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Assfalg V, Miller G, Stocker F, Hüser N, Hartmann D, Heemann U, Tieken I, Zanen W, Vogelaar S, Rosenkranz AR, Schneeberger S, Függer R, Berlakovich G, Ysebaert DR, Jacobs-Tulleneers-Thevissen D, Mikhalski D, van Laecke S, Kuypers D, Mühlfeld AS, Viebahn R, Pratschke J, Melchior S, Hauser IA, Jänigen B, Weimer R, Richter N, Foller S, Schulte K, Kurschat C, Harth A, Moench C, Rademacher S, Nitschke M, Krämer BK, Renders L, Koliogiannis D, Pascher A, Hoyer J, Weinmann-Menke J, Schiffer M, Banas B, Hakenberg O, Schwenger V, Nadalin S, Lopau K, Piros L, Nemes B, Szakaly P, Bouts A, Bemelman FJ, Sanders JS, de Vries APJ, Christiaans MHL, Hilbrands L, van Zuilen AD, Arnol M, Stippel D, Wahba R. Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation 2024; 108:1200-1211. [PMID: 38073036 DOI: 10.1097/tp.0000000000004878] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Wouter Zanen
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Függer
- Department of Surgery, Krankenhaus der Elisabethinen and Johannes Kepler University, Linz, Austria
| | | | - Dirk R Ysebaert
- Department of HPB and Transplantation Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | | | - Dimitri Mikhalski
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, ULB, Brussels, Belgium
| | | | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anja S Mühlfeld
- Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Richard Viebahn
- Chirurgische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Bochum, Germany
| | - Johann Pratschke
- Chirurgische Klinik CCM/CVK, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ingeborg A Hauser
- Department of Nephrology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Bernd Jänigen
- Department of General and Digestive Surgery, Transplant Unit, Freiburg, Germany
| | - Rolf Weimer
- Department of Internal Medicine, Nephrology/Renal Transplantation, University of Giessen, Giessen, Germany
| | - Nicolas Richter
- Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
| | - Susan Foller
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ana Harth
- Medizinische Klinik I Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Christian Moench
- General-, Visceral- and Transplantation Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Nitschke
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, LMU University of Munich, Munich, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplant Surgery, UKM Muenster, Münster, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, University Medical Center, Philipps University Marburg, Marburg, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, Division of Nephrology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Schiffer
- Nephrology and Hypertension, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Bernhard Banas
- Abteilung für Nephrologie, Universitäres Transplantationszentrum, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, Rostock University Medical Centre, Rostock, Germany
| | - Vedat Schwenger
- Department of Nephrology and Transplant Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg-Kidney Transplant Program, Wuerzburg, Germany
| | - Laszlo Piros
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Balazs Nemes
- Department of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Szakaly
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Antonia Bouts
- Pediatric Nephrology Department, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan S Sanders
- Departement of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center and Transplant Center, Leiden, the Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dirk Stippel
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Thomas P, Arenberger P, Bader R, Bircher AJ, Bruze M, de Graaf N, Hartmann D, Johansen JD, Jowitz-Heinke A, Krenn V, Kurek M, Odgaard A, Rustemeyer T, Summer B, Thyssen JP. A literature review and expert consensus statement on diagnostics in suspected metal implant allergy. J Eur Acad Dermatol Venereol 2024. [PMID: 38606660 DOI: 10.1111/jdv.20026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. OBJECTIVES To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. METHODS A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty-three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face-to-face (9/12) or virtual participation (3/12), an anonymous online voting was performed. RESULTS Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire-aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. CONCLUSIONS Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research.
