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Schließer P, Struebing FL, Northoff BH, Kurz A, Rémi J, Holdt L, Höglinger GU, Herms J, Koeglsperger T. Detection of a Parkinson's Disease-Specific MicroRNA Signature in Nasal and Oral Swabs. Mov Disord 2023; 38:1706-1715. [PMID: 37382573 DOI: 10.1002/mds.29515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Biomaterials from oral and nasal swabs provide, in theory, a potential resource for biomarker development. However, their diagnostic value has not yet been investigated in the context of Parkinson's disease (PD) and associated conditions. OBJECTIVE We have previously identified a PD-specific microRNA (miRNA) signature in gut biopsies. In this work, we aimed to investigate the expression of miRNAs in routine buccal (oral) and nasal swabs obtained from cases with idiopathic PD and isolated rapid eye movement sleep behavior disorder (iRBD), a prodromal symptom that often precedes α-synucleinopathies. We aimed to address their value as a diagnostic biomarker for PD and their mechanistic contribution to PD onset and progression. METHODS Healthy control cases (n = 28), cases with PD (n = 29), and cases with iRBD (n = 8) were prospectively recruited to undergo routine buccal and nasal swabs. Total RNA was extracted from the swab material, and the expression of a predefined set of miRNAs was quantified by quantitative real-time polymerase chain reaction. RESULTS Statistical analysis revealed a significantly increased expression of hsa-miR-1260a in cases who had PD. Interestingly, hsa-miR-1260a expression levels correlated with diseases severity, as well as olfactory function, in the PD and iRBD cohorts. Mechanistically, hsa-miR-1260a segregated to Golgi-associated cellular processes with a potential role in mucosal plasma cells. Predicted hsa-miR-1260a target gene expression was reduced in iRBD and PD groups. CONCLUSIONS Our work demonstrates oral and nasal swabs as a valuable biomarker pool in PD and associated neurodegenerative conditions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Patricia Schließer
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Felix L Struebing
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Bernd H Northoff
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Kurz
- Department of Gynaecology and Obstetrics, Klinikum Landsberg am Lech, Landsberg, Germany
| | - Jan Rémi
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Günter U Höglinger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases e.V. (DZNE) Munich, Munich, Germany
| | - Jochen Herms
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
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Kurz A, Kumar R, Northoff BH, Wenk C, Schirra J, Donakonda S, Höglinger GU, Schwarz J, Rozanski V, Hübner R, Bötzel K, Holdt LM, Koeglsperger T. Differential expression of gut miRNAs in idiopathic Parkinson's disease. Parkinsonism Relat Disord 2021; 88:46-50. [PMID: 34118643 DOI: 10.1016/j.parkreldis.2021.05.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In the present work, we aimed to investigate the expression of microRNAs (miRNAs) in routine colonic biopsies obtained from patients with idiopathic Parkinson's disease (PD) and to address their value as a diagnostic biomarker for PD and their mechanistic contribution to PD onset and progression. METHODS Patients with PD (n = 13) and healthy controls (n = 17) were prospectively recruited to undergo routine colonic biopsies for cancer screening. Total RNA was extracted from the biopsy material and the expression of miRNAs was quantified by Illumina High-Throughput Sequencing. RESULTS Statistical analysis revealed a significant submucosal enrichment of the miRNA hsa-miR-486-5p in colonic biopsies from PD patients compared to the control subjects. The expression of miR-486-5p correlated with age and disease severity as measured by the UPDRS and Hoehn & Yahr scale. miRNA gene target analysis identified 301 gene targets that are affected by miR-486-5p. A follow-up associated target identification and pathway enrichment analysis further determined their role in distinct biological processes in the enteric nervous system (ENS). INTERPRETATION Our work demonstrates an enrichment of submucosal miR-486-5p in routine colonic biopsies from PD patients. Our results will support the examination of miR-486-5p as a PD biomarker and help to understand the significance of the miR-486-5p gene targets for PD onset and progression. In addition, our data will support the investigation of the molecular and cellular mechanisms of GI dysfunction in PD.
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Affiliation(s)
- Anna Kurz
- Department of Neurology, Ludwig Maximilian University, Munich, Germany; Department of Translational Neurodegeneration, German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Rohit Kumar
- Technical University of Munich Medical School, Munich, Germany; Department of Translational Neurodegeneration, German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Bernd H Northoff
- Institute of Laboratory Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Catharina Wenk
- Institute of Laboratory Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Jörg Schirra
- Department of Internal Medicine III, Ludwig Maximilian University, Munich, Germany
| | - Sainitin Donakonda
- Institute of Immunology and Experimental Oncology, Technical University of Munich, Munich, Germany
| | - Günter U Höglinger
- Department of Neurology, Technical University, Munich, Germany; Department of Neurology, Hannover Medical School, Hannover, Germany; Department of Translational Neurodegeneration, German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Johannes Schwarz
- Department of Neurology, Klinik Haag I. OB, Mühldorf a. Inn, Germany
| | - Verena Rozanski
- Department of Neurology, Klinik Haag I. OB, Mühldorf a. Inn, Germany
| | - Rainer Hübner
- Department of Neurology, Klinik Haag I. OB, Mühldorf a. Inn, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Lesca Miriam Holdt
- Institute of Laboratory Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Thomas Koeglsperger
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany; Department of Neurology, Ludwig Maximilian University, Munich, Germany.
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Rak K, Ilgen L, Taeger J, Schendzielorz P, Voelker J, Kaulitz S, Müller-Graff FT, Kurz A, Neun T, Hagen R. Influence of cochlear parameters on the current practice in cochlear implantation : Development of a concept for personalized medicine. HNO 2021; 69:24-30. [PMID: 33459799 DOI: 10.1007/s00106-020-00969-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
Since the introduction of cochlear implants into clinical routine, the interest in measuring cochlear parameters, particularly the cochlear duct length (CDL) has increased, since these can have an influence on the correct selection of the electrode. On the one hand, coverage of an optimal frequency band is relevant for a good audiological result, and on the other hand, cochlear trauma due to too deep insertion or displacement of the electrode must be avoided. Cochlear implants stimulate the spiral ganglion cells (SGC). The number of SGC and particularly their distribution can also have an influence on the function of a cochlear implant. In addition, the frequency assignment of each electrode contact can play a decisive role in the postoperative success, since the frequency distribution of the human cochlea with varying CDL shows substantial interindividual differences. The aim of this work is to provide an overview of the methods used to determine the cochlear parameters as well as of relevant studies on the CDL, the number and distribution of SGZ, and the frequency assignment of electrode contacts. Based on this, a concept for individualized cochlear implantation will be presented. In summary, this work should help to promote individualized medicine in the field of cochlear implants in the future, in order to overcome current limitations and optimize audiological outcomes.
