QST). We used Generalized Estimating Equations to identify predictors of CIRP with logistic regression models. RESULTS In total, 204 patients (197/159 at 6/12 months after ICUDC ) were available for the analyses. In the multivariate models, moderate to severe average pain in the 4 weeks after ICUDC , lower age, female sex, increased inflammation and chronic pain conditions and increased levels of anxiety before ICU admission were predictive for CIRP. In addition, small fibre deficits and lower disease severity were associated with CIRP in the QST subsample (81 patients, 77/55 at 6/12 months after ICUDC ). Patients with CIRP reported significantly lower HRQOL than patients without CIRP. CONCLUSIONS Chronic intensive care-related pain is associated with specific decrements in HRQOL. Knowledge about the identified predictors is of clinical and scientific importance and might help to reduce the incidence of CIRP. SIGNIFICANCE Chronic intensive care-related pain is associated with specific decrements in health-related quality of life. While most of the identified predictors for CIRP can only be considered as risk factors, especially adequate (post-) acute pain management should be studied as preventive strategy.
Collapse
Affiliation(s)
- P Baumbach
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
| | - T Götz
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Biomagnetic Center, Hans-Berger-Klinik for Neurology, Jena University Hospital, Germany
| | - A Günther
- Biomagnetic Center, Hans-Berger-Klinik for Neurology, Jena University Hospital, Germany
| | - T Weiss
- Department of Biological and Clinical Psychology, Friedrich Schiller University of Jena, Germany
| | - W Meissner
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
| |
Collapse
|
27
|
|
28
|
Seidov Z, Krug von Nidda HA, Tsurkan V, Filippova I, Günther A, Najafov A, Aliyev MN, Vagizov FG, Kiiamov AG, Tagirov LR, Gavrilova T, Loidl A. Magnetic properties of chain antiferromagnets RbFeSe2, TlFeSe2, and TlFeS2. ACTA ACUST UNITED AC 2017. [DOI: 10.3103/s1062873817070267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Behr J, Günther A, Kreuter M, Koschel D, Prasse A, Pfeifer M, Costabel U. [Expert Knowledge and Supporting Advice for the Clinical Use of Nintedanib in Patients with Idiopathic Pulmonary Fibrosis]. Pneumologie 2017; 71:567-579. [PMID: 28772332 DOI: 10.1055/s-0043-109856] [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: 10/19/2022]
Abstract
In October 2016, a group of German IPF experts were invited by Boehringer Ingelheim to meet in Frankfurt with the aim, (a) to discuss relevant aspects of the management and treatment of idiopathic pulmonary fibrosis (IPF) using nintedanib; and, (b) to provide supportive advice for daily clinical practice with nintedanib. The resulting information compiled in this document is confined to practical issues regarding the use of nintedanib in patients with IPF. Where different therapeutic options were available, the choice of IPF medication was not discussed and the experts alluded to current guidelines for the diagnosis and treatment of IPF.The participants discussed a comprehensive spectrum of clinical questions related to 10 different topics, including patient-related aspects at initiation of IPF therapy, the treatment of anticoagulated IPF patients, and the handling of nintedanib-related adverse events such as gastrointestinal side effects and elevated liver enzymes. In addition, the experts evaluated therapeutic options for IPF patients with continuous disease progression, clinical scenarios that justify discontinuation of nintedanib treatment, and therapeutic options for IPF patients with an acute exacerbation or severe infection. Finally, the participants discussed the handling of nintendanib before/after elective surgical intervention (e. g. lung transplantation) and the current evidence for antifibrotic combination therapy in patients with IPF.For each topic discussed, the resulting information incorporates published evidence from clinical trials. In case of insufficient or lacking evidence, the experts have formulated recommendations based on their personal clinical experience and evaluation.