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Affiliation(s)
- P Thomas
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - R Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - A J Bircher
- Department of Dermatology and Allergology, University Hospital and University of Basel, Basel, Switzerland
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - N de Graaf
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - D Hartmann
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
- München Klinik gGmbH, Munich, Germany
| | - J D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - A Jowitz-Heinke
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - V Krenn
- MVZHZMD Trier GmbH, Trier, Germany
| | - M Kurek
- Hospital MEDICAM, Gryfice, Poland
| | - A Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - T Rustemeyer
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - B Summer
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - J P Thyssen
- Department of Dermatology and Allergy, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
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Steffani M, Nitsche U, Ollesky J, Kaufmann B, Schulze S, Novotny A, Friess H, Hüser N, Stoess C, Hartmann D. Liver Fibrosis Is Associated with Poorer Overall Survival and Higher Recurrence Rate in Patients with Cholangiocarcinoma. Dig Surg 2024; 41:53-62. [PMID: 38325358 DOI: 10.1159/000535733] [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: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study was to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma. METHODS Eighty patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-centre study. Clinical and histopathological features were analysed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors. RESULTS The present study shows that the median OS is significantly reduced in patients with fibrosis (p < 0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p < 0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS. CONCLUSION Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany,
| | - Ulrich Nitsche
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Johanna Ollesky
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sarah Schulze
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christian Stoess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
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4
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Kaufmann B, Leszczynska A, Reca A, Booshehri LM, Onyuru J, Tan Z, Wree A, Friess H, Hartmann D, Papouchado B, Broderick L, Hoffman HM, Croker BA, Zhu YP, Feldstein AE. NLRP3 activation in neutrophils induces lethal autoinflammation, liver inflammation, and fibrosis. EMBO Rep 2024; 25:455. [PMID: 38216786 PMCID: PMC10897131 DOI: 10.1038/s44319-023-00021-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Affiliation(s)
- Benedikt Kaufmann
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical, University of Munich, Munich, Germany
| | | | - Agustina Reca
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Laela M Booshehri
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Janset Onyuru
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - ZheHao Tan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alexander Wree
- Department of Hepatology and Gastroenterology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical, University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical, University of Munich, Munich, Germany
| | - Bettina Papouchado
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Lori Broderick
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Hal M Hoffman
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Ben A Croker
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Yanfang Peipei Zhu
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Ariel E Feldstein
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
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Wang B, Kaufmann B, Mogler C, Zhong S, Yin Y, Cheng Z, Schmid RM, Friess H, Hüser N, von Figura G, Hartmann D. Hepatocellular Brg1 promotes CCl4-induced liver inflammation, ECM accumulation and fibrosis in mice. PLoS One 2023; 18:e0294257. [PMID: 38033027 PMCID: PMC10688683 DOI: 10.1371/journal.pone.0294257] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Hepatic fibrosis is a progressive pathological process involving the exhaustion of hepatocellular regenerative capacity and ultimately leading to the development of cirrhosis and even hepatocellular carcinoma. Brg1, the core subunit of the SWI/SNF chromatin-remodeling complex, was recently identified as important for liver regeneration. This study investigates the role of Brg1 in hepatic fibrosis development. METHODS Hepatocyte-specific Brg1 knockout mice were generated and injected with carbon tetrachloride (CCl4) for 4, 6, 8, and 12 weeks to induce liver fibrosis. Afterwards, liver fibrosis and liver damage were assessed. RESULTS Brg1 expression was significantly increased in the fibrotic liver tissue of wild-type mice, as compared to that of untreated wild-type mice. The livers of the Brg1 knockout animals showed reduced liver inflammation, extracellular matrix accumulation, and liver fibrosis. TNF-α and NF-κB-mediated inflammatory response was reduced in Brg1 knockout animals. CONCLUSION Brg1 promotes the progression of liver fibrosis in mice and may therefore be used as a potential therapeutic target for treating patients with liver fibrosis due to chronic injury.
