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Wasserthal S, Lehmann M, Neumann C, Delis A, Philipsen A, Hurlemann R, Ettinger U, Schultz J. Effects of NMDA-receptor blockade by ketamine on mentalizing and its neural correlates in humans: a randomized control trial. Sci Rep 2023; 13:17184. [PMID: 37821513 PMCID: PMC10567921 DOI: 10.1038/s41598-023-44443-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
Schizophrenia is associated with various deficits in social cognition that remain relatively unaltered by antipsychotic treatment. While faulty glutamate signaling has been associated with general cognitive deficits as well as negative symptoms of schizophrenia, no direct link between manipulation of glutamate signaling and deficits in mentalizing has been demonstrated thus far. Here, we experimentally investigated whether ketamine, an uncompetitive N-methyl-D-aspartate receptor antagonist known to induce psychotomimetic effects, influences mentalizing and its neural correlates. In a randomized, placebo-controlled between-subjects experiment, we intravenously administered ketamine or placebo to healthy participants performing a video-based social cognition task during functional magnetic resonance imaging. Psychotomimetic effects of ketamine were assessed using the Positive and Negative Syndrome Scale. Compared to placebo, ketamine led to significantly more psychotic symptoms and reduced mentalizing performance (more "no mentalizing" errors). Ketamine also influenced blood oxygen level dependent (BOLD) response during mentalizing compared to placebo. Specifically, ketamine increased BOLD in right posterior superior temporal sulcus (pSTS) and increased connectivity between pSTS and anterior precuneus. These increases may reflect a dysfunctional shift of attention induced by ketamine that leads to mentalizing deficits. Our findings show that a psychotomimetic dose of ketamine impairs mentalizing and influences its neural correlates, a result compatible with the notion that deficient glutamate signaling may contribute to deficits in mentalizing in schizophrenia. The results also support efforts to seek novel psychopharmacological treatments for psychosis and schizophrenia targeting glutamatergic transmission.
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Affiliation(s)
- Sven Wasserthal
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Mirko Lehmann
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Claudia Neumann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | | | - Johannes Schultz
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute for Experimental Epileptology and Cognition Research, Medical Faculty, University of Bonn, Bonn, Germany
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Köksal M, Baumert J, Jazmati D, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Massoth G, Delis A, Heine A, Holderried T, Brossart P, Müdder T, Schmeel LC. Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics. J Cancer Res Clin Oncol 2023; 149:7007-7015. [PMID: 36856852 PMCID: PMC10374741 DOI: 10.1007/s00432-023-04657-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis. PATIENTS AND METHODS 46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests. RESULTS The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney). CONCLUSION Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.
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Affiliation(s)
- Mümtaz Köksal
- Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | | | - Danny Jazmati
- Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Schoroth
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | - Gregor Massoth
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas Müdder
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
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Delis A, Bautz D, Ehrentraut H, Doll K, Randau TM, Strauss AC, Habicht I, Güresir E, Bogatsch H, Kranke P, Wittmann M, Meybohm P, Velten M. Effects of Different Hemoglobin Levels on Near-Infrared Spectroscopy-Derived Cerebral Oxygen Saturation in Elderly Patients Undergoing Noncardiac Surgery. Transfus Med Hemother 2023; 50:270-276. [PMID: 37767283 PMCID: PMC10521215 DOI: 10.1159/000528888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/28/2022] [Indexed: 09/29/2023] Open
Abstract
Background Near-infrared spectroscopy (NIRS) is a commonly used technique to evaluate tissue oxygenation and prevent harmful cerebral desaturation in the perioperative setting. The aims of the present study were to assess whether surgery-related anemia can be detected via NIRS of cerebral oxygen saturation and to investigate the effects of different perioperative transfusion strategies on cerebral oxygenation, potentially affecting transfusion decision-making. Study Design and Methods Data from the ongoing multicenter LIBERAL-Trial (liberal transfusion strategy to prevent mortality and anemia-associated ischemic events in elderly noncardiac surgical patients, LIBERAL) were used. In this single-center sub-study, regional cerebral oxygenation saturation (rSO2) was evaluated by NIRS at baseline, pre-, and post-RBC transfusion. The obtained values were correlated with blood gas analysis-measured Hb concentrations. Results rSO2 correlated with Hb decline during surgery (r = 0.35, p < 0.0001). Different RBC transfusion strategies impacted rSO2 such that higher Hb values resulted in higher rSO2. Cerebral desaturation occurred at lower Hb values more often. Discussion Cerebral oxygenation monitoring using NIRS provides noninvasive rapid and continuous information regarding perioperative alterations in Hb concentration without the utilization of patients' blood for blood sampling. Further investigations are required to demonstrate if cerebral rSO2 may be included in future individualized transfusion decision strategies.