Collapse
Affiliation(s)
- J Behr
- Asklepios Fachkliniken München-Gauting und Medizinische Klinik V, Klinikum der Ludwig-Maximilians-Universität München
| | - A Günther
- Med. Klinik II, Klinische Forschergruppe "Lungenfibrose", Universitätsklinikum Gießen und Marburg.,Lungenfachklinik Waldhof-Elgershausen, Greifenstein
| | - M Kreuter
- Zentrum für seltene und interstitielle Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung
| | - D Koschel
- Abteilung Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin und Thoraxchirurgie
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Deutsches Zentrum für Lungenforschung BREATH.,Fraunhofer Institut ITEM Hannover
| | - M Pfeifer
- Zentrum für Pneumologie, Klinik Donaustauf
| | - U Costabel
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Essen
| |
Collapse
|
30
|
Hospach T, Hedrich C, Fernandez F, Girschick H, Borte M, Günther A, Martin L, Hahn G, von Kalle T, Horneff G, Kallinich T, Huppertz HI. Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Therapie. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0327-8] [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]
|
31
|
Günther A, Sackey P, Bjärtå A, Schandl A. The relation between skin conductance responses and recovery from symptoms of PTSD. Acta Anaesthesiol Scand 2017; 61:688-695. [PMID: 28421596 DOI: 10.1111/aas.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose was to investigate if potentially stressful reminders of the intensive care unit (ICU) stay influenced variability in transient skin conductance responses, and whether such changes were associated with post-traumatic stress symptoms (PTSS), and development of symptoms over time. METHODS Thirty patients with an ICU length of stay > 48 h were included in the study. Within the week after ICU discharge (T1), patients were exposed to authentic ICU sound and questions regarding traumatic ICU memories while skin conductance reactivity was monitored. PTSS was assessed using PTSS-10 at T1 and again 3 months later (T2). Changes in number of skin conductance fluctuations per second (NSCF) between baseline and during the cueing conditions and in relation to PTSS scores (T1) were investigated. PTSS scores at T2 and changes between T1 and T2 (PTSS-CS) were used to investigate if reactivity in NSCF could predict symptoms of PTSD. RESULTS The results showed increases in NSCF during both situational and verbal cueing, compared to baseline. However, no relation to PTSS scores was indicated. Negative correlations between NSCF during situational cueing and both PTSS-T2 and PTSS-CS were found among women, but not among men. CONCLUSION A low variability, or reactivity in skin conductance responses to situational cues could imply a risk of developing, or not being able to recover from, symptoms of PTSD in women. As such, the measurement could be used to predict this risk in women. However, further studies are necessary to evaluate this area of application.
Collapse
Affiliation(s)
- A. Günther
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Department of Cardiothoracic Surgery and Anaesthesiology; Karolinska University Hospital Solna; Stockholm Sweden
| | - P. Sackey
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Institution of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - A. Bjärtå
- Department of Psychology; Division of Social Sciences; Mid Sweden University; Östersund Sweden
| | - A. Schandl
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
| |
Collapse
|
32
|
Hospach T, Hedrich C, Fernandez F, Girschick H, Borte M, Günther A, Martin L, Hahn G, von Kalle T, Horneff G, Kallinich T, Huppertz HI. Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Diagnostik. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0326-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Middleton K, Al-Dujaili S, Mei X, Günther A, You L. Microfluidic co-culture platform for investigating osteocyte-osteoclast signalling during fluid shear stress mechanostimulation. J Biomech 2017; 59:35-42. [PMID: 28552413 DOI: 10.1016/j.jbiomech.2017.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 11/30/2022]
Abstract
Bone cells exist in a complex environment where they are constantly exposed to numerous dynamic biochemical and mechanical stimuli. These stimuli regulate bone cells that are involved in various bone disorders, such as osteoporosis. Knowledge of how these stimuli affect bone cells have been utilised to develop various treatments, such as pharmaceuticals, hormone therapy, and exercise. To investigate the role that bone loading has on these disorders in vitro, bone cell mechanotransduction studies are typically performed using parallel plate flow chambers (PPFC). However, these chambers do not allow for dynamic cellular interactions among different cell populations to be investigated. We present a microfluidic approach that exposes different cell populations, which are located at physiologically relevant distances within adjacent channels, to different levels of fluid shear stress, and promotes cell-cell communication between the different channels. We employed this microfluidic system to assess mechanically regulated osteocyte-osteoclast communication. Osteoclast precursors (RAW264.7 cells) responded to cytokine gradients (e.g., RANKL, OPG, PGE-2) developed by both mechanically stimulated (fOCY) and unstimulated (nOCY) osteocyte-like MLO-Y4 cells simultaneously. Specifically, we observed increased osteoclast precursor cell densities and osteoclast differentiation towards nOCY. We also used this system to show an increased mechanoresponse of osteocytes when in co-culture with osteoclasts. We envision broad applicability of the presented approach for microfluidic perfusion co-culture of multiple cell types in the presence of fluid flow stimulation, and as a tool to investigate osteocyte mechanotransduction, as well as bone metastasis extravasation. This system could also be applied to any multi-cell population cross-talk studies that are typically performed using PPFCs (e.g. endothelial cells, smooth muscle cells, and fibroblasts).
