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Berger C, Greiner A, Brandhorst P, Reimers SC, Kniesel O, Omran S, Treskatsch S. How Would I Treat My Own Thoracoabdominal Aortic Aneurysm: Perioperative Considerations From the Anesthesiologist Perspective. J Cardiothorac Vasc Anesth 2024; 38:1092-1102. [PMID: 38310068 DOI: 10.1053/j.jvca.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 02/05/2024]
Abstract
A thoracoabdominal aortic aneurysm (TAAA) can be potentially life-threatening due to its associated risk of rupture. Thoracoabdominal aortic aneurysm repair, performed as endovascular repair and/or open surgery, is the recommended therapy of choice. Hemodynamic instability, severe blood loss, and spinal cord or cerebral ischemia are some potential hazards the perioperative team has to face during these procedures. Therefore, preoperative risk assessment and intraoperative anesthesia management addressing these potential hazards are essential to improving patients' outcomes. Based on a presented index case, an overview focusing on anesthetic measures to identify perioperatively and manage these risks in TAAA repair is provided.
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Affiliation(s)
- Christian Berger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Vascular Surgery, Berlin, Germany
| | - Philipp Brandhorst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Sophie Claire Reimers
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Olaf Kniesel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Vascular Surgery, Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Niebuhr H, Reinpold W, Morgenroth F, Berger C, Dag H, Wehrenberg U, Trzewik J, Köckerling F. Assessment of myofascial medialization following intraoperative fascial traction (IFT) in a cadaveric model. Hernia 2024:10.1007/s10029-024-03003-1. [PMID: 38615297 DOI: 10.1007/s10029-024-03003-1] [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: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT. METHODS 4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30 min. Medial advancement of the anterior rectus sheath was measured after 15 and 30 min as well as traction forces. RESULTS Total medialization for anterior rectus sheath after 30 min of IFT was 10.5 cm (mean). The mean traction force was 16.28 kg. Total medialization was significantly higher during the first 15 min of vertical fascial traction (p < 0.05). CONCLUSIONS IFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery.
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Affiliation(s)
- H Niebuhr
- Hamburg Hernia Centre, Hamburg, Germany.
| | | | - F Morgenroth
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - C Berger
- Hamburg Hernia Centre, Hamburg, Germany
| | - H Dag
- Hamburg Hernia Centre, Hamburg, Germany
| | - U Wehrenberg
- Anatomical Institute University of Hamburg, Hamburg, Germany
| | - J Trzewik
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - F Köckerling
- Hernia Centre Vivantes Humboldt-Klinikum Berlin, Berlin, Germany
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 2024; 35:599-611. [PMID: 38040857 DOI: 10.1007/s00198-023-06975-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. PURPOSE We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. METHODS We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50-85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012-2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. RESULTS The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. CONCLUSION Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
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Affiliation(s)
- N Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - C Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Palacios D, Berger C, Kanacri BPL, Huisman M, Veenstra R. The role of academic performance, prosocial behaviour and friendships on adolescents' preferred studying partners: A longitudinal social network analysis. Br J Educ Psychol 2024. [PMID: 38514250 DOI: 10.1111/bjep.12675] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/14/2023] [Accepted: 02/16/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Peers constitute an important developmental context for adolescent academic behaviour providing support and resources to either promote or discourage attitudes and behaviours that contribute to school success. When looking for academic help, students may prefer specific partners based on their social goals regarding academic performance. AIMS Based on the social goals for wanting to achieve academically (e.g., studying to be with friends, increasing/maintaining their own social status), we examine the extent to which adolescents' selection of preferred academic partners (with whom they would like to study) is driven by peers' academic performance, prosocial behaviour and friendships. Moreover, as high-achieving students play an important role in academic settings, whether they are more likely to prefer to study with similar high-achieving peers and friends was examined. SAMPLE A total of 537 seventh-grade students from 13 classes over three waves. METHODS Longitudinal social network analyses (RSiena). RESULTS Adolescents were more likely to select high achievers, friends and prosocial peers as preferred academic partners. Furthermore, high achievers were more likely to choose other high achievers and friends as preferred academic partners. CONCLUSIONS Adolescents are likely to prefer as study partners someone they can learn from and who is more approachable, cooperative and friendly. Regarding high achievers, they would choose not only academic partners with similar academic interests and motivations to help them boost their academic achievement but also classmates with whom they like to spend time and share personal issues.
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Affiliation(s)
- Diego Palacios
- Society and Health Research Center, School of Psychology, Faculty of Social Sciences and Arts, Universidad Mayor, Santiago, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Millennium Nucleus on Sociomedicine (SocioMed), Santiago, Chile
| | - Christian Berger
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Mark Huisman
- University of Groningen, Groningen, The Netherlands
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Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, Berger C. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02498-8. [PMID: 38509186 DOI: 10.1007/s00068-024-02498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Prehospital airway management in trauma is a key component of care and is associated with particular risks. Endotracheal intubation (ETI) is the gold standard, while extraglottic airway devices (EGAs) are recommended alternatives. There is limited evidence comparing their effectiveness. In this retrospective analysis from the TraumaRegister DGU®, we compared ETI with EGA in prehospital airway management regarding in-hospital mortality in patients with trauma. METHODS We included cases only from German hospitals with a minimum Abbreviated Injury Scale score ≥ 2 and age ≥ 16 years. All patients without prehospital airway protection were excluded. We performed a multivariate logistic regression to adjust with the outcome measure of hospital mortality. RESULTS We included n = 10,408 cases of whom 92.5% received ETI and 7.5% EGA. The mean injury severity score was higher in the ETI group (28.8 ± 14.2) than in the EGA group (26.3 ± 14.2), and in-hospital mortality was comparable: ETI 33.0%; EGA 30.7% (27.5 to 33.9). After conducting logistic regression, the odds ratio for mortality in the ETI group was 1.091 (0.87 to 1.37). The standardized mortality ratio was 1.04 (1.01 to 1.07) in the ETI group and 1.1 (1.02 to 1.26) in the EGA group. CONCLUSIONS There was no significant difference in mortality rates between the use of ETI or EGA, or the ratio of expected versus observed mortality when using ETI.
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Affiliation(s)
- Moritz Weigeldt
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | | | - Dirk Stengel
- BG Kliniken - Hospital Group of the German Federal Statutory Accident Insurance, Leipziger Platz 1, 10117, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109, Cologne, Germany
- Committee On Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Reinpold W, Berger C, Adolf D, Köckerling F. Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results. Hernia 2024; 28:179-190. [PMID: 37603090 DOI: 10.1007/s10029-023-02847-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. METHODS Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8 cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. RESULTS This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. CONCLUSIONS The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03133000.
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Affiliation(s)
- W Reinpold
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany.
| | - C Berger
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany
| | - D Adolf
- Institute for Statistics, Otto-Von-Guerike-University, Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - F Köckerling
- Center of Hernia Surgery, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Germany
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Audinot B, Drubay D, Gaspar N, Mohr A, Cordero C, Marec-Bérard P, Lervat C, Piperno-Neumann S, Jimenez M, Mansuy L, Castex MP, Revon-Riviere G, Marie-Cardine A, Berger C, Piguet C, Massau K, Job B, Moquin-Beaudry G, Le Deley MC, Tabone MD, Berlanga P, Brugières L, Crompton BD, Marchais A, Abbou S. ctDNA quantification improves estimation of outcomes in patients with high-grade osteosarcoma: a translational study from the OS2006 trial. Ann Oncol 2023:S0923-7534(23)05113-X. [PMID: 38142939 DOI: 10.1016/j.annonc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Osteosarcoma stratification relies on clinical parameters and histological response. We developed a new personalized stratification using less invasive circulating tumor DNA (ctDNA) quantification. PATIENTS AND METHODS Plasma from patients homogeneously treated in the prospective protocol OS2006, at diagnosis, before surgery and end of treatment, were sequenced using low-passage whole-genome sequencing (lpWGS) for copy number alteration detection. We developed a prediction tool including ctDNA quantification and known clinical parameters to estimate patients' individual risk of event. RESULTS ctDNA quantification at diagnosis (diagCPA) was evaluated for 183 patients of the protocol OS2006. diagCPA as a continuous variable was a major prognostic factor, independent of other clinical parameters, including metastatic status [diagCPA hazard ratio (HR) = 3.5, P = 0.002 and 3.51, P = 0.012, for progression-free survival (PFS) and overall survival (OS)]. At the time of surgery and until the end of treatment, diagCPA was also a major prognostic factor independent of histological response (diagCPA HR = 9.2, P < 0.001 and 11.6, P < 0.001, for PFS and OS). Therefore, the addition of diagCPA to metastatic status at diagnosis or poor histological response after surgery improved the prognostic stratification of patients with osteosarcoma. We developed the prediction tool PRONOS to generate individual risk estimations, showing great performance ctDNA quantification at the time of surgery and the end of treatment still required improvement to overcome the low sensitivity of lpWGS and to enable the follow-up of disease progression. CONCLUSIONS The addition of ctDNA quantification to known risk factors improves the estimation of prognosis calculated by our prediction tool PRONOS. To confirm its value, an external validation in the Sarcoma 13 trial is underway.
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Affiliation(s)
- B Audinot
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - D Drubay
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif
| | - N Gaspar
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif; Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - A Mohr
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - C Cordero
- Pediatric Department, Institut Curie, Paris; French Cancer Society (SFCE), Bordeaux
| | - P Marec-Bérard
- Department of Oncology for Child and Adolescent, Centre Léon Bérard, Pediatric Oncology and Hematology Institute (IHOPe), Lyon; French Cancer Society (SFCE), Bordeaux
| | - C Lervat
- Department of Pediatric Oncology, Adolescents and Young Adults, Centre Oscar Lambret, Lille; French Cancer Society (SFCE), Bordeaux
| | | | - M Jimenez
- Research and Development Department, Unicancer, Paris
| | - L Mansuy
- Department of Pediatric Hematology and Oncology, Nancy University Hospital, Vandœuvre-lès-Nancy; French Cancer Society (SFCE), Bordeaux
| | - M-P Castex
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse; French Cancer Society (SFCE), Bordeaux
| | - G Revon-Riviere
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, Marseille; French Cancer Society (SFCE), Bordeaux
| | - A Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen; French Cancer Society (SFCE), Bordeaux
| | - C Berger
- Department of Pediatric Oncology, North Hospital, University Hospital of Saint Etienne, Saint Etienne; French Cancer Society (SFCE), Bordeaux
| | - C Piguet
- Pediatric Oncology Hematology Unit, Limoges University Hospital, Limoges; French Cancer Society (SFCE), Bordeaux
| | - K Massau
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - B Job
- National Institute for Health and Medical Research (INSERM) US23, Gustave Roussy, Villejuif
| | - G Moquin-Beaudry
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - M-C Le Deley
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif; Clinical Research Department, Centre Oscar Lambret, Lille
| | - M-D Tabone
- Pediatric Hematology Department, Trousseau Hospital, Sorbonne Université, Paris, France; French Cancer Society (SFCE), Bordeaux
| | - P Berlanga
- Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - L Brugières
- Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - B D Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston; Broad Institute of Harvard and MIT, Cambridge, USA
| | - A Marchais
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - S Abbou
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif; Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux.
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Bravo A, Berger C, Ortega-Ruiz R, Romera EM. Trajectories of defending behaviors: Longitudinal association with normative and social adjustment and self-perceived popularity. J Sch Psychol 2023; 101:101252. [PMID: 37951667 DOI: 10.1016/j.jsp.2023.101252] [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: 09/26/2022] [Revised: 04/17/2023] [Accepted: 09/24/2023] [Indexed: 11/14/2023]
Abstract
Defending the victim in bullying situations is a moral behavior that has received increasing attention in the literature. However, important questions about the development and maintenance of defending behaviors remain unanswered. The present study adopted a longitudinal design with two main goals: (a) identifying trajectories of change in individuals' defending behavior over time and (b) describing and comparing the initial levels and dynamics of change in normative and social adjustment and self-perceived popularity between the different defending trajectories. A total of 3303 students (49.8% girls; Wave 1 Mage = 12.61 years; SD = 1.47) participated in the study. Data were collected in four waves with self-report questionnaires. Using growth mixture modeling, we found four defending trajectories (84% stable-high, 5% decrease, 4% increase, and 7% stable-low). Growth mixture model multigroup and comparative analyses found that adolescents in the stable-high defending group exhibited the highest initial levels of normative adjustment (Mintercept = 5.47), social adjustment (Mintercept = 5.48), and self-perceived popularity (Mintercept = 5). Adolescents in the decrease defending group tended to reduce their normative adjustment over time (Mslope = -0.09), whereas the increase defending group increased their social adjustment (Mslope = 0.18) and self-perceived popularity (Mslope = -0.04). The stable-low defending group showed low and stable levels of normative adjustment (Mintercept = 5.01), social adjustment (Mintercept = 5.03), and self-perceived popularity (Mintercept = 4.4). These results indicate a strong association between normative and social adjustment and self-perceived popularity and involvement in defending behaviors. Bullying prevention programs could improve by adding a stronger focus on the development of classroom dynamics that promote adjusted behaviors and class-group cohesion.