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Affiliation(s)
- K Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - L Ilgen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - J Taeger
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - P Schendzielorz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - J Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - S Kaulitz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - F-T Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - A Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - T Neun
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - R Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Kurz A, Kumar R, Wenk C, Northoff B, Schirra J, Donakonda S, Höglinger G, Holdt L, Bötzel K, Koeglsperger T. miRNA sequencing from routine colonic biopsies reveals an enrichment of mucosal hsa-miRNA-486-5p in Parkinson's disease. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Godthardt K, Kurz A, Johannsen H, Jüngerkes F, Bretz A, Last A, Kuchler T, Bosio A, Knöbel S. Standardized qc assays and large scale expansion of pluripotent stem cells using an automated closed system. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.521] [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: 10/26/2022]
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Wiegel P, Centner C, Kurz A. How motor unit recruitment speed and discharge rates determine the rate of force development. J Physiol 2019; 597:2331-2332. [PMID: 30907430 DOI: 10.1113/jp277894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- P Wiegel
- Department of Sport Science, University of Freiburg, Freiburg, 79117, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, 79104, Germany
| | - C Centner
- Department of Sport Science, University of Freiburg, Freiburg, 79117, Germany
| | - A Kurz
- Department of Sport Science, University of Freiburg, Freiburg, 79117, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, 79104, Germany
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - A Kurz
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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Beattie WS, Wijeysundera DN, Chan MTV, Peyton PJ, Leslie K, Paech MJ, Sessler DI, Wallace S, Myles PS, Galagher W, Farrington C, Ditoro A, Baulch S, Sidiropoulos S, Bulach R, Bryant D, O’Loughlin E, Mitteregger V, Bolsin S, Osborne C, McRae R, Backstrom M, Cotter R, March S, Silbert B, Said S, Halliwell R, Cope J, Fahlbusch D, Crump D, Thompson G, Jefferies A, Reeves M, Buckley N, Tidy T, Schricker T, Lattermann R, Iannuzzi D, Carroll J, Jacka M, Bryden C, Badner N, Tsang MWY, Cheng BCP, Fong ACM, Chu LCY, Koo EGY, Mohd N, Ming LE, Campbell D, McAllister D, Walker S, Olliff S, Kennedy R, Eldawlatly A, Alzahrani T, Chua N, Sneyd R, McMillan H, Parkinson I, Brennan A, Balaji P, Nightingale J, Kunst G, Dickinson M, Subramaniam B, Banner-Godspeed V, Liu J, Kurz A, Hesler B, Fu AY, Egan C, Fiffick AN, Hutcherson MT, Turan A, Naylor A, Obal D, Cooke E. Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival. Anesth Analg 2018. [DOI: 10.1213/ane.0000000000003310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Maheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, Sessler DI, Kurz A. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia 2018; 73:1223-1228. [PMID: 30144029 DOI: 10.1111/anae.14416] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
Intra-operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non-cardiac surgery. Intra-operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0-14.7 [0.0-60.0]) min.h-1 before skin incision, compared with 1.7 [0.3-5.1 [0.0-57.5]) min.h-1 after incision: a median (IQR [range]) of 36% (0%-84% [0%-100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02-1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before skin incision and after, odds ratio (95%CI): 1.02 (1.01-1.04), p = 0.004; and 1.02 (1.00-1.04), p = 0.016, respectively. A substantial fraction of all hypotension happened before surgical incision and was thus completely due to anaesthetic management. We recommend that anaesthetists should avoid mean arterial pressure < 65 mmHg during surgery, especially after induction, assuming that its association with postoperative kidney injury is, at least in part, causal.
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Affiliation(s)
- K Maheshwari
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - A Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - G Mao
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - D Yang
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - A K Niazi
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - D Agarwal
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - A Kurz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
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Biccard BM, Sigamani A, Chan MTV, Sessler DI, Kurz A, Tittley JG, Rapanos T, Harlock J, Szalay D, Tiboni ME, Popova E, Vásquez SM, Kabon B, Amir M, Mrkobrada M, Mehra BR, El Beheiry H, Mata E, Tena B, Sabaté S, Zainal Abidin MK, Shah VR, Balasubramanian K, Devereaux PJ. Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2). Br J Surg 2018; 105:1591-1597. [PMID: 30019751 DOI: 10.1002/bjs.10925] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/13/2018] [Accepted: 05/31/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery. METHODS POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery. Patients were assigned to perioperative aspirin or placebo. The primary outcome was a composite of death or myocardial infarction at 30 days. Secondary outcomes included: vascular occlusive complications (a composite of amputation and peripheral arterial thrombosis) and major or life-threatening bleeding. RESULTS Of 10 010 patients in POISE-2, 603 underwent vascular surgery, 319 in the continuation and 284 in the initiation stratum. Some 272 patients had vascular surgery for occlusive disease and 265 had aneurysm surgery. The primary outcome occurred in 13·7 per cent of patients having aneurysm repair allocated to aspirin and 9·0 per cent who had placebo (hazard ratio (HR) 1·48, 95 per cent c.i. 0·71 to 3·09). Among patients who had surgery for occlusive vascular disease, 15·8 per cent allocated to aspirin and 13·6 per cent on placebo had the primary outcome (HR 1·16, 0·62 to 2·17). There was no interaction with the primary outcome for type of surgery (P = 0·294) or aspirin stratum (P = 0·623). There was no interaction for vascular occlusive complications (P = 0·413) or bleeding (P = 0·900) for vascular compared with non-vascular surgery. CONCLUSION This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - A Sigamani
- Narayana Hrudayalaya Limited, Bangalore, India
| | - M T V Chan
- Department of Anaesthetics, Chinese University of Hong Kong, Hong Kong, China
| | - D I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Kurz
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - J G Tittley
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - T Rapanos
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J Harlock
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - D Szalay
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - M E Tiboni
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - E Popova
- Biomedical Research Institute (IIB - Sant Pau), Barcelona, Spain
| | - S M Vásquez
- Grupo de Cardiología Preventiva Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - B Kabon
- Department of Anaesthesiology, Medical University of Vienna, Vienna, Austria
| | - M Amir
- Department of Surgery, Shifa International Hospital/Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - M Mrkobrada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - B R Mehra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - H El Beheiry