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Affiliation(s)
- Achilles Delis
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Derek Bautz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Heidi Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Karin Doll
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas M. Randau
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Andreas C. Strauss
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Ivana Habicht
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Holger Bogatsch
- Clinical Trial Center Leipzig, University Leipzig, Leipzig, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Neumann C, Straßberger-Nerschbach N, Delis A, Kamp J, Görtzen-Patin A, Cudian D, Fleischer A, Wietasch G, Coburn M, Schindler E, Schleifer G, Wittmann M. Digital Online Patient Informed Consent for Anesthesia before Elective Surgery-Recent Practice in Europe. Healthcare (Basel) 2023; 11:1942. [PMID: 37444775 DOI: 10.3390/healthcare11131942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Digitalization in the health system is a topic that is rapidly gaining popularity, and not only because of the current pandemic. As in many areas of daily life, digitalization is becoming increasingly important in the medical field amid the exponential rise in the use of computers and smartphones. This opens up new possibilities for optimizing patient education in the context of anesthesia. The main aim of this study was to assess the implementation of remote consent in Europe. METHODS An online survey entitled "Digital online Patient Informed Consent for Anesthesia before Elective Surgery. Recent practice in Europe," with a total of 27 questions, was sent by the European Society of Anesthesiology and Intensive Care (ESAIC) to their members in 47 European countries. To assess the effect of the economy on digitalization and legal status with regard to anesthesia consent, data were stratified based on gross domestic product per capita (GDPPC). RESULTS In total, 23.1% and 37.2% of the 930 participants indicated that it was possible to obtain consent online or via telephone, respectively. This observation was more often reported in countries with high GDPPC levels than in countries with low GDPPC levels. Furthermore, 27.3% of the responses for simple anesthesia, 18.7% of the responses for complex anesthesia, and 32.2% of the responses for repeated anesthesia indicated that remote consent was in accordance with the law, and this was especially prevalent in countries with high GDPPC. Concerning the timing of consent, patients were informed at least one day before in 67.1% of cases for simple procedures and in 85.2% of cases for complex procedures. CONCLUSION Even European countries with high GDPPC use remote informed consent only in a minority of cases, and most of the time for repeated anesthetic procedures. This might reflect the inconsistent legal situation and inhomogeneous medical technical structures across Europe.
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Affiliation(s)
- Claudia Neumann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | | | - Achilles Delis
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Johannes Kamp
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Alexandra Görtzen-Patin
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Dishalen Cudian
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Andreas Fleischer
- Department of Anesthesiology and Intensive Care Medicine, Hospital Vest, 45657 Recklinghausen, Germany
| | - Götz Wietasch
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Grigorij Schleifer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, 53127 Bonn, Germany
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Lehmann M, Neumann C, Wasserthal S, Delis A, Schultz J, Hurlemann R, Ettinger U. Ketamine increases fronto-posterior functional connectivity during meta-perceptual confidence ratings. Behav Brain Res 2022; 430:113925. [DOI: 10.1016/j.bbr.2022.113925] [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] [Received: 10/22/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
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Lehmann M, Neumann C, Wasserthal S, Schultz J, Delis A, Trautner P, Hurlemann R, Ettinger U. Effects of ketamine on brain function during metacognition of episodic memory. Neurosci Conscious 2021; 2021:niaa028. [PMID: 33747545 PMCID: PMC7959215 DOI: 10.1093/nc/niaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Only little research has been conducted on the pharmacological underpinnings of metacognition. Here, we tested the modulatory effects of a single intravenous dose (100 ng/ml) of the N-methyl-D-aspartate-glutamate-receptor antagonist ketamine, a compound known to induce altered states of consciousness, on metacognition and its neural correlates. Fifty-three young, healthy adults completed two study phases of an episodic memory task involving both encoding and retrieval in a double-blind, placebo-controlled fMRI study. Trial-by-trial confidence ratings were collected during retrieval. Effects on the subjective state of consciousness were assessed using the 5D-ASC questionnaire. Confirming that the drug elicited a psychedelic state, there were effects of ketamine on all 5D-ASC scales. Acute ketamine administration during retrieval had deleterious effects on metacognitive sensitivity (meta-d') and led to larger metacognitive bias, with retrieval performance (d') and reaction times remaining unaffected. However, there was no ketamine effect on metacognitive efficiency (meta-d'/d'). Measures of the BOLD signal revealed that ketamine compared to placebo elicited higher activation of posterior cortical brain areas, including superior and inferior parietal lobe, calcarine gyrus, and lingual gyrus, albeit not specific to metacognitive confidence ratings. Ketamine administered during encoding did not significantly affect performance or brain activation. Overall, our findings suggest that ketamine impacts metacognition, leading to significantly larger metacognitive bias and deterioration of metacognitive sensitivity as well as unspecific activation increases in posterior hot zone areas of the neural correlates of consciousness.