Collapse
Affiliation(s)
- K Middleton
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - S Al-Dujaili
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - X Mei
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario M5S 3G8, Canada
| | - A Günther
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario M5S 3G8, Canada
| | - L You
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario M5S 3G8, Canada.
| |
Collapse
|
34
|
Wahlgren CM, Blohmé L, Günther A, Nilsson L, Olsson C. Outcomes of Left Heart Bypass Versus Circulatory Arrest in Elective Open Surgical Descending and Thoraco-abdominal Aortic Repair. Eur J Vasc Endovasc Surg 2017; 53:672-678. [DOI: 10.1016/j.ejvs.2017.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/23/2017] [Indexed: 11/28/2022]
|
35
|
Glos M, Jelavic K, Günther A, Garcia C, Schöbel C, Fietze I, Penzel T. Charakterisierung von Apnoen mittels suprasternalem Drucksensor PneaVox® bei Patienten mit Schlafbezogenen Atmungsstörungen. Pneumologie 2017. [DOI: 10.1055/s-0037-1600139] [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: 10/19/2022]
Affiliation(s)
- M Glos
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - K Jelavic
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - A Günther
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - C Garcia
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - C Schöbel
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - I Fietze
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| | - T Penzel
- Charité – Universitätsmedizin Berlin, CCM-CC11, Interdisziplinäres Schlafmedizinisches Zentrum
| |
Collapse
|
36
|
Korfei M, Klaus D, Stelmaszek D, Herbel JN, Ruppert C, Henneke I, Seeger W, Günther A. Molekulare Mechanismen der Lungenalterung: Korrelation zu Pathogenitätsmechanismen bei der Idiopathischen Pulmonalen Fibrose (IPF) und bei der chronisch obstruktiven Lungenerkrankung (COPD). Pneumologie 2017. [DOI: 10.1055/s-0037-1598298] [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)
- M Korfei
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - D Klaus
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - D Stelmaszek
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - JN Herbel
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - C Ruppert
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - I Henneke
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - W Seeger
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| | - A Günther
- Universities of Gießen and Marburg Lung Center (Ugmlc), Biomedizinisches Forschungszentrum Seltersberg (Bfs), Justus-Liebig-Universität Gießen.; Ugmlc, Medizinische Klinik II.; Deutsches Zentrum für Lungenforschung (Dzl)
| |
Collapse
|
37
|
Kreuter M, Wacker M, Hammerl P, Wiederhold C, Kabitz HJ, Hagmeyer L, Skowasch D, Leidl R, Hellmann A, Pfeifer M, Behr J, Witt S, Kauschka D, Mall M, Günther A, Herth FJF, Markart P. Interims Analyse des EXCITING-ILD Registers (Registry for Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases). Pneumologie 2017. [DOI: 10.1055/s-0037-1598497] [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)
- M Kreuter
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - M Wacker
- Helmholtz Zentrum München, Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | | | - HJ Kabitz
- II. Medizinische Klinik, Klinikum Konstanz
| | - L Hagmeyer
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien gGmbH
| | - D Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie, Uniklinikum Bonn
| | - R Leidl
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | - M Pfeifer
- Krankenhaus Donaustauf; Universität Regensburg
| | - J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Med. Klinik V, LMU, München, Mitglied des Dzl
| | - S Witt
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München
| | - D Kauschka
- C/O Dagmar Kauschka, 1. Vorsitzende, Lungenfibrose e.V
| | - M Mall
- Zentrum für Kinder- und Jugendmedizin, Sektion Pädiatrische Pneumologie & Allergologie und Mukoviszidose-Zentrum, Universitätsklinikum Heidelberg
| | - A Günther
- Med. Klinik II, Schwerpunkt Pneumologie, Univ.-Klinikum Gießen
| | - FJF Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Markart
- Medizinische Klinik V, Klinikum Fulda
| |
Collapse
|
38
|
Diab M, Günther A, Fink J, Raphael T, Seyitoglu M, Goebel B, Hamadanchi A, Lehmann T, Färber G, Doenst T. Does Coronary Artery Bypass Grafting Concomitant to Valve Surgery Influence the Outcome in Patients with Active Infective Endocarditis? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598776] [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)