- University of Toronto, Trillium Health Partners, Toronto, Ontario, Canada
| | - E Mata
- Hospital Universitario La Princesa, Madrid, Spain
| | - B Tena
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - S Sabaté
- Department of Anaesthesiology, Fundació Puigvert (IUNA), Barcelona, Spain
| | - M K Zainal Abidin
- Department of Anaesthesiology and Intensive Care, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | | | | | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada
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Abbott T, Fowler A, Pelosi P, Gama de Abreu M, Møller A, Canet J, Creagh-Brown B, Mythen M, Gin T, Lalu M, Futier E, Grocott M, Schultz M, Pearse R, Myles P, Gan T, Kurz A, Peyton P, Sessler D, Tramèr M, Cyna A, De Oliveira G, Wu C, Jensen M, Kehlet H, Botti M, Boney O, Haller G, Grocott M, Cook T, Fleisher L, Neuman M, Story D, Gruen R, Bampoe S, Evered L, Scott D, Silbert B, van Dijk D, Kalkman C, Chan M, Grocott H, Eckenhoff R, Rasmussen L, Eriksson L, Beattie S, Wijeysundera D, Landoni G, Leslie K, Biccard B, Howell S, Nagele P, Richards T, Lamy A, Gabreu M, Klein A, Corcoran T, Jamie Cooper D, Dieleman S, Diouf E, McIlroy D, Bellomo R, Shaw A, Prowle J, Karkouti K, Billings J, Mazer D, Jayarajah M, Murphy M, Bartoszko J, Sneyd R, Morris S, George R, Moonesinghe R, Shulman M, Lane-Fall M, Nilsson U, Stevenson N, van Klei W, Cabrini L, Miller T, Pace N, Jackson S, Buggy D, Short T, Riedel B, Gottumukkala V, Alkhaffaf B, Johnson M. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. Br J Anaesth 2018; 120:1066-1079. [DOI: 10.1016/j.bja.2018.02.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023] Open
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Buggy DJ, Freeman J, Johnson MZ, Leslie K, Riedel B, Sessler DI, Kurz A, Gottumukkala V, Short T, Pace N, Myles PS. Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes. Br J Anaesth 2018; 121:38-44. [PMID: 29935592 DOI: 10.1016/j.bja.2018.03.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 02/21/2018] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance. METHODS We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician-researchers was then used to refine a recommended list of endpoints. RESULTS We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by ≥70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival). CONCLUSION Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia-analgesia technique on oncological outcomes.
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Affiliation(s)
- D J Buggy
- Department of Anaesthesia, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - J Freeman
- Department of Anaesthesia, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland
| | - M Z Johnson
- Department of Anaesthesia, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland
| | - K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Kurz
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - V Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T Short
- Auckland City Hospital, Auckland, New Zealand
| | - N Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
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Walter T, Schlegel J, Burgert A, Kurz A, Seibel J, Sauer M. Incorporation studies of clickable ceramides in Jurkat cell plasma membranes. Chem Commun (Camb) 2018; 53:6836-6839. [PMID: 28597878 DOI: 10.1039/c7cc01220a] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The incorporation properties of ceramide analogues for click chemistry in Jurkat T cells were investigated. The analogues varied in the acyl chain length and the position of the functional group for click chemistry. Fluorescence microscopy studies including anisotropy and quenching experiments showed significant differences in the accessibility of the functional group indicating different incorporation properties into the plasma membrane.
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Affiliation(s)
- T Walter
- Institute for Organic Chemistry, Julius-Maximilians University Würzburg, Am Hubland C1, 97074 Würzburg, Germany.
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Kurz A, Kopyeva T, Suliman I, Podolyak A, You J, Lewis B, Vlah C, Khatib R, Keebler A, Reigert R, Seuffert M, Muzie L, Drahuschak S, Gorgun E, Stocchi L, Turan A, Sessler D. Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial. Br J Anaesth 2018; 120:117-126. [DOI: 10.1016/j.bja.2017.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/04/2017] [Accepted: 08/31/2017] [Indexed: 01/29/2023] Open
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Patrick Mayr N, Hapfelmeier A, Martin K, Kurz A, van der Starre P, Babik B, Mazzitelli D, Lange R, Wiesner G, Tassani-Prell P. Patient factors that influence cerebral desaturation during transcatheter aortic valve implantation: Reply. Br J Anaesth 2016; 117:405. [DOI: 10.1093/bja/aew242] [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: 11/13/2022] Open
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Mrkobrada M, Hill M, Chan M, Sigamani A, Cowan D, Kurz A, Sessler D, Jacka M, Graham M, Dasgupta M, Dunlop V, Emery D, Gulka I, Guyatt G, Heels-Ansdell D, Murkin J, Pettit S, Sahlas D, Sharma M, Sharma M, Srinathan S, St John P, Tsai S, Gelb A, O’Donnell M, Siu D, Chiu P, Sharath V, George A, Devereaux P. Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth 2016; 117:191-7. [DOI: 10.1093/bja/aew179] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
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Abstract
Several recent articles have pointed out that caregivers of patients with frontotemporal dementia (FTD) need counselling and support. To date, however, no support groups have been provided other than those available to caregivers of patients with Alzheimer's disease (AD). At our outpatient unit for cognitive disorders we initiated a specific support group for caregivers of patients with FTD. This pilot project had four objectives: 1) to provide information, advice and support to caregivers, 2) to learn more about the specific problems and needs of family carers of patients with FTD and to explore the differences to caregiver burden in AD, 3) to encourage mutual support and development of coping strategies, 4) to evaluate the intervention using a questionnaire completed by the caregiver. Eight spouse caregivers of patients diagnosed with frontotemporal dementia (FTD) participated in special support groups. Seven weekly sessions of 90 minutes' duration were held. To evaluate the program participants were asked to complete a questionnaire about their satisfaction with the support group immediately after the final session. Six months after the intervention they received a questionnaire by mail gathering information on coping efficacy. It became obvious that many problems faced by caregivers of patients with FTD are different from those encountered in AD. During group meetings participants were encouraged to express their own needs and to deal with painful emotions, including aggression, anger, mourning and guilt. Caregivers felt relieved by sharing their problems with others. They were able to learn from each other and to share coping strategies. The group also helped to establish new social relations contacts and even friendships. The participants rated the program as useful and said that benefits were sustained even six months after termination. We conclude from these initial observations that caregiver support groups are a useful component in the management of patients with FTD. Such groups should be tailored to the specific problems and needs of these caregivers. To maintain benefits, self-help groups are recommended even in the absence of professional input.