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Affiliation(s)
- Mirko Lehmann
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Claudia Neumann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sven Wasserthal
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Johannes Schultz
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute for Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, Germany
| | - Achilles Delis
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Peter Trautner
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute for Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, Germany
- Department for NeuroCognition, Life & Brain Center, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
- Department of Psychiatry, School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
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Scheele D, Zimbal S, Feinstein JS, Delis A, Neumann C, Mielacher C, Philipsen A, Hurlemann R. Treatment-Resistant Depression and Ketamine Response in a Patient With Bilateral Amygdala Damage. Am J Psychiatry 2019; 176:982-986. [PMID: 31787017 DOI: 10.1176/appi.ajp.2019.18101219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dirk Scheele
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Sophia Zimbal
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Justin S Feinstein
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Achilles Delis
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Claudia Neumann
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Clemens Mielacher
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - Alexandra Philipsen
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
| | - René Hurlemann
- Division of Medical Psychology (Scheele, Zimbal, Mielacher, Hurlemann), Department of Anesthesiology (Delis, Neumann), and Department of Psychiatry (Philipsen, Hurlemann), University Hospital, Bonn, Germany; Laureate Institute for Brain Research, Tulsa, Okla. (Feinstein); and Department of Psychiatry, University of Oldenburg Medical Campus, Bad Zwischenahn, Germany (Hurlemann)
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Lueck S, Preusse C, Delis A, Schaefer M. Development of cell oedema in piglet hearts during ischaemia monitored by dielectric spectroscopy. Bioelectrochemistry 2019; 129:54-61. [DOI: 10.1016/j.bioelechem.2019.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
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Lueck S, Delis A, Minor T, Preusse CJ, Schaefer M. Age-related differences of intraischemic gap junction uncoupling in hearts during ischemia. J Thorac Cardiovasc Surg 2016; 152:729-36. [PMID: 27236865 DOI: 10.1016/j.jtcvs.2016.04.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/18/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Myocardial ischemia leads to energetic, morphologic, metabolic, and functional alterations. To evaluate differences in ischemia tolerance between neonatal and adult hearts, we investigated gap junction uncoupling (GJU) and its correlation to myocardial intracellular edema formation during normothermic ischemia. METHODS Hearts of landrace piglets (neonates, 7.4 ± 1.9 days of age, body weight 2.9 ± 0.5 kg, n = 5 and adults, 84 ± 9 days of age, body weight 30.5 ± 3.9 kg, n = 5) were investigated. After we harvested the hearts, the bioelectrical impedance spectra were measured continuously during normothermic global ischemia (35°C). Spectra of the dielectric permittivity, ε'(frequency), and conductivity, σ(frequency), were calculated from the impedance measurements, and GJU was identified in the sigmoidal time course of ε' (13 kHz). The extracellular volume was estimated by the ratio σ (100Hz)/σ (1MHz). Dielectric data were correlated with electron-microscopical images. RESULTS Intraischemic GJU was observed in neonates after 54 ± 9 minutes of ischemia and thus significantly earlier than in adults (90 ± 7 minutes, P < .05). A more than 20% increase of intercalated water was found in tissue samples of neonates after 20 ± 2 minutes, in contrast to adults after 137 ± 8 minutes (P < .05). CONCLUSIONS Intraischemic formation of edema and earlier GJU indicate faster intraischemic changes in neonates compared with adults. Intraischemic GJU and determination of intracellular water shifts are an experimental approach to establish the period of life-threatening damage. Because both parameters are linked and occur significantly earlier in neonates, they distinctly demonstrate the lower ischemia tolerance of neonatal hearts as both events interact.