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Affiliation(s)
- Ana Bravo
- Department of Psychology, Universidad de Córdoba, Avenue San Alberto Magno, s/n, 14071 Córdoba, Spain.
| | - Christian Berger
- School of Psychology, Pontificia Universidad Católica de Chile, Campus San Joaquín, Vicuña Mackenna 4860, Macul, Región Metropolitana, Chile.
| | - Rosario Ortega-Ruiz
- Department of Psychology, Universidad de Córdoba, Avenue San Alberto Magno, s/n, 14071 Córdoba, Spain.
| | - Eva M Romera
- Department of Psychology, Universidad de Córdoba, Avenue San Alberto Magno, s/n, 14071 Córdoba, Spain.
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Silimon N, Drop B, Clénin L, Nedeltchev K, Kahles T, Tarnutzer AA, Katan M, Bonati L, Salmen S, Albert S, Salerno A, Carrera E, Berger C, Peters N, Medlin F, Cereda C, Bolognese M, Kägi G, Renaud S, Niederhauser J, Bonvin C, Schärer M, Mono ML, Luft A, Rodic-Tatic B, Fischer U, Jung S, Arnold M, Meinel T, Seiffge D. Ischaemic stroke despite antiplatelet therapy: Causes and outcomes. Eur Stroke J 2023; 8:692-702. [PMID: 37622482 PMCID: PMC10472957 DOI: 10.1177/23969873231174942] [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: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT. METHODS In this cohort study, we enrolled patients with imaging-confirmed ischaemic stroke from the Swiss Stroke Registry (01/2014-07/2022). We determined the frequency of prior APT, assessed stroke aetiology (modified TOAST classification) and determined the association of prior APT with unfavourable functional outcome (modified Rankin Scale score 3-6) and recurrent ischaemic stroke at 3 months using regression models. RESULTS Among 53,352 patients, 27,484 (51.5%) had no prior antithrombotic treatment, 17,760 (33.3%) were on APT, 7039 (13.2%) on anticoagulation and 1069 (2.0%) were on APT + anticoagulation. In patients with a history of ischaemic stroke/TIA (n = 11,948; 22.4%), 2401 (20.1%) had no prior antithrombotic therapy, 6594 (55.2%) were on APT, 2489 (20.8%) on anticoagulation and 464 (3.9%) on APT + anticoagulation. Amongst patients with ischaemic stroke despite APT, aetiology was large artery atherosclerosis in 19.8% (n = 3416), cardiac embolism in 23.6% (n = 4059), small vessel disease in 11.7% (n = 2011), other causes in 7.4% (n = 1267), more than one cause in 6.3% (n = 1078) and unknown cause in 31.3% (n = 5388). Prior APT was not independently associated with unfavourable outcome (aOR = 1.06; 95% CI: 0.98-1.14; p = 0.135) or death (aOR = 1.10; 95% CI: 0.99-1.21; p = 0.059) at 3-months but with increased odds of recurrent stroke (6.0% vs 4.3%; aOR 1.26; 95% CI: 1.11-1.44; p < 0.001). CONCLUSIONS One-third of ischaemic strokes occurred despite APT and 20% of patients with a history of ischaemic stroke had no antithrombotic therapy when having stroke recurrence. Aetiology of breakthrough strokes despite APT is heterogeneous and these patients are at increased risk of recurrent stroke.
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Affiliation(s)
- Norbert Silimon
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - Boudewijn Drop
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Neurology, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital of Aarau, Aarau, Switzerland
| | | | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Reha Rheinfelden, Rheinfelden, Switzerland
| | | | - Sylvan Albert
- Stroke Unit, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Alexander Salerno
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Nils Peters
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
| | | | - Carlo Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Georg Kägi
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Neurology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Susanne Renaud
- Neurology and Stroke Unit, Neuchâtel Hospital Network, Neuchâtel, Switzerland
| | | | | | | | | | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Urs Fischer
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon Jung
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland
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Schiefenhövel F, Berger C, Penkova L, Grubitzsch H, Haller B, Meyer A, Heringlake M, Sander M, Erb JM, Balzer F, Treskatsch S. Influence of timing of Levosimendan administration on outcomes in cardiac surgery. Front Cardiovasc Med 2023; 10:1213696. [PMID: 37564910 PMCID: PMC10410848 DOI: 10.3389/fcvm.2023.1213696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Though a subgroup analysis has shown improved survival for patients suffering severely reduced ventricular function undergoing coronary artery bypass grafting, RCTs were not able to demonstrate overall beneficial effects of perioperative Levosimendan in cardiac surgery. This might be due to Levosimendan's pharmacokinetics reaching a steady-state concentration only 4-8 h after administration. Thus, this study now analysed the influence of timing of Levosimendan administration on perioperative outcome in cardiac surgery patients preoperatively presenting with severely reduced ventricular function and therefore considered at high-risk for intra- or postoperative low cardiac output syndrome. We hypothesized that prolonged preoperative Levosimendan administration ("preconditioning") would reduce mortality. Methods All adult patients undergoing cardiac surgery between 2006 and 2018 perioperatively receiving Levosimendan were included in this retrospective, observational cohort study (n = 498). Patients were stratified into 3 groups: Levosimendan started on the day prior to surgery ("preop"), Levosimendan started on the day of surgery ("intraop") or post ICU admission ("postop"). After propensity score matching (PSM) was performed, outcomes defined according to proposed standard definitions for perioperative outcome research were compared between groups. Results After PSM, there were no significant differences in patients' characteristics, comorbidities and type/priority of surgery between groups. Compared to intraop or postop Levosimendan treatment, preop treated patients had significantly lower in-hospital-mortality (preop vs. intraop. vs. postop = 16,7% vs. 33,3% vs. 42,3%), duration of mechanical ventilation and rate of continuous renal replacement therapy. Conclusions Prolonged preoperative treatment with Levosimendan of cardiac surgery patients preoperatively presenting with severely reduced left ventricular function might be beneficial in terms of postoperative outcome. Our results are in line with recent experts' recommendations concerning the prolonged perioperative use of Levosimendan. We strongly recommend that future randomized trials include this "preconditioning" treatment as an experimental arm.
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Affiliation(s)
- Fridtjof Schiefenhövel
- Department of Anaesthesiology and Intensive Care (AINS), Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence and Informatics in Medicine (AIIM), Chair of Medical Informatics, Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Christian Berger
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Liubov Penkova
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Mitte and Charité Campus Virchow, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Klinik für Kardiovaskuläre Chirurgie, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
| | - Bernhard Haller
- Institute for Artificial Intelligence and Informatics in Medicine (AIIM), Chair of Medical Informatics, Medical Center Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Meyer
- Klinik für Kardiovaskuläre Chirurgie, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matthias Heringlake
- Department of Anaesthesia, Heart and Diabetes Center, Klinikum Karlsburg, Karlsburg, Germany
| | - Michael Sander
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen UKGM, Justus-Liebig University Gießen, Gießen, Germany
| | - Joachim M. Erb
- Clinic for Anaesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Felix Balzer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Germany
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11
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Omran S, Schawe L, Konietschke F, Angermair S, Weixler B, Treskatsch S, Greiner A, Berger C. Identification of Perioperative Procedural and Hemodynamic Risk Factors for Developing Colonic Ischemia after Ruptured Infrarenal Abdominal Aortic Aneurysm Surgery: A Single-Centre Retrospective Cohort Study. J Clin Med 2023; 12:4159. [PMID: 37373851 DOI: 10.3390/jcm12124159] [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: 05/04/2023] [Revised: 06/04/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: This retrospective study evaluated perioperative and intensive care unit (ICU) variables to predict colonic ischemia (CI) after infrarenal ruptured abdominal aortic aneurysm (RAAA) surgery. (2) Materials and Methods: We retrospectively analyzed the data of the patients treated for infrarenal RAAA from January 2011 to December 2020 in our hospital. (3) Results: A total of 135 (82% male) patients were admitted to ICU after treatment of infrarenal RAAA. The median age of all patients was 75 years (IQR 68-81 years). Of those, 24 (18%) patients developed CI, including 22 (92%) cases within the first three postoperative days. CI was found more often after open repair compared to endovascular treatment (22% vs. 5%, p = 0.021). Laboratory findings in the first seven PODs revealed statistically significant differences between CI and non-CI patients for serum lactate, minimum pH, serum bicarbonate, and platelet count. Norepinephrine (NE) was used in 92 (68%) patients during ICU stay. The highest daily dose of norepinephrine was administered to CI patients at POD1. Multivariable analysis revealed that NE > 64 µg/kg (RD 0.40, 95% CI: 0.25-0.55, p < 0.001), operating time ≥ 200 min (RD 0.18, 95% CI: 0.05-0.31, p = 0.042), and pH < 7.3 (RD 0.21, 95% CI: 0.07-0.35, p = 0.019), significantly predicted the development of CI. A total of 23 (17%) patients died during the hospital stay, including 8 (33%) patients from the CI group and 15 (7%) from the non-CI group (p = 0.032). (4) Conclusions: CI after RAAA is a sever complication occurring most frequently within the first 3 postoperative days. Our study identified many surrogate markers associated with colonic ischemia after aortic RAAA, including norepinephrine dose > 64 µg/kg, operating time ≥ 200 min, and PH < 7.3. Future studies are needed to support these results.
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Affiliation(s)
- Safwan Omran
- Department of Vascular Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Larissa Schawe
- Department of Vascular Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Frank Konietschke
- Institute of Medical Biometrics and Clinical Epidemiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, 10178 Berlin, Germany
| | - Stefan Angermair
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
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12
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Haller K, Trauzeddel RF, Treskatsch S, Berger C. [Risk factors for postoperative hypoxemia during transport to the postanesthesia care unit and influence of transport monitoring : A retrospective propensity score-matched databank analysis]. Anaesthesiologie 2023:10.1007/s00101-023-01296-y. [PMID: 37296345 DOI: 10.1007/s00101-023-01296-y] [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] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/26/2023] [Accepted: 04/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Within a central operating room area, after general anesthesia (GA) patients are at risk of hypoxemia during transport to the postanesthesia care unit (PACU); however, specific risk factors have not been conclusively clarified and uniform recommendations for monitoring vital signs during transport within a central operating room area complex do not exist. The purpose of this retrospective database analysis was to identify risk factors for hypoxemia during this transport and to determine whether the use of transport monitoring (TM) affects the initial value of peripheral venous oxygen saturation (SpO2) in the PACU. MATERIAL AND METHODS This analysis was performed on a retrospectively extracted dataset of procedures in GA within a central operating room area of a tertiary care hospital from 2015 to 2020. The emergence from GA was conducted in the operating room with subsequent transport to the PACU. The transport distance was between 31 and 72 m. Risk factors for initial hypoxemia in the PACU, defined as peripheral oxygen saturation (SpO2) below 90%, were determined using multivariate analysis. After splitting the dataset into patients without TM (group OM) and with TM (group MM) and propensity score matching, the influence of TM on initial SpO2 and the Aldrete score after arrival in the PACU were examined. RESULTS AND DISCUSSION From a total of 22,638 complete datasets included in the analysis, 8 risk factors for initial hypoxemia in PACU were identified: age > 65 years, body mass index (BMI) > 30 kg/m2, chronic obstructive pulmonary disease (COPD), intraoperative airway driving pressure (∆p) > 15 mbar and positive endexpiratory pressure (PEEP) > 5 mbar, intraoperative administration of a long-acting opioids, first preoperative SpO2 < 97%, and last SpO2 < 97% measured after emergence from anesthesia before transport. At least 1 risk factor for postoperative hypoxemia was present in 90% of all patients. After propensity score matching, 3362 datasets per group remained for analysis of the influence of TM. Patients transported with TM revealed a higher SpO2 at PACU arrival (MM 97% [94; 99%], OM 96% [94; 99%], p < 0.001). In a subgroup analysis, this difference between groups remained in the presence of one or more risk factors (MM 97% [94; 99%], OM 96% [94; 98%], p < 0.001, n = 6044) but was not detectable in the absence of risk factors for hypoxemia (MM 97% [97; 100%], OM 99% [97; 100%], p < 0.393, n = 680). Furthermore, the goal of an Aldrete score > 8 at PACU arrival was achieved significantly more often in monitored patients (MM 2830 [83%], OM: 2665 [81%], p = 0.004). Critical hypoxemia (SpO2 < 90%) at PACU arrival had an overall low occurrence within propensity matched datasets and showed no difference between groups (MM: 161 [5%], OM 150 [5%], p = 0.755). According to these results, consistent use of TM leads to a higher SpO2 and Aldrete score at PACU arrival, even after a short transport distance within an operating room area. Consequently, it appears to be reasonable to avoid unmonitored transport after general anesthesia, even for short distances.