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Affiliation(s)
- Baocai Wang
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of General Surgery, The Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Suyang Zhong
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Yuhan Yin
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, The Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Roland M. Schmid
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Roeth AA, Jauch D, Buhr HJ, Klinger C, Sommer N, Wachter N, Hartmann D, Schnitzbauer A, Geis C, Boedecker C, Huber T. [Future of University Medicine: How Important are Research and Teaching? - An Inventory]. Zentralbl Chir 2023; 148:415-424. [PMID: 37339662 DOI: 10.1055/a-2068-4323] [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: 06/22/2023]
Abstract
The requirements and challenges for the university hospitals in Germany are changing. Especially in surgical subjects, it is more and more difficult to adequately serve these three pillars of university medicine - clinic, research and education. This survey was intended to determine the status quo of general and visceral surgery at universities, in order to provide a basis for proposed solutions.For this online survey, 1505 visceral surgeons at the 38 university clinics were contacted. The questionnaire contained 29 questions on the structure of the clinic, scientific motivation, opportunities for time-off and the appreciation of academic achievements. The type and scope of student courses and the preparation for them were also determined. With regard to patient care, the type and number of services and the course of surgical training were examined. Based on the data published on the websites of the individual clinics on the number, gender, position and academic title of the doctors, a demographic analysis of university visceral surgeons could also be created.Of 1505 surgeons successfully contacted, 352 took part in the survey, which corresponds to a response rate of 23.4%. Of the participants, 93.5% were scientifically active, the majority being in the field of clinical data collection. Many indicated that they were also active in translational and/or experimental research, while educational research was rarely named. 45% confirmed that they could perform scientific work during their normal working hours. The reward for this activity was mostly in the form of time-off for congresses and clinical appreciation. Most participants stated that they were involved in 3-4 student courses per week, with 24.4% reporting that they were not adequately prepared for them.The compatibility of the classic three pillars of clinic, research and teaching continues to be of great relevance. There is a high level of motivation among the participating visceral surgeons not to neglect research and teaching, despite increasing economic pressure in the field of patient care. However, arrangements must be created in order to reward and promote commitment in research and teaching in a structured way.
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Affiliation(s)
- Anjali A Roeth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
- AG Zukunfstdialog, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Dominik Jauch
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Heinz J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Carsten Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Nils Sommer
- Department of Surgery, University of Bonn, Bonn, Deutschland
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Nicolas Wachter
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Daniel Hartmann
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
- AG Zukunfstdialog, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Andreas Schnitzbauer
- Depratment for General and Visceral Surgery, Frankfurt Univeristy Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Deutschland
- AG Zukunfstdialog, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Christian Geis
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Christian Boedecker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
- Arbeitsgemeinschaft Junge Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
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7
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Ongena J, Castano-Bardawil D, Crombé K, Kazakov Y, Schweer B, Stepanov I, Van Schoor M, Vervier M, Krämer-Flecken A, Neubauer O, Nicolai D, Satheeswaran G, Offermanns G, Hollfeld K, Benndorf A, Dinklage A, Hartmann D, Kallmeyer J, Wolf R, TEC. Physics design, construction and commissioning of the ICRH system for the stellarator Wendelstein 7-X. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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8
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Kaufmann B, Seyfried N, Hartmann D, Hartmann P. Probiotics, prebiotics, and synbiotics in nonalcoholic fatty liver disease and alcohol-associated liver disease. Am J Physiol Gastrointest Liver Physiol 2023; 325:G42-G61. [PMID: 37129252 PMCID: PMC10312326 DOI: 10.1152/ajpgi.00017.2023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
The use of probiotics, prebiotics, and synbiotics has become an important therapy in numerous gastrointestinal diseases in recent years. Modifying the gut microbiota, this therapeutic approach helps to restore a healthy microbiome. Nonalcoholic fatty liver disease and alcohol-associated liver disease are among the leading causes of chronic liver disease worldwide. A disrupted intestinal barrier, microbial translocation, and an altered gut microbiome metabolism, or metabolome, are crucial in the pathogenesis of these chronic liver diseases. As pro-, pre-, and synbiotics modulate these targets, they were identified as possible new treatment options for liver disease. In this review, we highlight the current findings on clinical and mechanistic effects of this therapeutic approach in nonalcoholic fatty liver disease and alcohol-associated liver disease.