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Affiliation(s)
- Sabrina Lueck
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
| | - Achilles Delis
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - Thomas Minor
- Department of Surgical Research, University Hospital Essen, Essen, Germany
| | | | - Michael Schaefer
- Section Surgical Research, University Hospital Heidelberg, Heidelberg, Germany
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Lueck S, Delis A, Schaefer M, Preusse C. Gap Junction Regulation and Edema Formation in Neonatal and Adult Hearts. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lück S, Delis A, Minor T, Pliquett U, Martens S, Preuße C. Analysis of Ischemic Neonatal and Adult Myocardium by Bioelectrical Impedance Spectroscopy. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Contis J, Lykoudis P, Nastos C, Karakatsanis A, Dellaportas D, Delis A, Karandrea D, Pafiti-Kondi A. 479. Expression of the apoptosis inhibitors p53, bcl-2, EGFR and survivin in renal cell carcinomas: Correlation with pathological features and clinical outcome. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Dagtekin O, Berlet T, Delis A, Kampe S. Manually controlled total intravenous anesthesia augmented by electrophysiologic monitoring for complex stereotactic neurosurgical procedures. J Neurosurg Anesthesiol 2007; 19:45-8. [PMID: 17198100 DOI: 10.1097/01.ana.0000211030.72291.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stereotactically guided procedures are performed for an ever extending range of conditions. They present a unique anesthetic challenge. In our institution, a standardized anesthetic protocol for total intravenous anesthesia (TIVA) augmented by electrophysiologic monitoring with BIS or AEP monitors was introduced. We conducted a retrospective study of 21 patients (ASA status 2-3) presenting for stereotactically guided procedures who were anesthetized according to the protocol. Median duration of anesthesia was 260 minutes (222 to 325 min); on average 3.0 (1.0 to 4.2) adjustments to the TIVA-protocol were made per patient. Highest and lowest mean arterial blood pressures in relation to baselines were 100% (87.5% to 109.8%) and 68.7% (64.0% to 72.6%), respectively. Likewise highest and lowest heart rates recorded were 106.7% (98.5% to 119.0%) and 75.0% (68.2% to 83.3%). After discontinuation of TIVA, spontaneous breathing returned after 5.0 minutes (4.0 to 8.0 min), extubation was possible after 6.0 minutes (5.0 to 10.0 min) and patients were ready for discharge to the ward after 15.0 minutes (12.0 to 18.0 min). There were no cases of postoperative nausea or vomiting. We found that manually controlled TIVA, augmented by electrophysiologic monitoring, facilitated maintenance of an appropriate depth of anesthesia with stable hemodynamics and excellent recovery times.
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Affiliation(s)
- Oguzhan Dagtekin
- Department of Anesthesiology, University of Cologne, Cologne, Germany.
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Dagtekin O, Gerbershagen H, Delis A, Gärtner J, Petzke F, Radbruch L, Sabatowski R. 671 DRIVING ABILITY UNDER LONG-TERM TREATMENT WITH CONTROLLED RELEASE OXYCODONE IN NON-CANCER PAIN PATIENTS. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60674-5] [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]
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Deliveliotis C, Liakouras C, Delis A, Skolarikos A, Varkarakis J, Protogerou V. Prostate Operations: Long-Term Effects on Sexual and Urinary Function and Quality of Life. Comparison With an Age-Matched Control Population. J Urol 2006. [DOI: 10.1016/s0022-5347(06)00077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C. Deliveliotis
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - C. Liakouras
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - A. Delis
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - A. Skolarikos
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - J. Varkarakis
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - V. Protogerou
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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Deliveliotis C, Liakouras C, Delis A, Skolarikos A, Varkarakis J, Protogerou V. Prostate operations: long-term effects on sexual and urinary function and quality of life. Comparison with an age-matched control population. ACTA ACUST UNITED AC 2004; 32:283-9. [PMID: 15057494 DOI: 10.1007/s00240-004-0411-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2003] [Accepted: 02/23/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to investigate the effects of radical prostatectomy (RP) for prostate cancer, transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH), and the alterations induced by ageing on quality of life, urinary and sexual function, and bother. We evaluated 283 patients who filled in and returned the questionnaire used. A total of 105 were treated with RP and were selected prostate cancer patients with localised disease without recurrences. An additional 98 underwent TURP for BPH and a third group consisted of 80 apparently healthy men. The general quality of life was estimated by the Rand 36-Item Health Survey 1.0. Urinary function was estimated by the AUA Symptom Index and the UCLA Prostate Cancer Index (urinary function and bother scale). Sexual function and bother, were explored using the Brief Male Sexual Function Inventory for Urology. Patient outcome 2 years post treatment was compared to the pre-treatment status and to that of the matched control population. General quality of life was not affected by RP or TURP, with the exception of an increase in the emotional/well being domain in RP patients to control group levels. After RP there was more bother reported for the urinary function than urinary malfunction itself, while TURP, as expected, restored urinary function and bother to normal population norms. Elderly males had urinary function and bother similar to the operated patients. Estimating sexual function on RP patients, erectile dysfunction (ED) predominates, leading to decreased sexual life. TURP marginally affects sexual life, mainly due to the loss of ejaculation, while in men from the control group, sexual function, although affected, was still present.