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Affiliation(s)
- Katharina Haller
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - Ralf Felix Trauzeddel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Sascha Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - Christian Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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13
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Feldheiser A, Juhl-Olsen P, Nordine M, Stetzuhn M, Wiegank L, Knebel F, Treskatsch S, Berger C. A comprehensive echocardiographic analysis during simulated hypovolaemia: An observational study. Eur J Anaesthesiol 2023:00003643-990000000-00100. [PMID: 37265333 DOI: 10.1097/eja.0000000000001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Peri-operative and critically ill patients often experience mild to moderate hypovolaemic shock with preserved mean arterial pressure (MAP), heart rate (HR) and decreased stroke volume index (SVI). OBJECTIVES The aim of this study was to evaluate echocardiographic parameters during simulated mild to moderate central hypovolaemia. DESIGN This was a prospective preclinical study. SETTING Laboratory trial performed in Charité-Universitätsmedizin Berlin, Germany. PATIENTS AND METHODS Thirty healthy male volunteers underwent graded central hypovolaemia using a lower body negative pressure (LBNP) chamber with a stepwise decrease to simulate a mild (-15 mmHg), mild-to-moderate (-30 mmHg), and moderate state of hypovolaemic shock (-45 mmHg). During every stage, a transthoracic echocardiography examination (TTE) was performed by a certified examiner. MAIN OUTCOME MEASURES Systolic and diastolic myocardial performance markers, as well as cardiac volumes were recorded during simulated hypovolaemia and compared to baseline values. RESULTS During simulated hypovolaemia via LBNP, SVI decreased progressively at all stages, whereas MAP and HR did not consistently change. Left ventricular (LV) ejection fraction decreased at -30 and -45 mmHg. Simultaneously with SVI decline, LV global longitudinal strain (LV GLS), tricuspid annular plain systolic excursion (TAPSE), and right ventricular (RV) peak systolic tissue Doppler imaging annular velocity (S') and left-atrial end-systolic volume (LA ESV) decreased compared to baseline at all stages. CONCLUSIONS In this study, simulated central hypovolaemia using LBNP did not induce consistent changes in MAP and HR. SVI decreased and was associated with deteriorated right- and left-ventricular function, observed with echocardiography. The decreased filling status was characterised by decreased LA ESV. CLINICAL TRIAL NUMBER ClinicalTrials.gov Identifier: NCT03481855.
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Affiliation(s)
- Aarne Feldheiser
- From the Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (AF, MS, LW), Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Evang. Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany (AF), Department of Cardiothoracic- and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark (PJ-O), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany (MN, ST, CB), Sana Berlin-Klinkum Lichtenberg, Fanninger Straße 32, 10365 Berlin und Charité Universitätsmedizin, Campus Mitte, Klinik für Kardiologie und Angiologie. 10098 Berlin (FK)
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14
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Fan W, Jurado‐Arjona J, Alanis‐Lobato G, Péron S, Berger C, Andrade‐Navarro MA, Falk S, Berninger B. The transcriptional co-activator Yap1 promotes adult hippocampal neural stem cell activation. EMBO J 2023; 42:e110384. [PMID: 37083045 PMCID: PMC10233373 DOI: 10.15252/embj.2021110384] [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: 01/11/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
Most adult hippocampal neural stem cells (NSCs) remain quiescent, with only a minor portion undergoing active proliferation and neurogenesis. The molecular mechanisms that trigger the transition from quiescence to activation are still poorly understood. Here, we found the activity of the transcriptional co-activator Yap1 to be enriched in active NSCs. Genetic deletion of Yap1 led to a significant reduction in the relative proportion of active NSCs, supporting a physiological role of Yap1 in regulating the transition from quiescence to activation. Overexpression of wild-type Yap1 in adult NSCs did not induce NSC activation, suggesting tight upstream control mechanisms, but overexpression of a gain-of-function mutant (Yap1-5SA) elicited cell cycle entry in NSCs and hilar astrocytes. Consistent with a role of Yap1 in NSC activation, single cell RNA sequencing revealed a partial induction of an activated NSC gene expression program. Furthermore, Yap1-5SA expression also induced expression of Taz and other key components of the Yap/Taz regulon that were previously identified in glioblastoma stem cell-like cells. Consequently, dysregulated Yap1 activity led to repression of hippocampal neurogenesis, aberrant cell differentiation, and partial acquisition of a glioblastoma stem cell-like signature.
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Affiliation(s)
- Wenqiang Fan
- Institute of Physiological ChemistryUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Present address:
Neuroscience Therapeutic Area, New MedicinesUCB Biopharma SPRLBraine‐l'AlleudBelgium
| | - Jerónimo Jurado‐Arjona
- Institute of Physiological ChemistryUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Gregorio Alanis‐Lobato
- Faculty of BiologyJohannes Gutenberg University MainzMainzGermany
- Present address:
Global Computational Biology and Data SciencesBoehringer Ingelheim Pharma GmbH & Co. KGBiberach an der RissGermany
| | - Sophie Péron
- Institute of Physiological ChemistryUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Christian Berger
- Institute of GeneticsJohannes Gutenberg University MainzMainzGermany
| | | | - Sven Falk
- Institute of BiochemistryFriedrich‐Alexander‐Universität Nürnberg‐ErlangenErlangenGermany
| | - Benedikt Berninger
- Institute of Physiological ChemistryUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC Centre for Neurodevelopmental Disorders, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- The Francis Crick InstituteLondonUK
- Focus Program Translational NeuroscienceJohannes Gutenberg University MainzMainzGermany
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15
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Nordine M, Pille M, Kraemer J, Berger C, Brandhorst P, Kaeferstein P, Kopetsch R, Wessel N, Trauzeddel RF, Treskatsch S. Intraoperative Beat-to-Beat Pulse Transit Time (PTT) Monitoring via Non-Invasive Piezoelectric/Piezocapacitive Peripheral Sensors Can Predict Changes in Invasively Acquired Blood Pressure in High-Risk Surgical Patients. Sensors (Basel) 2023; 23:3304. [PMID: 36992016 PMCID: PMC10059272 DOI: 10.3390/s23063304] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Non-invasive tracking of beat-to-beat pulse transit time (PTT) via piezoelectric/piezocapacitive sensors (PES/PCS) may expand perioperative hemodynamic monitoring. This study evaluated the ability for PTT via PES/PCS to correlate with systolic, diastolic, and mean invasive blood pressure (SBPIBP, DBPIBP, and MAPIBP, respectively) and to detect SBPIBP fluctuations. METHODS PES/PCS and IBP measurements were performed in 20 patients undergoing abdominal, urological, and cardiac surgery. A Pearson's correlation analysis (r) between 1/PTT and IBP was performed. The predictive ability of 1/PTT with changes in SBPIBP was determined by area under the curve (reported as AUC, sensitivity, specificity). RESULTS Significant correlations between 1/PTT and SBPIBP were found for PES (r = 0.64) and PCS (r = 0.55) (p < 0.01), as well as MAPIBP/DBPIBP for PES (r = 0.6/0.55) and PCS (r = 0.5/0.45) (p < 0.05). A 7% decrease in 1/PTTPES predicted a 30% SBPIBP decrease (0.82, 0.76, 0.76), while a 5.6% increase predicted a 30% SBPIBP increase (0.75, 0.7, 0.68). A 6.6% decrease in 1/PTTPCS detected a 30% SBPIBP decrease (0.81, 0.72, 0.8), while a 4.8% 1/PTTPCS increase detected a 30% SBPIBP increase (0.73, 0.64, 0.68). CONCLUSIONS Non-invasive beat-to-beat PTT via PES/PCS demonstrated significant correlations with IBP and detected significant changes in SBPIBP. Thus, PES/PCS as a novel sensor technology may augment intraoperative hemodynamic monitoring during major surgery.
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Affiliation(s)
- Michael Nordine
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Marius Pille
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
| | - Jan Kraemer
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Philipp Brandhorst
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | | | | | - Niels Wessel
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
- Department of Human Medicine, MSB Medical School Berlin GmbH, 14197 Berlin, Germany
| | - Ralf Felix Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
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Berger C, Said E, Haller K, Nordine M, Reinthaler M, Landmesser U, Treskatsch S. Dexmedetomidine Sedation Combined With Remifentanil in MitraClip Procedures is Feasible and Improves Hemodynamics. J Cardiothorac Vasc Anesth 2023; 37:50-57. [PMID: 36347731 DOI: 10.1053/j.jvca.2022.10.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of the study was to compare the overall feasibility, respiratory and hemodynamic stability, as well as process times of a dexmedetomidine-based sedative regimen compared with general anesthesia among patients undergoing MitraClip procedures. DESIGN A retrospective cohort study. SETTING A single tertiary care university center. PARTICIPANTS The study included 79 patients. INTERVENTIONS Dexmedetomidine sedation versus general anesthesia. MEASUREMENTS AND MAIN RESULTS Seventy-nine MitraClip procedures in dexmedetomidine/remifentanil conscious sedation (DCS, n = 26) or general anesthesia (GA, n = 53), performed between 2018 and 2020 at Charité - Universitätsmedizin Berlin, were analyzed retrospectively. Patients' median age was 81 years in both groups without differences in preinterventional EuroScore I (DCS 6 [5; 8], GA 7 [6; 8]) or systolic function (left ventricular ejection fraction: DCS 50% [32; 60] v. GA 50% [36; 60]; tricuspid annular plane systolic excursion: DCS 19 mm [16; 22] v GA 19 mm [15; 22]). During MitraClip procedures, respiratory parameters revealed no differences between groups, whereas patients under DCS showed higher mean arterial pressures (DCS 64 mmHg [59; 74] v GA 58 mmHg [53; 66]) and needed less norepinephrine (DCS 0.0µg/kg/min [0.0; 0.2] v GA 0.08 µg/kg/min [0.05; 0.15]). Emergence from both anesthesia regimens to readiness for intensive care unit transfer was faster in DCS (8 min [4; 18] v GA 16 min [11; 23]); however, total process time was comparable between groups (DCS 128 min [104; 155] v GA 142 min [117; 190]). Two patients required a switch from DCS to GA due to oral bleeding or prolonged procedure time. Both were excluded from the analysis. There was no switch to open surgery and no differences in postoperative complications between DCS and GA. CONCLUSION Dexmedetomidine/remifentanil sedation appears to be feasible and a safe option for MitraClip procedures, and provides better hemodynamic stability with faster emergence times compared with general anesthesia.
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Affiliation(s)
- Christian Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany.
| | - Ebtisam Said
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Haller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Michael Nordine
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Markus Reinthaler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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De Moor EL, Cheng TY, Spitzer JE, Berger C, Carrizales A, Garandeau CF, Gerbino M, Hawk ST, Kaniušonytė G, Kumru A, Malonda E, Rovella A, Shen YL, Taylor LK, van Zalk M, Branje S, Carlo G, Padilla Walker L, Van der Graaff J. What Should I do and Who's to blame? A cross-national study on youth's attitudes and beliefs in times of COVID-19. PLoS One 2022; 17:e0279366. [PMID: 36542632 PMCID: PMC9770422 DOI: 10.1371/journal.pone.0279366] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 crisis has had a major impact on youth. This study examined factors associated with youth's attitudes towards their government's response to the pandemic and their blaming of individuals from certain risk groups, ethnic backgrounds, and countries or regions. In a sample of 5,682 young adults (Mage = 22) from 14 countries, lower perceived burden due to COVID-19, more collectivistic and less individualistic values, and more empathy were associated with more positive attitudes towards the government and less blaming of individuals of certain groups. Youth's social identification with others in the pandemic mediated these associations in the same direction, apart from the COVID-19 burden on attitudes, which had a positive indirect effect. No evidence of country-level moderation was found.
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Affiliation(s)
| | - Ting-Yu Cheng
- Department of Youth and Family, Utrecht University, Utrecht, The Netherlands
| | - Jenna E. Spitzer
- Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Christian Berger
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexia Carrizales
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States of America
| | | | - Maria Gerbino
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Skyler T. Hawk
- Educational Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Goda Kaniušonytė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
| | - Asiye Kumru
- Department of Psychology, Ozyegin University, Istanbul, Turkey
| | - Elisabeth Malonda
- Department of Basic Psychology, University of Valencia, Valencia, Spain
| | - Anna Rovella
- Psychology Department, San Luis National University, San Luis, Argentina
| | - Yuh-Ling Shen
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Laura K. Taylor
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Maarten van Zalk
- Developmental Psychology, Osnabrück University, Osnabrück, Germany
| | - Susan Branje
- Department of Youth and Family, Utrecht University, Utrecht, The Netherlands
| | - Gustavo Carlo
- School of Education, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Laura Padilla Walker
- School of Family Life, Brigham Young University, Provo, UT, United States of America
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Wolter E, Treskatsch S, Kniesel O, Berger C, Angermair S. [76/m-Acutely occurring intense diffuse abdominal pain : Preparation course anesthesiological intensive care medicine: case 17]. Anaesthesiologie 2022; 71:93-96. [PMID: 35925177 DOI: 10.1007/s00101-022-01147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Eike Wolter
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland.
| | - Sascha Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Olaf Kniesel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Christian Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Stefan Angermair
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
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19
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Goette A, Brandner S, Wojcik MJ, Berger C, Hammwöhner M. Successful catheter ablation of a left posterolateral accessory bypass tract and periinterventional management in a patient with MELAS syndrome. Herzschrittmacherther Elektrophysiol 2022; 33:330-333. [PMID: 35804205 PMCID: PMC9411246 DOI: 10.1007/s00399-022-00881-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/24/2022] [Indexed: 11/24/2022]
Abstract
MELAS syndrome is defined as a combination of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes resulting from mutations in mitochondrial DNA. All medical interventions in these patients appear challenging due to a high risk of lactate acidosis or anesthesiological complications. Of note, previous reports suggest that these patients have a higher incidence of Wolff-Parkinson-White (WPW) syndrome. Here, a case of successful catheter ablation of a posteroseptal bypass tract using analgosedation in a patient with MELAS syndrome combined with WPW syndrome is presented.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, Medizinische Klinik II, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany.