- M. Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - A. Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - J. Fink
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - T. Raphael
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - M. Seyitoglu
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - B. Goebel
- Department of Cardiology, Jena University Hospital, Jena, Germany
| | - A. Hamadanchi
- Department of Cardiology, Jena University Hospital, Jena, Germany
| | - T. Lehmann
- Center of Clinical Studies, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - G. Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - T. Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| |
Collapse
|
39
|
|
40
|
Günther A, Harding U, Weisner N, Jürgen S, Richter C. Ein Jahr Tätigkeit von Notfallsanitätern in einem städtischen Rettungsdienstbereich. Notarzt 2016. [DOI: 10.1055/s-0042-110686] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Günther
- Berufsfeuerwehr der Stadt Braunschweig, Rettungsdienst
| | - U. Harding
- Berufsfeuerwehr der Stadt Braunschweig, Rettungsdienst
| | - N. Weisner
- Berufsfeuerwehr der Stadt Braunschweig, Rettungsdienst
| | - S. Jürgen
- Notfallsanitäterschule, Bildungszentrum, Klinikum Braunschweig gGmbH
| | - C. Richter
- Berufsfeuerwehr der Stadt Braunschweig, Rettungsdienst
| |
Collapse
|
41
|
Schenk A, Günther A, Prell T, Ringer T, Gunkel A, Stubendorff B, Witte O, Grosskreutz J. EPV 6. Value of transcranial brain stem sonography in the diagnosis and prognosis of amyotrophic lateral sclerosis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.047] [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]
|
42
|
Kreuter M, Herth FJF, Wacker M, Leidl R, Hellmann A, Pfeifer M, Behr J, Witt S, Kauschka D, Mall M, Günther A, Markart P. Interims Analyse des EXCITING-ILD Registers (Registry for Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases). Pneumologie 2016. [DOI: 10.1055/s-0036-1572075] [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]
|
43
|
Drakopanagiotakis F, Carre Schoppe M, Crestani B, Bonniaud P, Vancheri C, Wells A, Günther A. Symptome respiratorischer Infekte gehen oftmals der Diagnose einer idiopathische pulmonalen Fibrose (IPF) voraus. Pneumologie 2016. [DOI: 10.1055/s-0036-1571994] [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]
|
44
|
Behr J, Bendstrup E, Crestani B, Günther A, Olschewski H, Sköld M, Wells A, Wuyts W, Koschel D, Kreuter M, Wallaert B, Tang H, Beck J, Albera C. Safety and tolerability of N-acetylcysteine (NAC) with pirfenidone in IPF: PANORAMA. Pneumologie 2016. [DOI: 10.1055/s-0036-1572009] [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]
|
45
|
Stahl M, Kyriss T, Linder A, Günther A, Kugler C, Städtler N, Timm J, Scharpenberg M, Walles T. Luftfistelabheilung nach thoraxchirurgischen Eingriffen: Ergebnisse einer prospektiven nicht-interventionellen klinischen multizentrischen Studie. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559954] [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]
|
46
|
Borggrefe J, Giravent S, Campbell G, Thomsen F, Chang D, Franke M, Günther A, Heller M, Wulff A. Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma. Eur J Radiol 2015; 84:2269-74. [PMID: 26283192 DOI: 10.1016/j.ejrad.2015.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/16/2015] [Accepted: 07/27/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. METHODS AND MATERIALS We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom(®)). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8mm (SO) and osteolytic lesions larger than 8mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. RESULTS 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p=0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC=0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC=0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC=0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC=0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC=0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC=0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC=0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC=0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC=0.57 ± .07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC=0.51 ± .05). CONCLUSION In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.