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Affiliation(s)
- Benedikt Kaufmann
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nick Seyfried
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Phillipp Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Pediatrics, University of California San Diego, La Jolla, California, United States
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9
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Esser K, Cheng X, Wettengel JM, Lucifora J, Hansen-Palmus L, Austen K, Suarez AAR, Heintz S, Testoni B, Nebioglu F, Pham MT, Yang S, Zernecke A, Wohlleber D, Ringelhan M, Broxtermann M, Hartmann D, Hüser N, Mergner J, Pichlmair A, Thasler WE, Heikenwalder M, Gasteiger G, Blutke A, Walch A, Knolle PA, Bartenschlager R, Protzer U. Hepatitis B virus targets lipid transport pathways to infect hepatocytes. Cell Mol Gastroenterol Hepatol 2023:S2352-345X(23)00051-6. [PMID: 37054914 PMCID: PMC10394270 DOI: 10.1016/j.jcmgh.2023.03.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND AND AIMS A single hepatitis B virus (HBV) particle is sufficient to establish chronic infection of the liver after intravenous injection, suggesting that the virus targets hepatocytes via a highly efficient transport pathway. We therefore investigated whether HBV utilizes a physiological liver-directed pathway that supports specific host-cell targeting in vivo. METHODS We established an ex vivo system of perfused human liver tissue that recapitulates the liver physiology to investigate HBV liver targeting. This model allowed us to investigate virus-host cell interactions in a cellular microenvironment mimicking the in vivo situation. RESULTS HBV was rapidly sequestered by liver macrophages within one hour after a virus pulse, but was detected in hepatocytes only after 16 hours. We found that HBV associates with lipoproteins. Electron- and immunofluorescence microscopy corroborated a co-localization in recycling endosomes within peripheral and liver macrophages. Importantly, recycling endosomes accumulated HBV and cholesterol, followed by transport of HBV back to the cell surface along the cholesterol efflux pathway. To reach hepatocytes as final target cells, HBV was able to utilise the hepatocyte-directed cholesterol transport machinery of macrophages. CONCLUSIONS Our results propose that HBV by binding to liver targeted lipoproteins and utilizing the reverse cholesterol transport pathway of macrophages hijacks the physiological lipid transport pathways to the liver to most efficiently reach its target organ. This may involve trans-infection of liver macrophages and result in deposition of HBV in the perisinusoidal space from where HBV can bind its receptor on hepatocytes.
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Affiliation(s)
- Knud Esser
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany.
| | - Xiaoming Cheng
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Jochen M Wettengel
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Julie Lucifora
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France, University of Lyon, Université Claude-Bernard (UCBL), Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Lea Hansen-Palmus
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Katharina Austen
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Armando A R Suarez
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Sarah Heintz
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Barbara Testoni
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Firat Nebioglu
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Minh Tu Pham
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Shangqing Yang
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Josef-Schneider-Str. 2, Würzburg 97080, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites
| | - Marc Ringelhan
- German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; 2nd Medical Department, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany
| | - Mathias Broxtermann
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich Germany
| | - Julia Mergner
- Bavarian Center for Biomolecular Mass Spectrometry at Klinikum rechts der Isar (BayBioMS@MRI), TUM, Munich, Germany
| | - Andreas Pichlmair
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; Bavarian Center for Biomolecular Mass Spectrometry at Klinikum rechts der Isar (BayBioMS@MRI), TUM, Munich, Germany
| | - Wolfgang E Thasler
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Grosshadern Hospital, Ludwig Maximilians University, Nussbaumstr. 20, 80336 Munich, Germany
| | - Mathias Heikenwalder
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Georg Gasteiger
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Andreas Blutke
- Institute of Pathology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Axel Walch
- Institute of Pathology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites
| | - Ralf Bartenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; Division Virus-Associated Carcinogenesis, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites.