| | - Sybille Brandner
- Department of Cardiology and Intensive Care Medicine, Medizinische Klinik II, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
| | - Michal Jakub Wojcik
- Department of Cardiology and Intensive Care Medicine, Medizinische Klinik II, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
| | - Christian Berger
- Department of Cardiology and Intensive Care Medicine, Medizinische Klinik II, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
| | - Matthias Hammwöhner
- Department of Cardiology and Intensive Care Medicine, Medizinische Klinik II, St. Vincenz Hospital, Am Busdorf 2, 33098, Paderborn, Germany
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20
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Varela JJ, Hernández C, Berger C, Souza SB, Pacheco E. To ignore or not to ignore: The differential effect of coping mechanisms on depressive symptoms when facing adolescent cyberbullying. Computers in Human Behavior 2022. [DOI: 10.1016/j.chb.2022.107268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Braemswig TB, Kusserow MM, Kruppa J, Reinthaler M, Erdur H, Fritsch M, Curio J, Alushi B, Villringer K, Galinovic I, Berger C, Leistner DM, Audebert HJ, Endres M, Landmesser U, Fiebach JB, Nolte CH, Beckhoff F, Lauten A. Cerebral embolisation during transcatheter edge-to-edge repair of the mitral valve with the MitraClip system: a prospective, observational study. EUROINTERVENTION 2022; 18:e160-e168. [PMID: 34916177 PMCID: PMC9904372 DOI: 10.4244/eij-d-21-00646] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND New ischaemic brain lesions on magnetic resonance imaging (MRI) are reported in up to 86% of patients after transcatheter edge-to-edge repair of the mitral valve (TEER-MV). Knowledge of the exact procedural step(s) that carry the highest risk for cerebral embolisation may help to further improve the procedure. AIMS The aim of this study was to identify the procedural step(s) that are associated with an increased risk of cerebral embolisation during TEER-MV with the MitraClip system. Furthermore, the risk of overt stroke and silent brain ischaemia after TEER-MV was assessed. METHODS In this prospective, pre-specified observational study, all patients underwent continuous transcranial Doppler examination during TEER-MV to detect microembolic signals (MES). MES were assigned to specific procedural steps: (1) transseptal puncture and placement of the guide, (2) advancing and adjustment of the clip in the left atrium, (3) device interaction with the MV, and (4) removal of the clip delivery system and the guide. Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) and cerebral MRI were performed before and after TEER-MV. RESULTS Fifty-four patients were included. The number of MES differed significantly between the procedural steps with the highest numbers observed during device interaction with the MV. Mild neurological deterioration (NIHSS ≤3) occurred in 9/54 patients. New ischaemic lesions were detected in 21/24 patients who underwent MRI. Larger infarct volume was significantly associated with neurological deterioration. CONCLUSIONS Cerebral embolisation is immanent to TEER-MV and predominantly occurs during device interaction with the MV. Improvements to the procedure may focus on this procedural step.
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Affiliation(s)
- Tim Bastian Braemswig
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Madeleine M.D. Kusserow
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Klinik für Innere Medizin, Bundeswehrkrankenhaus Berlin, Germany
| | - Jochen Kruppa
- Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hebun Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Merve Fritsch
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Department of Psychiatry, Campus Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jonathan Curio
- Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Brunilda Alushi
- Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany,Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany,Department of Interventional Cardiology, Klinik Vincentinum Augsburg, Augsberg, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David M. Leistner
- Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Heinrich J. Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany,ExcellenceCluster NeuroCure, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Jochen B. Fiebach
- Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian H. Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany,Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany
| | - Frederik Beckhoff
- Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany
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Raptis CE, Andrey DO, Polysopoulos C, Berger C, Ciurea A, Lescuyer P, Maletic T, Riek M, Scherer A, von Loga I, Safford J, Lauper K, Moeller B, Vuilleumier N, Finckh A, Rubbert-Roth A. OP0175 TYPE OF mRNA COVID-19 VACCINE AND TREATMENT INFLUENCE ANTIBODY KINETICS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients on immunomodulatory treatments mount an attenuated immune response following mRNA COVID-19 vaccination, yet long-term studies of vaccine-induced anti-SARS-CoV-2 antibody (Ab) kinetics are missing.ObjectivesIn this prospective observational study, we mapped the humoral antibody response to mRNA COVID-19 vaccines up to 24 weeks post full vaccination in patients with inflammatory rheumatic diseases (IRDs). We aimed to assess differences due to treatment, age, past SARS-CoV-2 infection, and vaccine (BNT162b2 vs. mRNA-1273).MethodsAdult patients from the SCQM cohort who assented to an mRNA COVID-19 vaccine were recruited between 3/21 – 9/21. Participants answered questionnaires via an app and received kits for the self-collection of capillary blood samples at baseline, 4, 12, and 24 weeks post full vaccination. Samples were tested for IgG Ab against the S1 domain of the SARS-CoV-2 spike protein (anti-S1-IgG) using the EUROIMMUN ELISA. To examine differences in Ab titres arising from the defined parameters, while accounting for inter-assay variability, mixed effects continuous outcome logistic regression models were applied at each timepoint.ResultsSamples were obtained from 570 patients: 67% female, mean age 53 y (SD 12 y) with 37% RA, 36% axSpA, 21% PsA, and 6% UA (undifferentiated arthritis), on no medication (no DMARDs & no glucocorticoids; 15%), csDMARDs (10%), TNFi (48%), IL-1/6/17/23i (14%), JAKi (6%), rituximab (RTX; 4%), or abatacept (ABA; 2%) in mono/combination therapy at the first vaccination. 10% of patients had a past SARS-CoV-2 infection, 54% received BNT162b2, 46% mRNA-1273.For any Ab threshold, the odds of having a higher Ab titre at 4, 12, and 24 weeks post full vaccination were 3.3 – 4 times higher with mRNA-1273 compared to BNT162b2 (Table 1, Figure 1). TNFi, JAKi, RTX, and ABA as monotherapy resulted in significantly lower Ab levels compared to no medication at almost all timepoints. In combination therapy, TNFi, IL-1/6/17/23i, RTX, and csDMARDs led to consistently lower Ab titres at all timepoints compared to respective monotherapy.Table 1.The OR of being above a given Ab threshold, regardless of the threshold. Ref. levels: mean age, no medication, no past SARS-CoV-2 inf., BNT162b2. Included in model but not shown: diagnosis, infrequently used medication (all non-signif.)Weeks post full vacc.41224OR (95% CI); pAge0.96 (0.94 – 0.97)****0.98 (0.96 – 0.996)*0.98 (0.97 – 1.00)mRNA-1273 (vs BNT162b2)3.28 (2.34 – 4.61)****3.96 (2.83 – 5.54)****3.94 (2.93 – 5.50)****Past COVID inf. (vs none)7.56 (4.32 – 13.2)****8.14 (4.78 – 13.86)****11.65 (6.62 – 20.50)****csDMARD†1.27 (0.67 – 2.41)1.78 (0.94 – 3.35)1.70 (0.86 – 3.36)TNFi†0.46 (0.28 – 0.71)****0.30 (0.19 – 0.48)****0.13 (0.081 – 0.22)****IL-1/6/17/23i†0.97 (0.54 – 1.75)1.04 (0.57 – 1.89)0.89 (0.49 – 1.64)JAKi†0.38 (0.16 – 0.91)*0.38 (0.16 – 0.91)*0.53 (0.22 – 1.28)RTX†0.078 (0.013 – 0.46)**0.078 (0.015 – 0.42)**0.16 (0.037 – 0.71)*ABA†0.14 (0.039 – 0.51)**0.087 (0.022 – 0.35)***0.068 (0.017 – 0.27)***Interactions§Age:vaccine‡1.04 (1.02 – 1.07)**1.02 (0.99 – 1.05)1.03 (1.0008 – 1.058)*csDMARD:combi0.12 (0.02 – 0.70)*0.17 (0.029 – 0.95)*0.11 (0.023 – 0.56)**TNFi:combi0.34 (0.20 – 0.59)***0.37 (0.22 – 0.61)***0.36 (0.21 – 0.62)***IL-1/6/17/23i:combi0.26 (0.09 – 0.78)*0.25 (0.085 – 0.70)**0.20 (0.071 – 0.58)**JAKi:combi1.76 (0.33 – 9.44)1.23 (0.32 – 4.70)0.95 (0.25 – 3.65)RTX:combi0.11 (0.01 – 0.87)*0.095 (0.012 – 0.73)*0.085 (0.0091 – 0.79)*ABA:combi1.75 (0.25 – 12.2)0.74 (0.096 – 5.75)0.51 (0.073 – 3.62)* p < 0.05; ** p < 0.01; *** p < 0.001; **** p < 0.0001;†Medication as monoth. vs no medication‡Interaction terms showing how OR of mRNA-1273 (vs BNT162b2) increases with age§Interaction terms with medications: medication in combination th. vs medication as monoth.ConclusionCompared to no medication, some immunomodulatory therapies resulted in markedly lower Ab levels at all timepoints. In IRD patients, a past SARS-CoV-2 infection resulted in strikingly increased immunogenicity, as did mRNA-1273 compared to BNT162b2.AcknowledgementsThis study is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM thanks the patients for their participation in this study. A list of rheumatology offices and hospitals that contribute to the SCQM registries can be found on www.scqm.ch/institutions. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors.Disclosure of InterestsCatherine Elizabeth Raptis Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Diego Olivier Andrey: None declared, Christos Polysopoulos Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Christoph Berger: None declared, Adrian Ciurea: None declared, Pierre Lescuyer: None declared, Tanja Maletic Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Myriam Riek Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Almut Scherer Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Isabell von Loga Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Judith Safford: None declared, Kim Lauper Speakers bureau: Kim Lauper reports consulting fees for Pfizer and speakers fees for Pfizer, Viatris and Celltrion outside of the submitted work., Consultant of: Kim Lauper reports consulting fees for Pfizer and speakers fees for Pfizer, Viatris and Celltrion outside of the submitted work., Burkhard Moeller: None declared, Nicolas Vuilleumier: None declared, Axel Finckh Speakers bureau: Axel Finckh has received consultancies or speaker honoraria for AbbVie, BMS, Eli-Lilly, Gilead, Pfizer, Sanofi, and UCB outside of the submitted work, Consultant of: Axel Finckh has received consultancies or speaker honoraria for AbbVie, BMS, Eli-Lilly, Gilead, Pfizer, Sanofi, and UCB outside of the submitted work, Grant/research support from: Axel Finckh has received research support from AbbVie, Eli-Lilly, Galapagos, and Pfizer outside of the submitted work, Andrea Rubbert-Roth: None declared
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Goeldlin MB, Mueller A, Siepen BM, Mueller M, Strambo D, Michel P, Schaerer M, Cereda CW, Bianco G, Lindheimer F, Berger C, Medlin F, Backhaus R, Peters N, Renaud S, Fisch L, Niederhaeuser J, Carrera E, Dirren E, Bonvin C, Sturzenegger R, Kahles T, Nedeltchev K, Kaegi G, Vehoff J, Rodic B, Bolognese M, Schelosky L, Salmen S, Mono ML, Polymeris AA, Engelter ST, Lyrer P, Wegener S, Luft AR, Z’Graggen W, Bervini D, Volbers B, Dobrocky T, Kaesmacher J, Mordasini P, Meinel TR, Arnold M, Fandino J, Bonati LH, Fischer U, Seiffge DJ. Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage. J Stroke 2022; 24:266-277. [PMID: 35677981 PMCID: PMC9194537 DOI: 10.5853/jos.2021.01823] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.Methods We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). Results We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; <i>P</i>=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; <i>P</i>=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; <i>P</i>=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; <i>P</i>=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; <i>P</i>=0.031).Conclusions Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.