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Affiliation(s)
- Janine Diehl
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - T. Mayer
- Department of Neurology, Technische Universität München, Munich, Germany
| | - H. Förstl
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - A. Kurz
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
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Khanna A, Sessler D, Sun Z, Naylor A, You J, Hesler B, Kurz A, Devereaux P, Saager L. Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis. Br J Anaesth 2016; 116:632-640. [DOI: 10.1093/bja/aew029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
The syndrome of posterior cortical atrophy (PCA) is a rare clinical manifestation of several neurodegenerative diseases which affect the parieto-occipital cortex. The most frequent underlying pathology is Alzheimer's disease but some cases are caused by Lewy body disease, progressive subcortical gliosis, corticobasal degeneration or prion diseases. The most prominent clinical feature of PCA is complex visual disturbances including object agnosia, simultanagnosia, optical ataxia and oculomotor apraxia while basic visual functions remain intact. These deficits lead to multiple impairments in activities of daily living that require visual control. On progression of the disease amnestic, apraxic and dysexecutive symptoms occur so that a global dementia gradually emerges. At the core of the diagnostic work-up are a detailed patient history, accurate analysis of behavior and neuropsychological testing. Structural and functional brain imaging are suitable to demonstrate the localization of the disease process. Measurement of cerebrospinal fluid proteins (e.g. beta amyloid, tau, phospho-tau and 14-3-3) serves to confirm or exclude Alzheimer's disease or prion diseases. The mainstay of treatment are non-pharmacological interventions to support activities of daily living and personal independence. These treatments include cognitive training and compensatory strategies which can be prescribed as neuropsychological treatment or occupational therapy. If Alzheimer's disease or Lewy body disease is the likely cause, a treatment with cholinesterase inhibitor may be tried. Caregiver education and support are another essential part of the treatment regimen as with all forms of dementia.
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Affiliation(s)
- M Ortner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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Mayr NP, Hapfelmeier A, Martin K, Kurz A, van der Starre P, Babik B, Mazzitelli D, Lange R, Wiesner G, Tassani-Prell P. Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome†. Br J Anaesth 2015; 116:90-9. [PMID: 26424178 DOI: 10.1093/bja/aev294] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a treatment strategy for patients with severe aortic stenosis. Although general anaesthesia (TAVI-GA) and sedation (TAVI-S) have previously been described for TAVI, the difference in safety and efficacy of both methods has not been studied in a randomized trial. METHODS The INSERT trial was a single centre, controlled parallel-group trial with balanced randomization. Sixty-six patients (68-94 yr) with acquired aortic stenosis undergoing transfemoral CoreValve™ were assigned to TAVI-GA or TAVI-S. Comparable operative risk was determined from risk-scores (EUROscore, STS-Score). Monitoring and anaesthetic drugs were standardized. Near-Infrared-Spectroscopy was used to monitor cerebral-oxymetry blinded. Primary outcome was the perioperative cumulative cerebral desaturation. As secondary outcomes, changes in neurocognitive function and respiratory and haemodynamic adverse events were evaluated. RESULTS Of 66 included patients, 62 (TAVI-GA: n=31, TAVI-S: n=31) were finally analysed. Baseline characteristics were comparable. In 24 patients (39%) cerebral desaturation was observed. Cumulative cerebral desaturation was comparable (TAVI-GA:(median [IQR]) (0[0/1308] s%) vs. TAVI-S:(0[0/276] s%); P=0.505) between the groups. Neurocognitive function did not change within and between groups. Adverse events were more frequently observed in TAVI-S patients (P<0.001). Bradypnoea (n=16, 52%) and the need for airway manoeuvres (n=11, 36%) or bag-mask-ventilation (n=6, 19%) were the most common respiratory adverse events. CONCLUSIONS Cerebral desaturation occurred in both patient groups, but there was no significant difference between the two groups. Based on primary outcome, both methods were shown to be comparable. Neurocognitive outcome was similar. The higher incidence of adverse events in the sedation group suggests a potential advantage of general anaesthesia. CLINICAL TRIAL REGISTRATION NCT 01251328.