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10
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Yin Y, Sichler A, Ecker J, Laschinger M, Liebisch G, Höring M, Basic M, Bleich A, Zhang XJ, Kübelsbeck L, Plagge J, Scherer E, Wohlleber D, Wang J, Wang Y, Steffani M, Stupakov P, Gärtner Y, Lohöfer F, Mogler C, Friess H, Hartmann D, Holzmann B, Hüser N, Janssen KP. Gut microbiota promote liver regeneration through hepatic membrane phospholipid biosynthesis. J Hepatol 2023; 78:820-835. [PMID: 36681162 DOI: 10.1016/j.jhep.2022.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 03/16/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Hepatocyte growth and proliferation depends on membrane phospholipid biosynthesis. Short-chain fatty acids (SCFAs) generated by bacterial fermentation, delivered through the gut-liver axis, significantly contribute to lipid biosynthesis. We therefore hypothesized that dysbiotic insults like antibiotic treatment not only affect gut microbiota, but also impair hepatic lipid synthesis and liver regeneration. METHODS Stable isotope labeling and 70% partial hepatectomy (PHx) was carried out in C57Bl/6J wild-type mice, in mice treated with broad-spectrum antibiotics, in germ-free mice and mice colonized with minimal microbiota. The microbiome was analyzed by 16S rRNA gene sequencing and microbial culture. Gut content, liver, blood and primary hepatocyte organoids were tested by mass spectrometry-based lipidomics, quantitative reverse-transcription PCR (qRT-PCR), immunoblot and immunohistochemistry for expression of proliferative and lipogenic markers. Matched biopsies from hyperplastic and hypoplastic liver tissue of patients subjected to surgical intervention to induce hyperplasia were analyzed by qRT-PCR for lipogenic enzymes. RESULTS Three days of antibiotic treatment induced persistent dysbiosis with significantly decreased beta-diversity and richness, but a massive increase of Proteobacteria, accompanied by decreased colonic SCFAs. After PHx, antibiotic-treated mice showed delayed liver regeneration, increased mortality, impaired hepatocyte proliferation and decreased hepatic phospholipid synthesis. Expression of the lipogenic enzyme SCD1 was upregulated after PHx but delayed by antibiotic treatment. Germ-free mice essentially recapitulated the phenotype of antibiotic treatment. Phospholipid biosynthesis, hepatocyte proliferation, liver regeneration and survival were rescued in gnotobiotic mice colonized with a minimal SCFA-producing microbial community. SCFAs induced the growth of murine hepatocyte organoids and hepatic SCD1 expression in mice. Further, SCD1 was required for proliferation of human hepatoma cells and was associated with liver regeneration in human patients. CONCLUSION Gut microbiota are pivotal for hepatic membrane phospholipid biosynthesis and liver regeneration. IMPACT AND IMPLICATIONS Gut microbiota affect hepatic lipid metabolism through the gut-liver axis, but the underlying mechanisms are poorly understood. Perturbations of the gut microbiome, e.g. by antibiotics, impair the production of bacterial metabolites, which normally serve as building blocks for membrane lipids in liver cells. As a consequence, liver regeneration and survival after liver surgery is severely impaired. Even though this study is preclinical, its results might allow physicians in the future to improve patient outcomes after liver surgery, by modulation of gut microbiota or their metabolites.
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Affiliation(s)
- Yuhan Yin
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anna Sichler
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Josef Ecker
- ZIEL - Inst. for Food & Health, TUM, Freising, Germany
| | - Melanie Laschinger
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Gerhard Liebisch
- Inst. of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marcus Höring
- Inst. of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marijana Basic
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
| | - Xue-Jun Zhang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Ludwig Kübelsbeck
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | | | - Emely Scherer
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jianye Wang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Yang Wang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Marcella Steffani
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Pavel Stupakov
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Yasmin Gärtner
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, School of Medicine, TUM, Munich, Germany
| | - Helmut Friess
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Daniel Hartmann
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Holzmann
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
| | - Norbert Hüser
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
| | - Klaus-Peter Janssen
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
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11
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Burra P, Arvanitakis M, Dias JA, Bretthauer M, Dugic A, Hartmann D, Michl P, Seufferlein T, Torres J, Törnblom H, van Leerdam ME, Zelber‐Sagi S, Botos A. UEG position paper: Obesity and digestive health. United European Gastroenterol J 2022; 10:1199-1201. [PMID: 36457185 PMCID: PMC9752259 DOI: 10.1002/ueg2.12334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant UnitDepartment of Surgery, Oncology and GastroenterologyPadua University HospitalPaduaItaly