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Affiliation(s)
- Martina B. Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Achim Mueller
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard M. Siepen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Madlaine Mueller
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Davide Strambo
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Michael Schaerer
- Department of Neurology, Buergerspital Solothurn, Solothurn, Switzerland
| | - Carlo W. Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Giovanni Bianco
- Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Florian Lindheimer
- Stroke Unit, Department of Internal Medicine, Hospital of Grabs, Grabs, Switzerland
| | - Christian Berger
- Stroke Unit, Department of Internal Medicine, Hospital of Grabs, Grabs, Switzerland
| | - Friedrich Medlin
- Stroke Unit and Division of Neurology, Department of Internal Medicine, HFR Fribourg–Cantonal Hospital, Villars-sur-Glâne, Switzerland
| | - Roland Backhaus
- Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
| | - Nils Peters
- Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
| | - Susanne Renaud
- Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland
| | | | | | - Emmanuel Carrera
- Stroke Research Group, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elisabeth Dirren
- Stroke Research Group, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Rolf Sturzenegger
- Department of Internal Medicine, Hospital Graubünden, Chur, Switzerland
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Georg Kaegi
- Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland
| | - Jochen Vehoff
- Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland
| | - Biljana Rodic
- Stroke Unit, Department of Neurology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Manuel Bolognese
- Neurology Department, Lucerne Cantonal Hospital (LUKS), Luzern, Switzerland
| | - Ludwig Schelosky
- Division of Neurology, Kantonsspital Münsterlingen, Munsterlingen, Switzerland
| | - Stephan Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Stroke Unit, Department of Neurology, Hospital Biel, Biel, Switzerland
| | | | - Alexandros A. Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Werner Z’Graggen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Bastian Volbers
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R. Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Co-correspondence: Urs Fischer Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland Tel: +41-61-265-41-51 Fax: +41-61-265-41-00 E-mail:
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Correspondence: David J. Seiffge Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland Tel: +41-31-664-05-09 E-mail:
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24
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Ardila Jurado E, Sturm V, Brugger F, Nedeltchev K, Arnold M, Bonati LH, Carrera E, Michel P, Cereda CW, Bolognese M, Albert S, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Mono ML, Rodic B, Tarnutzer AA, Schwegler G, Salmen S, Luft AR, Peters N, Vehoff J, Kägi G. Central Retinal Artery Occlusion: Current Practice, Awareness and Prehospital Delays in Switzerland. Front Neurol 2022; 13:888456. [PMID: 35677327 PMCID: PMC9167925 DOI: 10.3389/fneur.2022.888456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Central retinal artery occlusion (CRAO) often leads to permanent monocular blindness. Hence, early recognition and rapid re-perfusion is of paramount importance. This study aims to describe prehospital pathways in CRAO compared to stroke and study the knowledge about CRAO. Methods (1) Description of baseline characteristics, prehospital pathways/delays, and acute treatment (thrombolysis/thrombectomy vs. standard of care) of patients with CRAO and ischemic stroke registered in the Swiss Stroke Registry. (2) Online survey about CRAO knowledge amongst population, general practitioners (GPs) and ophthalmologists in Eastern Switzerland. Results Three hundred and ninety seven CRAO and 32,816 ischemic stroke cases were registered from 2014 until 2019 in 20 Stroke Centers/Units in Switzerland. In CRAO, 25.6% arrived at the hospital within 4 h of symptom onset and had a lower rate of emergency referrals. Hence, the symptom-to-door time was significantly longer in CRAO compared to stroke (852 min. vs. 300 min). The thrombolysis/thrombectomy rate was 13.2% in CRAO and 30.9% in stroke. 28.6% of the surveyed population recognized CRAO-symptoms, 55.4% of which would present directly to the emergency department in contrast to 90.0% with stroke symptoms. Almost 100% of the ophthalmologist and general practitioners recognized CRAO as a medical emergency and 1/3 of them considered IV thrombolysis a potentially beneficial therapy. Conclusions CRAO awareness of the general population and physician awareness about the treatment options as well as the non-standardized prehospital organization, seems to be the main reason for the prehospital delays and impedes treating CRAO patients. Educational efforts should be undertaken to improve awareness about CRAO.
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Affiliation(s)
- Elena Ardila Jurado
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Veit Sturm
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florian Brugger
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo W. Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | | | | | | | - Ludwig Schelosky
- Division of Neurology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Susanne Renaud
- Division of Neurology, Cantonal Hospital Neuchatel, Neuchâtel, Switzerland
| | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Guido Schwegler
- Division of Neurology, Hospital Limmattal, Schlieren, Switzerland
| | | | - Andreas R. Luft
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitaiton, Vitznau, Switzerland
| | - Nils Peters
- Department of Neurology, Hirslanden Clinic, Zurich, Switzerland
| | - Jochen Vehoff
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Georg Kägi
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Georg Kägi
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25
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Fischer U, Branca M, Bonati LH, Carrera E, Vargas MI, Platon A, Kulcsar Z, Wegener S, Luft A, Seiffge DJ, Arnold M, Michel P, Strambo D, Dunet V, De Marchis GM, Schelosky L, Andreisek G, Barinka F, Peters N, Fisch L, Nedeltchev K, Cereda CW, Kägi G, Bolognese M, Salmen S, Sturzenegger R, Medlin F, Berger C, Renaud S, Bonvin C, Schaerer M, Mono ML, Rodic B, Psychogios M, Mordasini P, Gralla J, Kaesmacher J, Meinel TR. MRI or CT for Suspected Acute Stroke: Association of Admission Image Modality with Acute Recanalization Therapies, Workflow Metrics and Outcomes. Ann Neurol 2022; 92:184-194. [PMID: 35599442 PMCID: PMC9545922 DOI: 10.1002/ana.26413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/23/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Objective To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door‐to‐needle (DTN) time, door‐to‐puncture (DTP) time, and functional outcome between patients with admission magnetic resonance imaging (MRI) versus computed tomography (CT). Methods An observational cohort study of consecutive patients using a target trial design within the nationwide Swiss‐Stroke‐Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed‐effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0–2) at 90 days. Results Of the 11,049 patients included (mean [SD] age, 71 [15] years; 4,811 [44%] women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median [interquartile range] 2 [0–6] vs 4 [1–11]), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73–0.96), but not with MT (aOR 1.11, 0.93–1.34); longer adjusted DTN (+22 min [13–30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30–1.81). Interpretation We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue‐based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184–194
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Affiliation(s)
- Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.,Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
| | | | | | - Emmanuel Carrera
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Maria I Vargas
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Alexandra Platon
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Zsolt Kulcsar
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Susanne Wegener
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Andreas Luft
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ludwig Schelosky
- Department of Neurology, Institute for Radiology, Cantonal Hospital Muensterlingen, Switzerland
| | - Gustav Andreisek
- Department of Neurology, Institute for Radiology, Cantonal Hospital Muensterlingen, Switzerland
| | - Filip Barinka
- Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | | | | | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
| | | | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Switzerland
| | | | - Friedrich Medlin
- Stroke and Neurology Unit, Cantonal Hospital Fribourg, Switzerland
| | | | | | | | | | | | | | - Marios Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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Altersberger VL, Wright PR, Schaedelin SA, De Marchis GM, Gensicke H, Engelter ST, Psychogios M, Kahles T, Goeldlin M, Meinel TR, Mordasini P, Kaesmacher J, von Hessling A, Vehoff J, Weber J, Wegener S, Salmen S, Sturzenegger R, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Schaerer M, Mono ML, Rodic B, Schwegler G, Peters N, Bolognese M, Luft AR, Cereda CW, Kägi G, Michel P, Carrera E, Arnold M, Fischer U, Nedeltchev K, Bonati LH. Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers—An analysis of the Swiss Stroke Registry. Eur Stroke J 2022; 7:117-125. [DOI: 10.1177/23969873221094408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time. Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday–Friday 8:00–17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months. Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59–116) vs 95 (66–130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04–1.18]) and increased mortality (1.13 [95%CI: 1.01–1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased. Discussion and Conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine A Schaedelin
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | | | - Jochen Vehoff
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Biel, Switzerland
| | | | - Friedrich Medlin
- Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland
| | | | | | - Susanne Renaud
- Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland
| | | | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland
| | | | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland
| | - Carlo W Cereda
- Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
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Lammer J, Berger C, Löffler S, Knez D, Longo P, Kothleitner G, Hofer F, Haberfehlner G, Bucher E, Sitte W, Grogger W. A method for a column-by-column EELS quantification of barium lanthanum ferrate. Ultramicroscopy 2022; 234:113477. [PMID: 35123207 DOI: 10.1016/j.ultramic.2022.113477] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
High-resolution STEM-EELS provides information about the composition of crystalline materials at the atomic scale, though a reliable quantitative chemical analysis is often hampered by zone axis conditions, where neighbouring atomic column intensities contribute to the signal at the probe position. In this work, we present a procedure to determine the concentration of two elements within equivalent atomic columns from EELS elemental maps - in our case barium and lanthanum within the A-sites of Ba1.1La1.9Fe2O7, a second order Ruddlesden-Popper phase. We took advantage of the large changes in the elemental distribution from column to column and introduced a technique, which substitutes inelastic scattering cross sections during the quantification step by using parameters obtained from the actual experiment. We considered channelling / de-channelling effects via inelastic multislice simulations and were thereby able to count occupancies in each atomic column. The EELS quantification results were then used as prior information during the Rietveld refinement in XRD measurements in order to differentiate between barium and lanthanum.
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Affiliation(s)
- Judith Lammer
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria.
| | - Christian Berger
- Chair of Physical Chemistry, Montanuniversitaet Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
| | - Stefan Löffler
- University Service Centre for Transmission Electron Microscopy (USTEM), TU Wien, Wiedner Hauptstraße 8-10, 1040 Vienna, Austria
| | - Daniel Knez
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria
| | - Paolo Longo
- Gatan Inc., 5794W Las Positas Blvd, Pleasanton, CA 94588, USA
| | - Gerald Kothleitner
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria
| | - Ferdinand Hofer
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria
| | - Georg Haberfehlner
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria
| | - Edith Bucher
- Chair of Physical Chemistry, Montanuniversitaet Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
| | - Werner Sitte
- Chair of Physical Chemistry, Montanuniversitaet Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
| | - Werner Grogger
- Institute of Electron Microscopy and Nanoanalysis (FELMI), Graz University of Technology & Graz Centre for Electron Microscopy (ZFE), Steyrergasse 17, 8010 Graz, Austria
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Reiterer C, Kabon B, Taschner A, Adamowitsch N, Graf A, Fraunschiel M, Horvath K, Kuhrn M, Clement T, Treskatsch S, Berger C, Fleischmann E. Effect of perioperative levosimendan administration on postoperative N-terminal pro-B-type natriuretic peptide concentration in patients with increased cardiovascular risk factors undergoing non-cardiac surgery: protocol for the double-blind, randomised, placebo-controlled IMPROVE trial. BMJ Open 2022; 12:e058216. [PMID: 35063963 PMCID: PMC8785196 DOI: 10.1136/bmjopen-2021-058216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Elevated N-terminal pro-brain natriuretic peptide (NT-pro-BNP) after non-cardiac surgery is a strong predictor for cardiovascular complications and reflects increased myocardial strain. NT-pro-BNP concentrations significantly rise after non-cardiac surgery within the first 3 days. Levosimendan is a potent inotropic drug that increases calcium sensitivity to cardiac myocytes, which results in improved cardiac contractility that last for approximately 7 days. Thus, we will test the effect of a pre-emptive perioperative administration of levosimendan on postoperative NT-pro-BNP concentration as compared with the administration of a placebo in patients undergoing moderate-risk to high-risk major abdominal surgery. METHODS AND ANALYSIS We will conduct a double-blinded prospective randomised trial at the Medical University of Vienna, Vienna, Austria (and potentially a second centre in Germany), including 230 patients at-risk for cardiovascular complications undergoing moderate- to high-risk major abdominal surgery. Patients will be randomly assigned to receive a single dose of 12.5 mg levosimendan versus placebo after induction of anaesthesia. The primary outcome will be the postoperative maximum NT-pro-BNP concentration between both group within the first three postoperative days. Our secondary outcomes will be the incidence of myocardial ischaemia, myocardial injury after non-cardiac surgery and a composite of myocardial infarction and death within 30 days and 1 year after surgery between both groups. Our further secondary outcome will be stratification of NT-pro-BNP values according to previously thresholds to predict mortality of myocardial infarction after surgery. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Medical University of Vienna on 14 July 2020 (EK 2187/2019). Written informed consent will be obtained from all patients a day before surgery. Results of this study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04329624.
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Affiliation(s)
- Christian Reiterer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Outcome Research Consortium, Cleveland, Ohio, USA
| | - Barbara Kabon
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Alexander Taschner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Nikolas Adamowitsch
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Alexandra Graf
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | - Melanie Fraunschiel
- ITSC - IT Systems & Communications, Medical University of Vienna, Wien, Austria
| | - Katharina Horvath
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Melanie Kuhrn
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Theresa Clement
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Edith Fleischmann
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Outcome Research Consortium, Cleveland, Ohio, USA
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Wien, Austria
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29
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De Marchis GM, Wright PR, Michel P, Strambo D, Carrera E, Dirren E, Luft AR, Wegener S, Cereda CW, Kägi G, Vehoff J, Gensicke H, Lyrer P, Nedeltchev K, Khales T, Bolognese M, Salmen S, Sturzenegger R, Bonvin C, Berger C, Schelosky L, Mono ML, Rodic B, von Reding A, Schwegler G, Tarnutzer AA, Medlin F, Humm AM, Peters N, Beyeler M, Kriemler L, Bervini D, Fandino J, Hemkens LG, Mordasini P, Arnold M, Fischer U, Bonati LH. Association of the COVID-19 Outbreak with Acute Stroke Care in Switzerland. Eur J Neurol 2021; 29:724-731. [PMID: 34894018 PMCID: PMC9305499 DOI: 10.1111/ene.15209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Abstract
Background and purpose In Switzerland, the COVID‐19 incidence during the first pandemic wave was high. Our aim was to assess the association of the outbreak with acute stroke care in Switzerland in spring 2020. Methods This was a retrospective analysis based on the Swiss Stroke Registry, which includes consecutive patients with acute cerebrovascular events admitted to Swiss Stroke Units and Stroke Centers. A linear model was fitted to the weekly admission from 2018 and 2019 and was used to quantify deviations from the expected weekly admissions from 13 March to 26 April 2020 (the “lockdown period”). Characteristics and 3‐month outcome of patients admitted during the lockdown period were compared with patients admitted during the same calendar period of 2018 and 2019. Results In all, 28,310 patients admitted between 1 January 2018 and 26 April 2020 were included. Of these, 4491 (15.9%) were admitted in the periods March 13–April 26 of the years 2018–2020. During the lockdown in 2020, the weekly admissions dropped by up to 22% compared to rates expected from 2018 and 2019. During three consecutive weeks, weekly admissions fell below the 5% quantile (likelihood 0.38%). The proportion of intracerebral hemorrhage amongst all registered admissions increased from 7.1% to 9.3% (p = 0.006), and numerically less severe strokes were observed (median National Institutes of Health Stroke Scale from 3 to 2, p = 0.07). Conclusions Admissions and clinical severity of acute cerebrovascular events decreased substantially during the lockdown in Switzerland. Delivery and quality of acute stroke care were maintained.