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Affiliation(s)
- N P Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - A Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich, Germany
| | - K Martin
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - A Kurz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich, Germany
| | - P van der Starre
- Department of Anesthesia, Stanford University Medical Center, Stanford, California, 300 Pasteur Drive, MC 5640, Stanford, CA 94305, USA
| | - B Babik
- Department of Anesthesiology and Intensive Therapy, University of Szeged, 6. Semmelweis st., 6725 Szeged, Hungary
| | - D Mazzitelli
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - R Lange
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - G Wiesner
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
| | - P Tassani-Prell
- Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, Germany
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Kurz A, Fleischmann E, Sessler D, Buggy D, Apfel C, Akça O, Fleischmann E, Erdik E, Eredics K, Kabon B, Herbst F, Kazerounian S, Kugener A, Marschalek C, Mikocki P, Niedermayer M, Obewegeser E, Ratzenboeck I, Rozum R, Sindhuber S, Schlemitz K, Schebesta K, Stift A, Kurz A, Sessler DI, Bala E, Chen ST, Devarajan J, Maheshwari A, Mahboobi R, Mascha E, Nagem H, Rajogopalan S, Reynolds L, Alvarez A, Stocchi L, Doufas AG, Govinda R, Kasuya Y, Komatsu R, Lenhardt R, Orhan-Sungur M, Sengupta P, Wadhwa A, Galandiuk S, Buggy D, Arain M, Burke S, McGuire B, Ragheb J, Taguchi A. Effects of supplemental oxygen and dexamethasone on surgical site infection: a factorial randomized trial ‡. Br J Anaesth 2015; 115:434-43. [DOI: 10.1093/bja/aev062] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 11/13/2022] Open
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22
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Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, Meyhoff CS, Allard R, Landoni G, Jara X, Lurati Buse G, Candiotti K, Lee HS, Gupta R, VanHelder T, Purayil W, De Hert S, Treschan T, Devereaux PJ. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†. Br J Anaesth 2015. [PMID: 26209855 DOI: 10.1093/bja/aev255] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. RESULTS Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09). CONCLUSIONS Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - D McIlroy
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
| | - J Khan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada
| | - C S Meyhoff
- Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark
| | - R Allard
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada
| | - G Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - X Jara
- Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile
| | - G Lurati Buse
- Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada
| | - K Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA
| | - H-S Lee
- Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - R Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, India
| | - T VanHelder
- Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada
| | - W Purayil
- Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India
| | - S De Hert
- Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
| | - T Treschan
- Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - P J Devereaux
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
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Csépányi-Kömi R, Bartos B, Lévai P, Kurz A, Bierschenk S, Ligeti E, Sperandio M. A6.4 The possible role of ARHGAP25 in the regulation of leukocyte migration. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.130] [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: 11/03/2022]
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Buggy DJ, Borgeat A, Cata J, Doherty DG, Doornebal CW, Forget P, Gottumukkala V, Gottschalk A, Gupta A, Gupta K, Hales TG, Hemmings HC, Hollmann MW, Kurz A, Ma D, Parat MO, Sessler DI, Shorten G, Singleton P. Consensus statement from the BJA Workshop on Cancer and Anaesthesia. Br J Anaesth 2015; 114:2-3. [PMID: 25104229 DOI: 10.1093/bja/aeu262] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D J Buggy
- Department of Anaesthesia, Mater Hospital-Anaesthesia, The Mater Misericordiae Hospital, Dublin 7, Ireland
| | - A Borgeat
- Orthopaedic University Hospital-Anaesthesiology, Forchstrasse 340, Zurich 8008, Switzerland
| | - J Cata
- MC Anderson-Anaesthesia, TX, USA
| | - D G Doherty
- Trinity College-Anaesthetics, Dublin, Ireland
| | | | - P Forget
- Université Catholique de Louvain-Anesthesiology, av. Hippocrate, 10, Brussels 1200, Belgium
| | - V Gottumukkala
- MD Anderson Cancer Center-Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - A Gottschalk
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Albert-Schweizer-Campus 1, Muenster 48149, Germany
| | - A Gupta
- University of Minnesota-Medicine-Heme/Onc/Transplant, Mayo Mail Code 480, 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - K Gupta
- Fairfield Hospital-Anaesthetics, Manchester, UK
| | - T G Hales
- Institute of Academic Anaesthesia, Division of Neuroscience, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
| | | | | | - A Kurz
- Cleveland Clinic-Outcomes Research, 9500 Euclid Ave-P77, Cleveland, OH 44195, USA
| | - D Ma
- Imperial College London-Anaesthetics, 369 Fulham Rd, London SW10 9NH, UK
| | - M O Parat
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Woolongabba, QLD 4102, Australia
| | - D I Sessler
- Cleveland Clinic-Outcomes Research, 9500 Euclid Ave-P77, Cleveland, OH 44195, USA
| | - G Shorten
- University College Cork-Anaesthetics, Cork, Ireland
| | - P Singleton
- University of Chicago-Medicine, 5841 South Maryland Avenue MC 6076, I-503C, Chicago, IL 60657, USA
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Akça O, Kurz A, Fleischmann E, Buggy D, Herbst F, Stocchi L, Galandiuk S, Iscoe S, Fisher J, Apfel C, Sessler D. Hypercapnia and surgical site infection: a randomized trial †. Br J Anaesth 2013; 111:759-67. [DOI: 10.1093/bja/aet233] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Kurz A, Skoro-Sajer N, Ristl R, Lang I. D-dimer in chronic thromboembolic pulmonary hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abdelmalak B, Bonilla A, Mascha E, Maheshwari A, Wilson Tang W, You J, Ramachandran M, Kirkova Y, Clair D, Walsh R, Kurz A, Sessler D. Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial. Br J Anaesth 2013; 111:209-221. [DOI: 10.1093/bja/aet050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Perneczky R, Guo LH, Kagerbauer SM, Werle L, Kurz A, Martin J, Alexopoulos P. Soluble amyloid precursor protein β as blood-based biomarker of Alzheimer's disease. Transl Psychiatry 2013; 3:e227. [PMID: 23423136 PMCID: PMC3591004 DOI: 10.1038/tp.2013.11] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to explore concentrations differences of soluble amyloid precursor protein (sAPP) α and β in blood plasma in patients with probable Alzheimer's disease (AD) and cognitively healthy age-matched control subjects, as well as patients with behavioural variant frontotemporal dementia (bvFTD). Concentrations of sAPPα and β were measured using enzyme-linked immunosorbent assay technology in 80 patients with probable AD, 37 age-matched control subjects and 14 patients with bvFTD. Concentration differences were explored using parametric tests. Significantly decreased plasma concentrations in the AD group compared with both the control group and the bvFTD group were detected for sAPPβ (P = 0.03 for both group comparisons), but not for sAPPα. The study provides a further piece of evidence in support of sAPPβ as a promising new biomarker of AD, which may potentially improve the diagnostic accuracy of existing markers and also enable a less invasive diagnostic workup. Further research is required to establish normal ranges and to replicate the results in independent cohorts including larger numbers of participants covering a wider spectrum of cognitive impairment.