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and GI OncologyErasme University HospitalUniversité Libre de BruxellesBrusselsBelgium,Nutrition TeamErasme University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | - Michael Bretthauer
- Department of Transplantation MedicineClinical Effectiveness Research GroupOslo University HospitalOsloNorway,Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Ana Dugic
- Department of GastroenterologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)Medizincampus OberfrankenBayreuthGermany,Department of MedicineKarolinska InstitutetStockholmSweden
| | - Daniel Hartmann
- Department of SurgeryKlinikum rechts der Isar Technische Universität MunichMunichGermany
| | - Patrick Michl
- Department of Internal Medicine IMartin‐Luther University Halle‐WittenbergHalleGermany
| | | | - Joana Torres
- Division of GastroenterologyHospital Beatriz ÂngeloLouresPortugal,Faculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | - Hans Törnblom
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Shira Zelber‐Sagi
- School of Public HealthFaculty of Social Welfare and Health SciencesUniversity of HaifaHaifaIsrael,Department of GastroenterologyTel Aviv Medical CenterTel AvivIsrael
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12
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Lecoq FA, Barnouin L, Ardouin L, Hartmann D, Obert L. Inverted human umbilical artery as a 3D scaffold for sciatic nerve regeneration in rats. Cell Tissue Bank 2022; 23:909-922. [PMID: 35503142 PMCID: PMC9675695 DOI: 10.1007/s10561-022-10006-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/03/2022] [Indexed: 11/02/2022]
Abstract
Treatment of peripheral nerve injuries (PNIs) remains a challenge. Interposing a graft delivers better regenerative outcomes. Autografts present major drawbacks which have given rise to the development of alternatives such as artificial scaffolds, some of which are very promising. This study was designed to investigate the potential use of an inverted human umbilical cord artery (iHUA) as a 3D scaffold nerve chamber, for nerve regeneration after transection of the sciatic nerve (SN) in rats. Rats underwent surgical SN transection in their right hindlimb, followed by suture of the device at the resected stumps. Local tolerance, insert biodegradability and nerve reconstruction over time were thoroughly studied by histopathological and morphometric analysis, completed by functional test assessment of sensitivity and motricity recovery. We have demonstrated that nerve reconstruction in the presence of an iHUA insert is effective. The device is well tolerated and highly biodegraded. Although the regenerated nerve is still immature at the end of our study, signs of sensitivity and partial functional recovery were witnessed, confirming our histological findings. Our results support the potential clinical use of iHUA as a 3D scaffold to bridge nerve discontinuity and guide axonal regrowth in selected cases of PNIs.
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Affiliation(s)
- Flore-Anne Lecoq
- Institut de la Main Nantes Atlantique, Elsan Santé Atlantique, Saint Herblain, France
| | | | - Ludovic Ardouin
- Institut de la Main Nantes Atlantique, Elsan Santé Atlantique, Saint Herblain, France
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13
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Kaufmann B, Leszczynska A, Reca A, Booshehri LM, Onyuru J, Tan Z, Wree A, Friess H, Hartmann D, Papouchado B, Broderick L, Hoffman HM, Croker BA, Zhu YP, Feldstein AE. NLRP3 activation in neutrophils induces lethal autoinflammation, liver inflammation, and fibrosis. EMBO Rep 2022; 23:e54446. [PMID: 36194627 PMCID: PMC9638850 DOI: 10.15252/embr.202154446] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/04/2021] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Sterile inflammation is a central element in liver diseases. The immune response following injurious stimuli involves hepatic infiltration of neutrophils and monocytes. Neutrophils are major effectors of liver inflammation, rapidly recruited to sites of inflammation, and can augment the recruitment of other leukocytes. The NLRP3 inflammasome has been increasingly implicated in severe liver inflammation, fibrosis, and cell death. In this study, the role of NLRP3 activation in neutrophils during liver inflammation and fibrosis was investigated. Mouse models with neutrophil-specific expression of mutant NLRP3 were developed. Mutant mice develop severe liver inflammation and lethal autoinflammation phenocopying mice with a systemic expression of mutant NLRP3. NLRP3 activation in neutrophils leads to a pro-inflammatory cytokine and chemokine profile in the liver, infiltration by neutrophils and macrophages, and an increase in cell death. Furthermore, mutant mice develop liver fibrosis associated with increased expression of pro-fibrogenic genes. Taken together, the present work demonstrates how neutrophils, driven by the NLRP3 inflammasome, coordinate other inflammatory myeloid cells in the liver, and propagate the inflammatory response in the context of inflammation-driven fibrosis.