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Affiliation(s)
- C Deliveliotis
- University of Athens, 2nd Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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Kampe S, Kiencke P, Delis A, Auweiler M, König DP, Kasper SM. The continuous epidural infusion of ropivacaine 0.1% with 0.5 microg x mL(-1) sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study. Can J Anaesth 2003; 50:580-5. [PMID: 12826550 DOI: 10.1007/bf03018644] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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] Open
Abstract
PURPOSE To assess the analgesic efficacy and functional outcome of postoperative epidural infusion of ropivacaine combined with sufentanil in a randomized, controlled trial. METHODS Thirty-two ASA I-III patients undergoing elective total hip replacement (THR) were included. Lumbar epidural block using 0.75% ropivacaine was combined with either propofol sedation or general anesthesia for surgery. On arrival in the recovery room, the epidural infusion was commenced at a rate in mL calculated as follows: (height in cm - 100) x 0.1. Eleven patients received an epidural infusion of ropivacaine 0.1% with 0.5 microg x mL(-1) sufentanil (Group R+S0.5), ten patients ropivacaine 0.1% with 0.75 microg x mL(-1) sufentanil (Group R+S0.75), and 11 patients ropivacaine 0.1% with 1 microg x mL(-1) sufentanil (Group R+S1) over a postoperative study period of 44 hr. All patients had access to iv piritramide via a patient-controlled analgesia (PCA) device. Postel-Merle-d'Aubigné scoring system (PMA score) was assessed preoperatively, three weeks after surgery, and three months after surgery by an orthopedic surgeon blinded to study group. RESULTS Motor block was negligible in all three groups. After eight hours of epidural infusion, sensory block had regressed completely in all patients. There was no significant difference with regard to visual analogue scale (VAS) scores (at rest: P = 0.55, on movement: P = 0.63), consumption of rescue medication (P = 0.99), patient satisfaction (P = 0.22), and the incidence of adverse events. All treatment regimens provided effective postoperative analgesia with only a minimal use of supplemental opioid PCA. There was no difference between groups regarding orthopedic PMA score (pain: P = 0.24, mobility: P = 0.65, and ability to walk: P = 0.44). CONCLUSION Ropivacaine 0.1% with 0.5 microg x mL(-1) sufentanil for postoperative analgesia after THR provides efficient pain relief and, compared with 0.75 and 1 microg x mL(-1) sufentanil, reduces sufentanil consumption without compromise in patient satisfaction, VAS scores, and functional outcome.
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Affiliation(s)
- Sandra Kampe
- Department of Anesthesiology, University of Cologne, Cologne, Germany.
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Affiliation(s)
- A Delis
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln
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Kontothanasi G, Moschovakis E, Tararas V, Delis A, Anagnostou E. Determination of sensitivity of inhalant allergens in patients with allergic rhinitis in West Athens. Rhinology 1995; 33:234-5. [PMID: 8919218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this study we have determined the sensitivity to inhalant (pollen and non-pollen) allergens in patients with allergic rhinitis from West Athens, Greece. The frequency of SPT positivity was highest for Dactylis glomerata, Parietaria, Olea europea, Dermatophagoides and several moulds.
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