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Affiliation(s)
- Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland
| | - Patrick R Wright
- Department of Clinical Research, University of Basel, Switzerland
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital - Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital - Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Emmanuel Carrera
- Department of Neurology, University Hospital Geneva, Switzerland
| | - Elisabeth Dirren
- Department of Neurology, University Hospital Geneva, Switzerland
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Carlo W Cereda
- Department of Neurology and Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Cantonal Hospital St, Gallen, Switzerland.,Department of Neurology and Stroke Center, University Hospital Berne - Inselspital, Switzerland
| | - Jochen Vehoff
- Department of Neurology, Cantonal Hospital St, Gallen, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland
| | | | - Timo Khales
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | | | | | | | | | | | | | | | - Biljana Rodic
- Stroke Unit, Cantonal Hospital Winterthur, Switzerland
| | | | | | | | | | - Andrea M Humm
- Stroke Unit, HFR Fribourg - Hôpital Cantonal, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, Hirslanden Clinic Zurich, Switzerland
| | - Morin Beyeler
- Department of Neurology and Stroke Center, University Hospital Berne - Inselspital, Switzerland
| | - Lilian Kriemler
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland
| | - David Bervini
- Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Hirslanden Clinic Aarau & Zurich, Switzerland
| | - Lars G Hemkens
- Department of Clinical Research, University of Basel, Switzerland.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | | | - Marcel Arnold
- Department of Neurology and Stroke Center, University Hospital Berne - Inselspital, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland.,Department of Neurology and Stroke Center, University Hospital Berne - Inselspital, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland
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30
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Konrad A, Bernsteiner D, Budini F, Reiner MM, Glashüttner C, Berger C, Tilp M. Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height. Eur J Sport Sci 2021; 21:1648-1658. [PMID: 33315544 DOI: 10.1080/17461391.2020.1853818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the effects of a single floss band treatment of the thigh on hip and knee range of motion (ROM), knee extensor passive resistive torque (PRT), knee extensor maximum voluntary contraction (MVC) torque, and countermovement jump (CMJ) height.Sixteen healthy male volunteers were tested before and after both the flossing treatment and the control condition, in random order. For the flossing treatment, the floss band was wound around both thighs for 120 s, and the subject was then asked to perform 20 squats. During the control treatment, only the 20 squats were performed. Before and after the treatments, knee and hip ROM were assessed using a Thomas test with 3D motion caption. The PRT and MVC of the knee extensors were measured with a dynamometer, and the electromyographic (EMG) signal was collected from the vastus lateralis. CMJs were performed on a force plate.Compared to the control condition, the flossing treatment showed a positive effect on the MVC of the knee extensors (P = 0.01); however, no effects on hip ROM (P = 0.58), knee ROM (P = 0.37), CMJ height (P = 0.75), or PRT (P = 0.22) were observed. Correlation analyses revealed that the increase in MVC was not significantly related to changes in the tension of the muscle-tendon unit (rP = -0.13; P = 0.64) or vastus lateralis EMG (rS = 0.44; P = 0.10). Since the increase in MVC cannot be explained by changes of the mechanical (PRT) or neuromuscular (EMG) properties, we speculate that an enhancement of growth hormone and norepinephrine levels following the compression release is instead responsible for the increase in MVC.
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Affiliation(s)
- Andreas Konrad
- Institute of Sports Science, University of Graz, Graz, Austria
| | | | | | | | | | | | - Markus Tilp
- Institute of Sports Science, University of Graz, Graz, Austria
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31
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Strambo D, De Marchis GM, Bonati LH, Arnold M, Carrera E, Galletta S, Nedeltchev K, Kahles T, Cereda CW, Bianco G, Kägi G, Luft AR, Bolognese M, Lakatos LB, Salmen S, Correia P, Sturzenegger R, Sylvan A, Medlin F, Berger C, Lindheimer F, Baumgärtner M, Schelosky L, Bonvin C, Mono ML, Rodic B, von Reding A, Schwegler G, Massini F, Tarnutzer AA, Taheri S, Peters N, Beyeler M, Altersberger V, Engelter ST, Fischer U, Michel P. Ischemic stroke in COVID-19 patients: Mechanisms, treatment, and outcomes in a consecutive Swiss Stroke Registry analysis. Eur J Neurol 2021; 29:732-743. [PMID: 34845794 PMCID: PMC9299927 DOI: 10.1111/ene.15199] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/02/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 01/19/2023]
Abstract
Background Most case series of patients with ischemic stroke (IS) and COVID‐19 are limited to selected centers or lack 3‐month outcomes. The aim of this study was to describe the frequency, clinical and radiological features, and 3‐month outcomes of patients with IS and COVID‐19 in a nationwide stroke registry. Methods From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID‐19 (25 February to 8 June 2020). We compared baseline features, etiology, and 3‐month outcome of SARS‐CoV‐2 polymerase chain reaction‐positive (PCR+) IS patients to SARS‐CoV‐2 PCR− and/or asymptomatic non‐tested IS patients. Results Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID‐19 infection, of which 33 were within 1 month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR 2.35, 95% CI 1.08–5.14, p = 0.032) and fewer cryptogenic strokes (OR 0.37, 95% CI 0.14–0.99, p = 0.049). COVID‐19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12 (36%), and likely not contributing to stroke in 13 patients (40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity, and revascularization treatments (PS‐adjusted common OR for shift towards higher modified Rankin Scale (mRS) = 1.85, 95% CI 0.96–3.58, p = 0.07). Conclusions In this nationwide analysis of consecutive ischemic strokes, concomitant COVID‐19 was relatively rare. COVID+ patients more often had multi‐territory stroke and less often cryptogenic stroke, and their 3‐month functional outcome tended to be worse.
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Affiliation(s)
- Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gian Marco De Marchis
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Santi Galletta
- Stroke Center, Geneva University Hospital, Geneva, Switzerland
| | | | - Timo Kahles
- Stroke Center, Kantonsspital Aarau, Aarau, Switzerland
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Giovanni Bianco
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Stroke Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Andreas R Luft
- Stroke Center, University Hospital Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | | | - Albert Sylvan
- Stroke Unit, Kantonsspital Graubünden, Chur, Switzerland
| | - Friedrich Medlin
- Stroke Unit, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland
| | | | | | | | - Ludwig Schelosky
- Stroke Unit, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | | | - Marie-Luise Mono
- Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Stroke Unit, Stadtspital Waid and Triemli, Zurich, Switzerland
| | - Biljana Rodic
- Stroke Unit, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Guido Schwegler
- Stroke Unit, Stroke Unit, Spital Limmattal, Schlieren, Switzerland
| | - Federico Massini
- Stroke Unit, Stroke Unit, Spital Limmattal, Schlieren, Switzerland
| | | | - Shadi Taheri
- Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Nils Peters
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Morin Beyeler
- Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Valerian Altersberger
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Urs Fischer
- Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Palacios D, Dijkstra JK, Berger C, Huisman M, Veenstra R. Disentangling dyadic and reputational perceptions of prosociality, aggression, and popularity in explaining friendship networks in early adolescence. Social Development 2021. [DOI: 10.1111/sode.12565] [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: 12/01/2022]
Affiliation(s)
- Diego Palacios
- Department of Sociology University of Groningen Groningen The Netherlands
- Society and Health Research Center, Facultad de Humanidades Universidad Mayor Santiago Chile
| | | | - Christian Berger
- Escuela de Psicología Pontificia Universidad Católica de Chile Santiago Chile
| | - Mark Huisman
- Department of Sociology University of Groningen Groningen The Netherlands
| | - René Veenstra
- Department of Sociology University of Groningen Groningen The Netherlands
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33
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Omran S, Raude B, Schawe L, Carstens JC, Angermair S, Berger C, Konietschke F, Treskatsch S, Greiner A. Isolated Ruptured Paravisceral Penetrating Aortic Ulcers. Ann Vasc Surg 2021; 81:138-147. [PMID: 34780950 DOI: 10.1016/j.avsg.2021.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goal of this study is to investigate the clinical presentation, treatment options, and outcomes of the patients with isolated ruptured paravisceral penetrating aortic ulcers (PV-PAU). METHODS All patients presenting with acute aortic syndrome from 2015 to 2020 were screened, of which patients with isolated ruptured PV-PAU were included in this retrospective study. Study endpoints were the assessment of treatment options, technical success, and clinical outcome. Outcome measures included major perioperative complications and mortality. RESULTS Sixteen patients (11 men; median age 68; IQR 60 - 75 years) presented with isolated ruptured PV-PAU were included in this study. The median follow-up was 25 months (range 1 - 51). Ruptured PV-PAUs represented 12.3% of the ruptured aortic aneurysms in all locations. PV-PAUs were found in segment A (n = 8, 50%), segment B (n = 5, 31%), and segment C (n = 3, 19%). PV-PAUs showed a mean protrusion distance of 27±10 mm, a mean neck diameter of 21 ± 7 mm, and maximal aortic diameter of 50 ± 11 mm. Five patients (31%) showed hemodynamic instability on admission and needed intense fluid resuscitation. Of those, 2 patients needed urgent laparotomy with a fast transabdominal supraceliac aortic clamping, one needed an aortic balloon occlusion to obtain rapid aortic control. The open aortic repair was the most frequently performed surgery (11/16, 69%), followed by hybrid procedures (3/16) and parallel graft chimney technique (2/16). Two patients died during the follow-up, calculating for in-hospital and 1-year mortality rates of 6 - 12%, respectively. The postoperative morbidity rate was 31%. Postoperative complications included acute renal failure (31%), pneumonia (25%), and 1case of ischemic colitis (6%). No spinal cord ischemia was reported. CONCLUSIONS Ruptured PV-PAU is a rare and challenging diagnostic and therapeutic entity. Open aortic repair seems to be a reliable option in treating patients with isolated ruptured PV-PAUs. Hybrid procedures and parallel stent-graft techniques can only be used in selected patients.
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Affiliation(s)
- Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany.
| | - Ben Raude
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Larissa Schawe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Jan Christoph Carstens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
| | - Stefan Angermair
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Christian Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Biometrics and Clinical Epidemiology and Berlin Institute of Health (BIH), Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of vascular surgery, Berlin, Germany
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Omran S, Gröger S, Schawe L, Berger C, Konietschke F, Treskatsch S, Greiner A, Angermair S. Preoperative and ICU Scoring Models for Predicting the In-Hospital Mortality of Patients With Ruptured Abdominal Aortic Aneurysms. J Cardiothorac Vasc Anesth 2021; 35:3700-3707. [PMID: 34493435 DOI: 10.1053/j.jvca.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study's objective was to compare several preoperative and intensive care unit (ICU) prognostic scoring systems for predicting the in-hospital mortality of ruptured abdominal aortic aneurysms (RAAAs). DESIGN Retrospective cohort study. SETTING Single tertiary university center. PARTICIPANTS The study comprised 157 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 157 patients (82% male) presented with RAAA at Charité University Hospital from January 2011 to December 2020. The mean age was 74 years (standard deviation ten years). In-hospital mortality was 29% (n = 45), of whom nine patients (6%) died en route to the operating room, 13 (8%) on the operating table, and 23 (15%) in the ICU. A total of 135 patients (86%) were admitted to the ICU. All six models demonstrated good discriminating performance between survivors and nonsurvivors. Overall, the area under the curve (AUC) for RAAA preoperative scores was greater than those for ICU scores. The largest AUC was achieved with the Vascular Study Group of New England (VSGNE) RAAA risk score (AUC = 0.87 for all patients, AUC = 0.84 for patients admitted to the ICU), followed by Hardman Index (AUC = 0.83 for all patients, AUC = 0.81 for patients admitted to the ICU), and Glasgow Aneurysm Score (AUC = 0.74 for all patients, AUC = 0.83 for patients admitted to the ICU). The largest AUC for ICU scores (only patients admitted to the ICU) was achieved with Simplified Acute Physiology Score II (0.75), followed by Sepsis-related Organ Failure Assessment (0.73), and Acute Physiology and Chronic Health Evaluation II (0.71). CONCLUSIONS Preoperative and ICU scores can predict the mortality of patients presenting with RAAA. In addition, the discriminatory ability of preoperative scores between survivors and nonsurvivors was larger than that for ICU scores.