Collapse
Affiliation(s)
- J Borggrefe
- Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany.
| | - S Giravent
- Sektion für Biomedizinische Bildgebung, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany
| | - G Campbell
- Sektion für Biomedizinische Bildgebung, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany
| | - F Thomsen
- Universidad Nacional del Sur, Bahía Blanca, Argentina
| | - D Chang
- Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany
| | - M Franke
- Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany
| | - A Günther
- Sektion für Immun- und Stammzelltransplantation, Klinik für Innere Medizin, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany
| | - M Heller
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - A Wulff
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Germany
| |
Collapse
|
47
|
Götz T, Gundula S, Hamzei F, Witte O, Günther A. P139. Cognitive impairments in survivors of severe sepsis can be measured via magnetoencephalography. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Behr J, Bonella F, Bonnet R, Gläser S, Grohé C, Günther A, Koschel D, Kreuter M, Kirsten D, Krögel C, Markart P, Müller-Quernheim J, Neurohr C, Pfeifer M, Prasse A, Schönfeld N, Schreiber J, Wirtz H, Witt C, Costabel U. [Position Paper: Significance of the Forced Vital Capacity in Idiopathic Pulmonary Fibrosis]. Pneumologie 2015; 69:455-8. [PMID: 26227628 DOI: 10.1055/s-0034-1392602] [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: 10/23/2022]
Abstract
Spirometry is a highly standardized method which allows to measure the forced vital capacity (FVC) with high precision and reproducibility. In patients with IPF FVC is directly linked to the disease process which is characterized by scaring of alveoli and shrinkage of the lungs. Consequently, there is ample evidence form clinical studies that the decline of FVC over time is consistently associated with mortality in IPF. As for the first time effective drugs for the treatment of IPF are available it becomes obvious that in studies which could demonstrate that the drug reduces FVC decline, a numerical effect on mortality was also observed, while in one study where a significant effect on FVC decline was missed, there was also no change in mortality. Based on these studies FVC decline is a validated surrogate of mortality in IPF. It is concluded that FVC decline is not only accepted as an endpoint of clinical treatment trials in IPF but is also valid as a patient related outcome parameter which should be considered for the assessment of the efficacy of an IPF drug.
Collapse
Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH
| | - R Bonnet
- Abteilung Pneumologie, Zentralklinik Bad Berka GmbH
| | - S Gläser
- Klinik für Innere Medizin B - Bereich Pneumologie, Infektiologie und Weaningzentrum Forschungsbereich Pneumologie und Pneumologische Epidemiologie Universitätsmedizin Greifswald
| | - C Grohé
- Pneumologische Klinik Evangelische Lungenklinik Berlin - Krankenhausbetriebs gGmbH
| | - A Günther
- Medizinische Klinik III, Pneumologie und Internistische Intensivmedizin Agaplesion Evangelisches Krankenhaus Mittelhessen und Schwerpunkt "Fibrosierende Lungenerkrankungen", Universitätsklinikum Gießen Marburg GmbH, Mitglied des Deutschen Zentrums für Lungenforschung
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie
| | - M Kreuter
- Pneumologie und Beatmungsmedizin, Zentrum für seltene und interstitielle Lungenerkrankungen Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung
| | | | - C Krögel
- Abteilung Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena
| | - P Markart
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen und Medizinische Klinik V (Pneumologie), Herz-Thorax-Zentrum, Klinikum Fulda gAG
| | | | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - M Pfeifer
- Klinik Donaustauf, Klinik für Pneumologie und konservative Intensivmedizin Krankenhaus Barmherzige Brüder, Regensburg, Klinik und Poliklinik für Innere Medizin II Universität Regensburg
| | - A Prasse
- Abteilung Pneumologie, Medizinische Hochschule Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin
| | - J Schreiber
- Klinik für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität, Magdeburg
| | - H Wirtz
- Abteilung Pneumologie, Universitätsklinikum Leipzig
| | - C Witt
- Abteilung Pneumologie und Transplantation, Universitätsklinikum Charité, Berlin
| | - U Costabel
- Senior Consultant, Interstitielle und Seltene Lungenkrankheiten, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH
| |
Collapse
|
49
|
Shalashova I, Hühn M, Ruppert C, Klymenko O, Henneke I, Günther A. The role of ER stress mediators XBP1, ATF6 and ATF4 in AEC II apoptosis. Pneumologie 2015. [DOI: 10.1055/s-0035-1556651] [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]
|
50
|
Venkatesan S, Chillappagari S, Henneke I, Seeger W, Bellusci S, Günther A, Mahavadi P. Mitochondrial autophagy in the development of amiodarone induced pulmonary fibrosis. Pneumologie 2015. [DOI: 10.1055/s-0035-1556647] [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]
|