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Affiliation(s)
- R Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK.
| | - L-H Guo
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - S M Kagerbauer
- Department of Anaesthesiology, Technische Universität München, Munich, Germany
| | - L Werle
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - A Kurz
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - J Martin
- Department of Anaesthesiology, Technische Universität München, Munich, Germany
| | - P Alexopoulos
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
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Abd-Elsayed AA, Sessler DI, Mendoza-Cuartas M, Dalton JE, Said T, Meinert J, Upton G, Franklin C, Kurz A. A randomized controlled study to assess patients' understanding of and consenting for clinical trials using two different consent form presentations. Minerva Anestesiol 2012; 78:564-573. [PMID: 22337156] [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: 05/31/2023]
Abstract
BACKGROUND Informed consent is the ethical basis for clinical research. The physical appearance of the consent document may influence patients' willingness to carefully read the consent document. We therefore tested the hypothesis that presentation of consent documents in an enhanced format improves patients' attention, understanding and therefore willingness to consent for clinical research. METHODS Patients being asked to participate in three large clinical trials were randomly assigned to enhanced or routine presentation. The enhanced document was printed on 20-pound, cream-colored bond paper and presented in a blue folio. In contrast, patients assigned to routine presentation were given an otherwise identical stapled set of photocopied pages. The primary outcome was the effect of the enhanced format on the proportion of patients consenting; the major secondary outcome was patient's understanding of the presented procedures and risks. RESULTS A total of 189 of 251 (75%) patients approached with standard format consenting documents consented for an underlying study, whereas 164 of 248 (66%) approached with enhanced format documents consented; the adjusted odds ratio (95% confidence interval) for consenting (comparing enhanced to standard formats) was 0.64 (0.43, 0.95), P=0.03. About 90% of the patients in each group correctly identified the major study intervention and major associated risk. Neither patients' characteristics nor understanding affected the consenting rate for the presented clinical research. CONCLUSION Consent forms in an enhanced format (i.e., printed on fine paper and presented in a folio) did not improve patients' understanding or willingness to consent to participate in clinical trials.
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Affiliation(s)
- A A Abd-Elsayed
- Departments of Outcomes Research and Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA
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Redel P, Bublak P, Sorg C, Kurz A, Förstl H, Müller H, Schneider W, Perneczky R, Finke K. Deficits of spatial and task-related attentional selection in mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2012; 33:195.e27-42. [DOI: 10.1016/j.neurobiolaging.2010.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 04/29/2010] [Accepted: 05/14/2010] [Indexed: 10/19/2022]
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Cummings K, Napierkowski D, Parra-Sanchez I, Kurz A, Dalton J, Brems J, Sessler D. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth 2011; 107:446-53. [DOI: 10.1093/bja/aer159] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Articus K, Baier M, Tracik F, Kühn F, Preuss UW, Kurz A. A 24-week, multicentre, open evaluation of the clinical effectiveness of the rivastigmine patch in patients with probable Alzheimer's disease. Int J Clin Pract 2011; 65:790-6. [PMID: 21645184 DOI: 10.1111/j.1742-1241.2011.02713.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cholinesterase inhibitors form the mainstay of treatment for persons with mild-to-moderate Alzheimer's disease (AD). The rivastigmine patch may increase compliance and the proportion of patients maintaining an efficacious dose compared with oral cholinesterase inhibitors. OBJECTIVE To investigate the proportion of patients who reached and maintained the target rivastigmine patch dose compared with the target rivastigmine capsule dose reported in clinical trials. METHODS This was a multicentre, 24-week, open-label study in persons with probable AD and a Mini-Mental State Examination (MMSE) score of ≥ 10 and ≤ 26. The primary outcome was the proportion of patients (ITT population) treated with 9.5 mg/24 h rivastigmine patch for at least 8 weeks at week 24. Secondary outcomes included week 24 MMSE, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), Trail Making Test Part A (TMT-A) and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scores. RESULTS Overall, 208 participants received treatment and 155 (74.5%) completed the study. Within the ITT population, 147/182 patients (80.8%; 95% CI 75.0-86.5%) were treated for at least 8 weeks with the 9.5 mg/24 h rivastigmine patch; 135/182 patients (74.2%; 95% CI 67.8-80.5%) were treated for at least 8 weeks and completed the study. The most common adverse events were nausea (10.1% of patients), erythema (8.7%), pruritus (8.2%) and vomiting (7.2%). At week 24, patients treated with the rivastigmine patch showed improvements on MMSE, ADCS-ADL, ADCS-CGIC and TMT-A scores. Caregivers reported acceptance, preference and satisfaction with the patch. CONCLUSION Transdermal delivery may allow more patients to reach and maintain therapeutic doses of rivastigmine compared with oral rivastigmine.
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Affiliation(s)
- K Articus
- Novartis Pharma GmbH, Nuremberg, Germany.
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Perneczky R, Tsolakidou A, Arnold A, Diehl-Schmid J, Grimmer T, Forstl H, Kurz A, Alexopoulos P. CSF soluble amyloid precursor proteins in the diagnosis of incipient Alzheimer disease. Neurology 2011; 77:35-8. [DOI: 10.1212/wnl.0b013e318221ad47] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Farag E, Manno EM, Kurz A. Use of hypothermia for traumatic brain injury: point of view. Minerva Anestesiol 2011; 77:366-370. [PMID: 21283076] [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: 05/30/2023]
Abstract
Traumatic brain injury (TBI) is one of the major causes of disability in modern society. The World Health Organization has predicted that, by 2020, traffic accidents will represent the greatest burden of global disease and injury. Brain injury after trauma occurs in two stages. Primary injury is directly associated with the biomechanical effects of the trauma, whereas secondary injury occurs later and can be attributed to processes that develop within the brain. Currently, there is no consensus for the use of hypothermia in the treatment of secondary injury after TBI. Until the results of ongoing studies are published, maintaining normothermia and avoiding hyperthermia should be used in managing patient with TBI.
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Affiliation(s)
- E Farag
- General Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA.
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Friedrich P, Feulner T, Laws S, Eckart K, Perneczky R, Kurz A, Förstl H, Riemenschneider M. No association of Tachykinin receptor 2 (TACR2) polymorphisms with Alzheimer's disease. Neurobiol Aging 2011; 32:544-5. [DOI: 10.1016/j.neurobiolaging.2009.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 02/16/2009] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
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Natale B, Wohlrab D, Förtsch B, Kurz A, Diehl-Schmid J. [Early onset Alzheimer's disease - diagnosis, therapy and management]. Fortschr Neurol Psychiatr 2011; 79:144-151. [PMID: 21394705 DOI: 10.1055/s-0029-1245811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This work describes the characteristics of diagnosis, therapy and management of patients with presenile, early onset Alzheimer's disease on the basis of two case reports. The current state of knowledge regarding aetiological, pathophysiological and clinical characteristics is presented. The diagnostic procedures and differential diagnostic considerations are illustrated. The importance of the disclosure of the diagnosis is highlighted. Options for non-cognitive treatment, counselling and support are described.