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Affiliation(s)
- Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany.
| | - Steffen Gröger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Larissa Schawe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Christian Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Biometrics and Clinical Epidemiology and Berlin Institute of Health (BIH), Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Berlin, Germany
| | - Stefan Angermair
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
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Schiefenhövel F, Trauzeddel RF, Sander M, Heringlake M, Groesdonk HV, Grubitzsch H, Kruppa J, Berger C, Treskatsch S, Balzer F. High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. J Clin Med 2021; 10:jcm10173945. [PMID: 34501390 PMCID: PMC8432196 DOI: 10.3390/jcm10173945] [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: 08/08/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
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Affiliation(s)
- Fridtjof Schiefenhövel
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Ralf F. Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (R.F.T.); (C.B.); (S.T.)
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Gießen, Justus-Liebig University Giessen, 35392 Gießen, Germany;
| | - Matthias Heringlake
- Department of Anesthesia, Heart and Diabetes Center, Klinikum Karlsburg, 17495 Karlsburg, Germany;
| | - Heinrich V. Groesdonk
- Department of Intensive Care Medicine, Helios Klinikum Erfurt, 99089 Erfurt, Germany;
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
| | - Jochen Kruppa
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (R.F.T.); (C.B.); (S.T.)
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (R.F.T.); (C.B.); (S.T.)
| | - Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany;
- Correspondence:
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Rejeski K, Perez A, Sesques P, Berger C, Jentzsch L, Mougiakakos D, Frölich L, Ackermann J, Bücklein V, Blumenberg V, Schmidt C, Jallades L, Fehse B, Faul C, Karschnia P, Weigert O, Dreyling M, Hoster E, Locke F, Bergwelt‐Baildon M, Mackensen A, Bethge W, Ayuk F, Bachy E, Salles G, Jain M, Subklewe M. CAR‐HEMATOTOX: A DISCRIMINATIVE MODEL FOR CAR T‐CELL RELATED HEMATOTOXICITY IN RELAPSED/REFRACTORY LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.82_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K. Rejeski
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Perez
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - P. Sesques
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - C. Berger
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - L. Jentzsch
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - D. Mougiakakos
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - L. Frölich
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - J. Ackermann
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Bücklein
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Blumenberg
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - C. Schmidt
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - L. Jallades
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - B. Fehse
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - C. Faul
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - P. Karschnia
- University Hospital of the LMU Munich Department of Neurosurgery Munich Germany
| | - O. Weigert
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - M. Dreyling
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - E. Hoster
- LMU Munich Institute for Medical Informatics Biometry and Epidemiology Munich Germany
| | - F. Locke
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Bergwelt‐Baildon
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Mackensen
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - W. Bethge
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - F. Ayuk
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - E. Bachy
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - G. Salles
- MSKCC, Lymphoma Service Department of Medicine NYC New York USA
| | - M. Jain
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Subklewe
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
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Gozzoli DS, Hemmig A, Hemkens L, Werlen L, Ewald H, Berger C, Kyburz D, Imfeld S, Aschwanden M, Stegert M, Camellino D, Cimmino MA, Campochiaro C, Tomelleri A, Henckaerts L, Blockmans D, Moya P, Corominas H, Buchanan R, Owen C, Van Sleen Y, Brouwer E, Ymashita H, Daikeler T. POS0806 FINDINGS CONSISTENT WITH SUBCLINICAL VASCULITIS IN PATIENTS WITH NEW ONSET POLYMYALGIA: A SYSTEMATIC LITERATURE REVIEW AND A META-ANALYSIS OF COHORT DATA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:GCA is characterized by cranial symptoms but imaging techniques show that patients with non-specific symptoms such as systemic inflammation or PMR may have undiagnosed large vessel (LV) GCA1. Although silent GCA in patients with clinically isolated PMR may have consequences for patients’ outcome, little is known about its prevalence and characteristics of affected patients.Objectives:To review data on the prevalence of silent GCA in newly diagnosed PMR patients without cranial GCA symptoms and to analyze which characteristics are associated with vascular involvement among PMR patients.Methods:We systematically screened PubMed, Embase and Web of Science databases and included studies screening for GCA in steroid naïve PMR patients without cranial symptoms consistent with GCA. Authors of the publications that used PET for vasculitis screening were invited to share their individual patient data (IPD) for a meta-analysis. We sought to define patient characteristics that were associated with vasculitis using univariable mixed effects logistic regression models with vascular involvement as the outcome, missing values were imputed using multilevel joint modeling multiple imputation. To fit a multivariable model with the candidate predictors we excluded variables that were hypothesized to have less medical relevance for the outcome and highly correlated inflammation markers (ESR, Lc).Results:Out of the 3047 studies screened independently by 2 authors (DG and TD), 13 fulfilled the inclusion criteria. These studies (published 1963-2019) reported on 543 PMR patients examined by temporal artery biopsy (n=175), ultrasound (n=110), PET or PET-CT (n=258). 115 PMR patients were diagnosed with GCA (21.2%), with prevalence ranging from 0-92%.We collected IPD for 243 patients from 4 cohorts using PET and 3 using PET/CT for GCA diagnosis. The overall median age of patients was 72.3 years (IQR 66.4-78.0) and vasculitis was found in 65 patients (26.7%) (table 1).Table 1.OverallPMRPMR+GCAn (%)243178 (73.3)65 (26.7)Female sex (%)146 (60.1)98 (55.1)48 (73.8)Shoulder girdle pain (%)236 (97.1)174 (97.8)62 (95.4)Pelvic girdle pain (%)174 (71.6)127 (71.3)47 (72.3)Inflammatory back pain (%)No107 (44.0)83 (46.6)24 (36.9)Yes106 (43.6)70 (39.3)36 (55.4)Lower limb pain (%)No87 (35.8)61 (34.3)26 (40.0)Yes81 (33.3)68 (38.2)13 (20.0)Weight loss (%)112 (46.1)78 (43.8)34 (52.3)CRP (mg/l) (median [IQR])46.0 [19.0, 77.7]44.0 [16.9, 74.2]52.0 [27.9, 85.0]ESR (mm/h) (mean (SD))65.2 (30.3)62.7 (30.2)72.3 (29.7)Hemoglobin (g/dl) (mean (SD))12.1 (1.5)12.2 (1.5)11.7 (1.6)Thrombocytes (1e+09/ml) (mean (SD))341.9 (106.3)323.9 (103.2)375.8 (104.6)In the univariable analyses the following factors were most strongly associated with vasculitic PET findings: female sex (OR 2.31, CI 1.17-4.58), inflammatory back pain (OR 2.73, CI 1.32-5.64), temperature >37° (OR 1.83, CI 0.90-3.7), weight loss (OR 1.83, CI 0.96-3.51), thrombocytosis (i.e., patients with a thrombocyte count 1 SD above mean have an OR of 1.51, CI 1.05-2.18), anemia (i.e., 1 g/dl decrease in Hb below mean corresponds to an OR of 1.25, CI 1.00-1.56). Patients with lower limb pain were less likely to have vasculitis (OR 0.43, CI 0.19–0.95). The estimated ORs were very similar in the multivariable model although the 95%CIs became wider.Conclusion:Although the prevalence across published studies showed substantial variation, 6 out of 13 studies reported a prevalence of silent GCA in 18-40% of all PMR patients. The exploratory analysis of the collected IPD identified female sex, inflammatory back pain, fever, weight loss, absence of lower leg pain, thrombocytosis and anemia as factors associated with LV-GCA. These findings should be validated in future prospective cohort studies. The presence or absence of these factors may further aid in diagnosing LV-GCA in PMR patients.References:[1]Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. JAMA. 2016 Jun 14;315(22):2442–58.Acknowledgements:The study is funded by the “Schweizerische Stiftung für die Erforschung der Muskelkrankheiten (SSEM)”.Disclosure of Interests:Daniele Silvio Gozzoli: None declared, Andrea Hemmig: None declared, Lars Hemkens: None declared, Laura Werlen: None declared, Hannah Ewald: None declared, Christoph Berger: None declared, Diego Kyburz Grant/research support from: DK reports personal fees from Abbvie, Gilead, Lilly, Novartis and Pfizer, outside of the submitted work, Stephan Imfeld: None declared, Markus Aschwanden: None declared, Mihaela Stegert: None declared, Dario Camellino: None declared, Marco Amedeo Cimmino: None declared, Corrado Campochiaro Grant/research support from: personal fees from Roche, Alessandro Tomelleri: None declared, Liesbet Henckaerts: None declared, Daniel Blockmans Speakers bureau: Paid speaker for Roche, Consultant of: Paid consultant for Roche, Patricia Moya: None declared, Hector Corominas: None declared, Russell Buchanan: None declared, Claire Owen Speakers bureau: CO has received speaking honoraria from Roche, Janssen, Novartis and Pfizer, and meeting sponsorship from Roche, UCB and Janssen, Yannick van Sleen: None declared, Elisabeth Brouwer Speakers bureau: E. Brouwer as an employee of the UMCG received speaker fees and consulting fees from Roche in 2017, 2018 which were paid to the UMCG, Consultant of: E. Brouwer as an employee of the UMCG received speaker fees and consulting fees from Roche in 2017, 2018 which were paid to the UMCG, Hiroyuki Ymashita: None declared, Thomas Daikeler: None declared
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van den Berg MH, van Dijk M, Byrne J, Berger C, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, Haupt R, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, van der Kooi ALF, Kremer LCM, Kruseova J, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Spix C, Twisk JWR, Ronckers CM, Kaatsch P, van Dulmen-den Broeder E. Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod 2021; 36:1561-1573. [PMID: 33744927 DOI: 10.1093/humrep/deab035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M van Dijk
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Byrne
- Boyne Research Institute, Department of Epidemiology, Drogheda, Ireland
| | - C Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Etienne, France
| | - U Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - J F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - S D Fossa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - D Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | | | - R Haupt
- Gaslini Children Hospital, Epidemiology and Biostatistics Section, Genova, Italy
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - A L F van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Leiper
- Great Ormond Street Children's Hospital, London, UK
| | - D Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, THE Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Institute for Biostatistics and Registry Research, Medical University Brandenburg, Neuruppin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Jiménez-Moya G, Luengo Kanacri BP, Cumsille P, Martínez ML, Berger C. You May Have My Help but Not Necessarily My Care: The Effect of Social Class and Empathy on Prosociality. Front Psychol 2021; 12:588017. [PMID: 33897519 PMCID: PMC8062701 DOI: 10.3389/fpsyg.2021.588017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Previous research has focused on the relation between social class and prosocial behavior. However, this relation is yet unclear. In this work, we shed light on this issue by considering the effect of the level of empathy and the social class of the recipient of help on two types of prosociality, namely helping and caring. In one experimental study, we found that for high-class participants, empathy had a positive effect on helping, regardless of the recipient’s social class. However, empathy had no effect for low-class participants. When it comes to caring, empathy had a positive effect for both high and low-class participants, but only when the recipient of help belonged to the same social class. This highlights that empathy by itself is not sufficient to promote cooperative relations and that the social class of the recipient of help should be taken into account to shed light on this issue.
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Affiliation(s)
- Gloria Jiménez-Moya
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricio Cumsille
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Loreto Martínez
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christian Berger
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Trauzeddel RF, Ertmer M, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter D, Scheeren TWL, Berger C, Treskatsch S. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography. J Clin Monit Comput 2021; 35:229-243. [PMID: 32458170 PMCID: PMC7943502 DOI: 10.1007/s10877-020-00534-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.
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Affiliation(s)
- R. F. Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M. Ertmer
- Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - M. Nordine
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H. V. Groesdonk
- Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Hospital Erfurt, Erfurt, Germany
| | - G. Michels
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R. Pfister
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D. Reuter
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - T. W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - C. Berger
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Chávez D, Palacios D, Luengo-Kanacri BP, Berger C, Jiménez-Moya G. The role of perspective-taking and low social class prejudice on cross-ethnic friendship formation. New Dir Child Adolesc Dev 2021; 2021:61-79. [PMID: 33786968 DOI: 10.1002/cad.20403] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cross-ethnic friendships offer a unique opportunity for improving intergroup relations and reduce prejudice, yet ethnic segregation of friendship networks is often seen as a major obstacle to the integration of immigrant students in educational contexts. This article examines the role of perspective-taking abilities and prejudice towards low social class peers on the probability of cross-ethnic friendships in a sample of 242 students from five multicultural classrooms in Chile (Mage = 12.3; SD = 0.69, 45% girls). It was expected that students who reported high levels of perspective-taking abilities and low levels of prejudice towards low social class peers were more likely to form and maintain cross-ethnic friendships. Longitudinal network analysis (RSiena) was used to examine these hypotheses, confirming the role of both variables in fostering (and reducing) friendships among Chilean and immigrant adolescents. Results are discussed in light of an intersectional framework between social class and ethnicity. Implications for social-emotional interventions in multicultural educational contexts are also discussed.