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Affiliation(s)
- B Natale
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Germany
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37
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Laws S, Eckart K, Friedrich P, Kurz A, Förstl H, Riemenschneider M. Lack of evidence to support the association of polymorphisms within the alpha- and beta-secretase genes (ADAM10/BACE1) with Alzheimer's disease. Neurobiol Aging 2011; 32:541-3. [DOI: 10.1016/j.neurobiolaging.2009.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 02/23/2009] [Indexed: 12/01/2022]
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Abstract
Alzheimer's disease (AD) is a histopathologically defined progressive neurodegenerative disorder. Its clinical manifestation can be subdivided into the stage of mild cognitive impairment (MCI) and the stage of dementia. According to ICD-10 the diagnosis of AD can only be made in the stage of dementia. The indication for anti-dementia drugs is restricted to the stage of dementia in AD, too. Diagnostic tools to detect AD have improved considerably in recent years. They include the MRI findings of atrophy of the medial temporal lobe, cerebrospinal fluid (CSF) biomarkers β-amyloid and τ, the visualisation of metabolic deficits on positron emission tomography (PET) using [(18)F]-fluoro-2-deoxy-D-glucose (FDG) and the emerging possibility to demonstrate amyloid deposits in vivo using PET ligands. The application of these methods allows the diagnosis of AD to be established already in the stage of MCI. While diagnostic methods improve and enable us to make the diagnosis of AD very early, there is no such progress in the development of treatment options. Early diagnosis of AD appears to have benefits and drawbacks. It is most important to include the patient in the decision on early diagnosis and to make clear that there is a lack of therapeutic options if the diagnosis is positive.
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Affiliation(s)
- H-J Gertz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstraße 10, 04103 Leipzig, Deutschland.
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Alexopoulos P, Ebert A, Richter-Schmidinger T, Schöll E, Natale B, Aguilar CA, Gourzis P, Weih M, Perneczky R, Diehl-Schmid J, Kneib T, Förstl H, Kurz A, Danek A, Kornhuber J. Validation of the German revised Addenbrooke's cognitive examination for detecting mild cognitive impairment, mild dementia in alzheimer's disease and frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2010; 29:448-56. [PMID: 20502019 DOI: 10.1159/000312685] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The diagnostic accuracy of the German version of the revised Addenbrooke's Cognitive Examination (ACE-R) in identifying mild cognitive impairment (MCI), mild dementia in Alzheimer's disease (AD) and mild dementia in frontotemporal lobar degeneration (FTLD) in comparison with the conventional Mini Mental State Examination (MMSE) was assessed. METHODS The study encompasses 76 cognitively healthy elderly individuals, 75 patients with MCI, 56 with AD and 22 with FTLD. ACE-R and MMSE were validated against an expert diagnosis based on a comprehensive diagnostic procedure. Statistical analysis was performed using the receiver operating characteristic method and regression analyses. RESULTS The optimal cut-off score for the ACE-R for detecting MCI, AD, and FTLD was 86/87, 82/83 and 83/84, respectively. ACE-R was superior to MMSE only in the detection of patients with FTLD [area under the curve (AUC): 0.97 vs. 0.92], whilst the accuracy of the two instruments did not differ in identifying MCI and AD. The ratio of the scores of the memory ACE-R subtest to verbal fluency subtest contributed significantly to the discrimination between AD and FTLD (optimal cut-off score: 2.30/2.31, AUC: 0.77), whereas the MMSE and ACE-R total scores did not. CONCLUSION The German ACE-R is superior to the most commonly employed MMSE in detecting mild dementia in FTLD and in the differential diagnosis between AD and FTLD. Thus it might serve as a valuable instrument as part of a comprehensive diagnostic workup in specialist centres/clinics contributing to the diagnosis and differential diagnosis of the cause of dementia.
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Affiliation(s)
- P Alexopoulos
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. panos.alexopoulos @ lrz.tu-muenchen.de
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Grimmer T, Drzezga A, Kurz A. [Visualization of amyloid with positron emission tomography. Useful improvement in the diagnosis of dementia?]. Nervenarzt 2010; 81:602-6. [PMID: 20221742 DOI: 10.1007/s00115-010-2951-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Imaging techniques for in vivo visualization of cerebral amyloid using positron emission tomography (PET) have been tested in clinical trails over the past 5 years. Based on a selected overview of the literature including our own studies the various radiopharmaceuticals are presented and the current status of research on the validity of amyloid PET imaging as well as its suitability for early and differential diagnosis of Alzheimer's disease (AD) are described. The findings available up to now support the validity of amyloid PET imaging and suggest a possible benefit in differential diagnosis. However, there are as yet no studies with large sample sizes. The possible use for the early diagnosis of AD should be viewed critically, particularly due to the lack of treatment options.
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Affiliation(s)
- T Grimmer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für kognitive Störungen, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675, München, Deutschland.
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Perneczky R, Wagenpfeil S, Lunetta KL, Cupples LA, Green RC, Decarli C, Farrer LA, Kurz A. Head circumference, atrophy, and cognition: implications for brain reserve in Alzheimer disease. Neurology 2010; 75:137-42. [PMID: 20625166 DOI: 10.1212/wnl.0b013e3181e7ca97] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical and epidemiologic studies suggest that patients with Alzheimer disease (AD) with larger head circumference have better cognitive performance at the same level of brain pathology than subjects with smaller head circumference. METHODS A total of 270 patients with AD participating in the Multi-Institutional Research in Alzheimer's Genetic Epidemiology (MIRAGE) study underwent cognitive testing, APOE genotyping, and MRI of the brain in a cross-sectional study. Linear regression analysis was used to examine the association between cerebral atrophy, as a proxy for AD pathology, and level of cognitive function, adjusting for age, duration of AD symptoms, gender, head circumference, APOE genotype, diabetes mellitus, hypertension, major depression, and ethnicity. An interaction term between atrophy and head circumference was introduced to explore if head circumference modified the association between cerebral atrophy and cognition. RESULTS There was a significant inverse association between atrophy and cognitive function, and a significant interaction between atrophy and head circumference. With greater levels of atrophy, cognition was higher for individuals with greater head circumference. CONCLUSION This study suggests that larger head circumference is associated with less cognitive impairment in the face of cerebral atrophy. This finding supports the notion that head circumference (and presumably brain size) offers protection against AD symptoms through enhanced brain reserve.
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Affiliation(s)
- R Perneczky
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
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43
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Alexopoulos P, Kurz A, Lewczuk P, Kornhuber J, Wiltfang J, Maier W, Förstl H, Perneczky R. The sortilin-related receptor SORL1 and the amyloid cascade: a possible explanation for the concurrent elevation of CSF soluble APPalpha and APPbeta in Alzheimer's disease. Int J Geriatr Psychiatry 2010; 25:542-3. [PMID: 20391590 DOI: 10.1002/gps.2349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Alexopoulos P, Topalidis S, Irmisch G, Prehn K, Jung SU, Poppe K, Sebb H, Perneczky R, Kurz A, Bleich S, Herpertz SC. Homocysteine and cognitive function in geriatric depression. Neuropsychobiology 2010; 61:97-104. [PMID: 20090379 DOI: 10.1159/000275821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/11/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVES Cognitive dysfunction is a common aspect of the spectrum of symptoms of geriatric depression. High homocysteine levels have been linked to cognitive decline in neuropsychiatric disorders. The present study investigated possible associations between cognitive impairment observed in geriatric depression and homocysteine levels. METHODS The performance of 25 mentally healthy individuals and 40 patients with geriatric depression in terms of language processing, processing speed, concentration and attention was assessed with the Stroop Test and the d2 Test of Attention. Serum homocysteine was determined with an enzyme immunoassay. RESULTS The performance of depressed patients was significantly worse in language processing (p = 0.001) and processing speed (p < 0.0001). Depressed patients with high levels of homocysteine performed better than patients with homocysteine concentrations <or=11.7 micromol/l in both cognitive domains (p = 0.006 and 0.009, respectively). Moreover, homocysteine level was positively associated with language processing (p = 0.002) and processing speed (p = 0.002). CONCLUSIONS These findings indicate that under the special circumstances of geriatric depression (perturbation of glutamatergic transmission and glutamate metabolism), homocysteine is positively associated with the performance in language processing and processing speed.
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Affiliation(s)
- P Alexopoulos
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany. panos.alexopoulos @ lrz.tu-muenchen.de
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Alexopoulos P, Lehrl S, Richter-Schmidinger T, Kreusslein A, Hauenstein T, Bayerl F, Jung P, Kneib T, Kurz A, Kornhuber J, Bleich S. Short-term influence of elevation of plasma homocysteine levels on cognitive function in young healthy adults. J Nutr Health Aging 2010; 14:283-7. [PMID: 20305995 DOI: 10.1007/s12603-010-0062-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acute homocysteine elevation has been shown to have a significant impact on cognitive function in animal models. OBJECTIVES Investigation of the short-term impact of elevation of plasma homocysteine levels through a dietary intervention on cognitive abilities of young healthy adults. PARTICIPANTS 100 healthy medical students of both genders were enrolled in the study. DESIGN AND MEASUREMENTS Homocysteine levels and cognitive abilities were measured at 08:30 (before breakfast) and at 15:00 (two hours after lunch and six hours after breakfast). Food intake was restricted to specified comestibles. The cognitive assessment comprised a version of the Short Test for General Intelligence, three subtests of the Syndrome Short Test and the Stroop test. RESULTS At 15:00 plasma homocysteine was significantly elevated in 56 participants (P < 0.00001), whilst in 44 it was decreased (P < 0.00001) in comparison to baseline (08:30). The decrease was however of limited clinical significance. The differences in the changes in cognitive performance between the two groups did not attain statistical significance (P > 0.05) and the direction of the changes did not differ between them. Accordingly, the multiple linear regression analysis did not reveal an important influence of homocysteine elevation on cognitive performance variations. CONCLUSIONS Significant increase of plasma homocysteine is not associated with a straightforward inhibitory or facilitatory short-term effect on physiological cognitive parameters in young healthy adults.
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Affiliation(s)
- P Alexopoulos
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Kurz A, Wöhr M, Walter M, Bonin M, Auburger G, Gispert S, Schwarting R. Alpha-synuclein deficiency affects brain Foxp1 expression and ultrasonic vocalization. Neuroscience 2010; 166:785-95. [DOI: 10.1016/j.neuroscience.2009.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/22/2009] [Accepted: 12/23/2009] [Indexed: 12/17/2022]
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Albayrak O, Tirniceriu A, Riemenschneider M, Kurz A, Scherag A, Egensperger R. The cathepsin D (224C/T) polymorphism confers an increased risk to develop Alzheimer's disease in men. J Gerontol A Biol Sci Med Sci 2010; 65:219-24. [PMID: 20083556 DOI: 10.1093/gerona/glp209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The lysosomal protease cathepsin D is likely involved in beta-amyloidogenesis in Alzheimer's disease (AD). There is evidence for a single nucleotide polymorphism (rs17571) of the cathepsin D gene to be associated with increased AD risk. However, little is known about gender-specific differences. Therefore, we performed a genetic association study focusing on gender-specific differences in 434 participants (219 AD and 215 controls). Screening of the rs17571 shows a significantly higher proportion of T-allele carriers among male Alzheimer patients (28.5%) when compared with male controls (13.8%, p = .013, p(corr) = .039). The odds ratio was 2.48 (95% confidence interval: 1.14-5.58). There was no significant difference in the T-allele distribution in women. Including APOE4 status and age did not have an additional effect on the morbidity risk. Thus, our results support the idea that rs17571 confers an increased risk for AD in men but not in women. Further investigation should substantiate the role of gender for AD risk of rs17571.
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Affiliation(s)
- O Albayrak
- Department of Child and Adolescent Psychiatry, LVR Klinikum Essen, University of Duisburg-Essen, Germany
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Redel P, Bublak P, Sorg C, Kurz A, Förstl H, Müller H, Schneider W, Finke K. PW01-87 - Deficits of spatial and task-related attentional selection in mild cognitive impairment and Alzheimer's disease. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71486-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Perneczky R, Drzezga A, Boecker H, Foerstl H, Kurz A, Haeussermann P. P1.097 Brain functional correlates of geriatric assessment in dementia with Lewy bodies. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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