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Affiliation(s)
- Daniela Chávez
- School of Psychology, Pontificia Universidad Católica de Chile, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Diego Palacios
- Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
| | | | - Christian Berger
- School of Psychology, Pontificia Universidad Católica de Chile, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Gloria Jiménez-Moya
- School of Psychology, Pontificia Universidad Católica de Chile, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
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Trauzeddel RF, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter DA, Scheeren TWL, Berger C, Treskatsch S. [Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide]. Anaesthesist 2021; 70:772-784. [PMID: 33660043 DOI: 10.1007/s00101-021-00934-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. OBJECTIVE To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. METHODS AND RESULTS Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. CONCLUSION Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.
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Affiliation(s)
- R F Trauzeddel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - M Nordine
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - H V Groesdonk
- Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Erfurt, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - T W L Scheeren
- Klinik für Anästhesiologie, Universitätsmedizin Groningen, Groningen, Niederlande
| | - C Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
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Goeldlin M, Mueller A, Siepen B, Mueller M, Strambo D, Cereda CW, Berger C, Medlin F, Peters N, Renaud S, Niederhaeuser J, Carrera E, Bonvin C, Sturzenegger R, Kahles T, Nedeltchev K, Kaegi G, Rodic B, Bolognese M, Schelosky L, Salmen S, Mono ML, Bonati LH, Polymeris A, Engelter S, Lyrer P, Wegener S, Z’Graggen W, Bervini D, Volbers B, Dobrocky T, Fandino J, Arnold M, Fischer UM, Seiffge D. Abstract P407: Etiology And Outcomes Of Non-traumatic Intracerebral Hemorrhage - Data From The Swiss Stroke Registry. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We determined the frequency of different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their association with clinical characteristics and outcomes.
Methods:
We analyzed data from consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014-2019). Etiology of ICH was determined according to prespecified, mutually exclusive categories. We assessed prevalence of ICH etiologies, their association with clinical characteristics, functional independence (modified Rankin Scale 0-2), mortality, recurrent ICH and ischemic stroke at 3 months.
Results:
We included 2584 patients (median age 72y, IQR 64-82, 46.6% female, median NIHSS 10; IQR 3-15). 2037 patients (80%) had hypertension and 553 (22.3%) were on anticoagulants. Distribution of etiologies was as follows: Hypertension (n=1216 patients; 47.1% of all / 56.3% of patients with hypertension), unknown etiology (n=542, 21.0%), antithrombotic therapy (n=225, 8.7% of all / 38% of patients on anticoagulants), cerebral amyloid angiopathy (CAA, n=211, 8.2%), macro-vascular (n=121, 4.7%), other determined etiologies (n=269, 10.4%). Patients with hypertensive ICH had significantly higher NIHSS (median 9; IQR 4-16) and blood pressure levels (median systolic 176; IQR 156-195) on admission. Patients with CAA had significantly lower NIHSS at baseline (median 5; IQR 2-12). Three month follow-up was available for 2109/2584 patients (81.6%). 820 (38.9%) were functionally independent, 658 have died (31.2%). Hypertensive ICH was associated with an increased rate of functional independence (aOR =1.42, 95%CI 1.06-1.90, p=0.02). 5.2% of patients had a cerebrovascular event within 3 months. CAA was associated with a high risk of recurrent ICH (HR 6.95, 95%CI 3.05-15.84, p<0.001). The risk of ischemic stroke (2.2%) was higher than that of ICH (1.5%) in patients with hypertensive ICH.
Conclusions:
In Swiss Stroke Units and Centers, one of two patients has ICH from a different cause than hypertension. The rate of functionally independent patients at 3 months seems higher than mortality. Absolute and relative risks of recurrent ICH and ischemic stroke after recent ICH differ among underlying etiologies.
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Affiliation(s)
- Martina Goeldlin
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Achim Mueller
- Dept of Neurology, Univ Hosp and Univ of Zurich, Zurich, Switzerland
| | - Bernhard Siepen
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Madlaine Mueller
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Davide Strambo
- Neurology Service, Dept of Clinical Neurosciences, Lausanne Univ Hosp, Lausanne, Switzerland
| | - Carlo W Cereda
- Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Christian Berger
- Dept of Internal Medicine, Spitalregion Rheintal, Werdenberg, Sarganserland, Grabs, Grabs, Switzerland
| | - Friedrich Medlin
- Dept of Internal Medicine, Unit of Neurology, HFR Fribourg – Cantonal Hosp, Fribourg, Switzerland
| | - Nils Peters
- Stroke Cntr Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
| | - Susanne Renaud
- Div of Neurology, Pourtalès Hosp, Neuchâtel, Switzerland
| | | | | | | | - Rolf Sturzenegger
- Dept of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Timo Kahles
- Dept of Neurology, Cantonal Hosp Aarau, Aarau, Switzerland
| | | | | | - Biljana Rodic
- Dept of Neurology and Stroke Unit, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Ludwig Schelosky
- Div of Neurology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Stephan Salmen
- Dept of Neurology and Stroke Unit, Spitalzentrum Biel and Inselspital Bern Univ Hosp and Univ of Bern, Biel, Switzerland
| | | | | | - Alexandros Polymeris
- Dept of Neurology and Stroke Cntr, Univ Hosp and Univ of Basel, Basel, Switzerland
| | - Stefan Engelter
- Dept of Neurology and Stroke Cntr, Univ Hosp and Univ of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Dept of Neurology and Stroke Cntr, Univ Hosp and Univ of Basel, Basel, Switzerland
| | - Susanne Wegener
- Dept of Neurology, Univ Hosp and Univ of Zurich, Zurich, Switzerland
| | - Werner Z’Graggen
- Dept of Neurosurgery and Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - David Bervini
- Dept of Neurosurgery, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Bastian Volbers
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern and Univ Hosp Erlangen, Friedrich-Alexander-Univ Erlangen-Nuremberg (FAU), Bern and Erlangen, Switzerland
| | - Tomas Dobrocky
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Javier Fandino
- Dept of Neurolosurgery, Cantonal Hosp Aarau, Aarau, Switzerland
| | - Marcel Arnold
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - Urs M Fischer
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
| | - David Seiffge
- Dept of Neurology, Inselspital Bern Univ Hosp and Univ of Bern, Bern, Switzerland
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Brotfeld C, Berger C. El rol de la empatía y apertura en la intimidad de las amistades adolescentes. RevPsicología 2020. [DOI: 10.5354/0719-0581.2020.52231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Si bien se ha estudiado la relevancia de las amistades de calidad como un factor favorecedor del bienestar de los adolescentes, es menos claro cuáles son las variables que facilitan que las amistades sean percibidas como íntimas. Este estudio aporta evidencias sobre el rol que podría cumplir la empatía para favorecer la construcción de amistades íntimas, utilizando como referencia el modelo de intimidad interpersonal (Reis & Shaver, 1988), que plantea que la intimidad se logra y construye desde la apertura de experiencias personales con amigos. El diseño es no experimental y la muestra corresponde a preadolescentes y adolescentes entre 10 y 19 años. A través de un modelo SEM, se contrastó y confirmó el modelo hipotetizado, encontrándose que la empatía afectiva y cognitiva tienen un efecto en la dimensión de apertura, y que esta dimensión a su vez media la relación entre ambas formas de empatía con la intimidad. Los resultados se discuten a la luz de los procesos a través de los que se mantiene la intimidad en la adolescencia, y sobre cómo la empatía puede ser un factor explicativo de estos procesos.
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Affiliation(s)
- Edith Zavala
- Services and Information Systems Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Xavier Franch
- Services and Information Systems Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Marco
- Computer Science Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Christian Berger
- Computer Science and Engineering Department, University of Gothenburg, Gothenburg, Sweden
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Pudszuhn A, Voegeler S, Berger C, Treskatsch S, Angermair S, Hansen S, Hofmann VM. [Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach]. HNO 2020; 68:838-846. [PMID: 32840646 PMCID: PMC7445822 DOI: 10.1007/s00106-020-00917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.
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Affiliation(s)
- A Pudszuhn
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - S Voegeler
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Berger
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Angermair
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Hansen
- Institut für Hygiene und Umweltmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - V M Hofmann
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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47
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Meinel TR, Branca M, De Marchis GM, Nedeltchev K, Kahles T, Bonati L, Arnold M, Heldner MR, Jung S, Carrera E, Dirren E, Michel P, Strambo D, Cereda CW, Bianco G, Kägi G, Vehoff J, Katan M, Bolognese M, Backhaus R, Salmen S, Albert S, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Schaerer M, Mono ML, Rodic B, Tarnutzer AA, Mordasini P, Gralla J, Kaesmacher J, Engelter S, Fischer U, Seiffge DJ. Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation. Ann Neurol 2020; 89:42-53. [PMID: 32996627 PMCID: PMC7756294 DOI: 10.1002/ana.25917] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes. METHODS This was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months. RESULTS Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15], p < 0.001; quantile regression: β -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51). INTERPRETATION Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42-53.
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Affiliation(s)
- Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mattia Branca
- Clinicial Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Leo Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elisabeth Dirren
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Giovanni Bianco
- Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jochen Vehoff
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mira Katan
- Department of Neurology, University Hospital Zurich, Basel, Switzerland
| | | | | | | | | | | | | | - Ludwig Schelosky
- Neurology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Susanne Renaud
- Neurology, Cantonal Hospital Neuchatel, Neuchâtel, Switzerland
| | | | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Stefan Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatic Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Berger C, Patel D, Kityamuwesi A, Ggita J, Tinka LK, Turimumahoro P, Neville K, Chehab L, Chen AZ, Gupta N, Turyahabwe S, Katamba A, Cattamanchi A, Sammann A. Opportunities to improve digital adherence technologies and TB care using human-centered design. Int J Tuberc Lung Dis 2020; 24:1112-1115. [PMID: 33126949 PMCID: PMC9094398 DOI: 10.5588/ijtld.20.0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C Berger
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine
| | - D Patel
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - A Kityamuwesi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - J Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - L K Tinka
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K Neville
- Design Impact Program, Department of Mechanical Engineering, Stanford University, Palo Alto, CA, USA
| | - L Chehab
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - A Z Chen
- Everwell Health Solutions, Bangalore, India
| | - N Gupta
- Everwell Health Solutions, Bangalore, India
| | - S Turyahabwe
- Uganda National Tuberculosis and Leprosy Programme, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, ,
| | - A Cattamanchi
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - A Sammann
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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49
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Wyler J, Meyer Sauteur PM, Zbinden R, Berger C. Improved diagnosis of cat-scratch disease with an IgM enzyme-linked immunosorbent assay for Bartonella henselae using N-lauroyl-sarcosine-insoluble protein antigen. Clin Microbiol Infect 2020; 26:1271-1273. [PMID: 32437955 DOI: 10.1016/j.cmi.2020.04.044] [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] [Received: 03/13/2020] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J Wyler
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - P M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
| | - R Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - C Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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50
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Gil-Ranedo J, Gonzaga E, Jaworek KJ, Berger C, Bossing T, Barros CS. STRIPAK Members Orchestrate Hippo and Insulin Receptor Signaling to Promote Neural Stem Cell Reactivation. Cell Rep 2020; 27:2921-2933.e5. [PMID: 31167138 PMCID: PMC6581792 DOI: 10.1016/j.celrep.2019.05.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 04/14/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Abstract
Adult stem cells reactivate from quiescence to maintain tissue homeostasis and in response to injury. How the underlying regulatory signals are integrated is largely unknown. Drosophila neural stem cells (NSCs) also leave quiescence to generate adult neurons and glia, a process that is dependent on Hippo signaling inhibition and activation of the insulin-like receptor (InR)/PI3K/Akt cascade. We performed a transcriptome analysis of individual quiescent and reactivating NSCs harvested directly from Drosophila brains and identified the conserved STRIPAK complex members mob4, cka, and PP2A (microtubule star, mts). We show that PP2A/Mts phosphatase, with its regulatory subunit Widerborst, maintains NSC quiescence, preventing premature activation of InR/PI3K/Akt signaling. Conversely, an increase in Mob4 and Cka levels promotes NSC reactivation. Mob4 and Cka are essential to recruit PP2A/Mts into a complex with Hippo kinase, resulting in Hippo pathway inhibition. We propose that Mob4/Cka/Mts functions as an intrinsic molecular switch coordinating Hippo and InR/PI3K/Akt pathways and enabling NSC reactivation. Transcriptional profiling of reactivating versus quiescent NSCs identifies STRIPAK members PP2A/Mts phosphatase inhibits Akt activation, maintaining NSC quiescence Mob4 and Cka target Mts to Hippo to inhibit its activity and promote NSC reactivation Mob4/Cka/Mts coordinate Hippo and InR/PI3K/Akt signaling in NSCs
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Affiliation(s)
- Jon Gil-Ranedo
- Faculty of Medicine and Dentistry, University of Plymouth, PL6 8BU Plymouth, UK
| | - Eleanor Gonzaga
- Faculty of Medicine and Dentistry, University of Plymouth, PL6 8BU Plymouth, UK
| | - Karolina J Jaworek
- Faculty of Medicine and Dentistry, University of Plymouth, PL6 8BU Plymouth, UK
| | - Christian Berger
- Institute of Genetics, Johannes Gutenberg University, 55099 Mainz, Germany
| | - Torsten Bossing
- Faculty of Medicine and Dentistry, University of Plymouth, PL6 8BU Plymouth, UK
| | - Claudia S Barros
- Faculty of Medicine and Dentistry, University of Plymouth, PL6 8BU Plymouth, UK.
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