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Affiliation(s)
- Benedikt Kaufmann
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, TechnicalUniversity of MunichMunichGermany
| | | | - Agustina Reca
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Laela M Booshehri
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Janset Onyuru
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - ZheHao Tan
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Alexander Wree
- Department of Hepatology and GastroenterologyCharité, Universitätsmedizin BerlinBerlinGermany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, TechnicalUniversity of MunichMunichGermany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, TechnicalUniversity of MunichMunichGermany
| | - Bettina Papouchado
- Department of PathologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Lori Broderick
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hal M Hoffman
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Ben A Croker
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Yanfang Peipei Zhu
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Ariel E Feldstein
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
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14
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Steffani M, Stöss C, Laschinger M, Assfalg V, Schulze S, Mogler C, Lohöfer F, Paprottka P, Hüser N, Friess H, Hartmann D, Novotny A. softALPPS - A novel, individual procedure for patients with advanced liver tumors. HPB (Oxford) 2022; 24:1362-1364. [PMID: 35289281 DOI: 10.1016/j.hpb.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The first-line therapy for liver malignancies is a radical extended liver resection. This high-risk operation has a high incidence of post-hepatectomy liver failure (PHLF) due to a small future liver remnant (FLR). One of the procedures to increase the FLR is the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) which is still associated with high morbidity and mortality. Here, we present a new, less invasive ALPPS variant that may be associated with lower morbidity. METHODS SoftALPPS is characterized by reduced trauma to the liver tissue and individual adaptation to the patient's health constitution. In softALPPS, portal vein embolization (PVE) is performed instead of portal vein ligation (PVL) after complete recovery of liver function. In addition, a non-absorbable foil was avoided in order to be able to extend the interval to step two or skip step two when required. RESULTS Four patients successfully underwent softALPPS. Two of these patients have been followed-up for over a year (one patient with Klatskin tumor, one patient with extensive HCC). Both patients show no evidence of recurrence after 12 months and are in good medical condition. The other two patients who recently had surgery are also doing well. CONCLUSION SoftALPPS offers the chance to curatively resect patients with high tumor burden of the liver even when the FLR is inadequate. This individual therapy method can give patients the possibility of complete tumor resection and can help to reduce perioperative morbidity.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Christian Stöss
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Sarah Schulze
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Carolin Mogler
- Institute of General and Surgical Pathology, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Fabian Lohöfer
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Philipp Paprottka
- Department of Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany.
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Krammer S, Li Y, Jakob N, Boehm AS, Wolff H, Tang P, Lasser T, French LE, Hartmann D. Deep learning-based classification of dermatological lesions given a limited amount of labeled data. J Eur Acad Dermatol Venereol 2022; 36:2516-2524. [PMID: 35876737 DOI: 10.1111/jdv.18460] [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: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Artificial intelligence (AI) techniques are promising in early diagnosis of skin diseases. However, a precondition for their success is the access to large-scaled annotated data. Until now, obtaining this data has only been feasible with very high personnel and financial resources. OBJECTIVES The aim of this study was to overcome the obstacle caused by the scarcity of labeled data. METHODS To simulate the scenario of label shortage, we discarded a proportion of labels of the training set. The training set consisted of both labeled and unlabeled images. We then leveraged a self-supervised learning technique to pre-train the AI model on the unlabeled images. Next, we fine-tuned the pre-trained model on the labeled images. RESULTS When the images in the training dataset were fully labeled, the self-supervised pre-trained model achieved 95.7% of accuracy, 91.7% of precision and 90.7% of sensitivity. When only 10% of the data was labeled, the model could still yield 87.7% of accuracy, 81.7% of precision and 68.6% of sensitivity. In addition, we also empirically verified that the AI model and dermatologists are consistent in visually inspecting the skin images. CONCLUSIONS The experimental results demonstrate the great potential of the self-supervised learning in alleviating the scarcity of annotated data.
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Affiliation(s)
- S Krammer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Y Li
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - N Jakob
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - A S Boehm
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - H Wolff
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - P Tang
- Department of Informatics, School of Computations, Information, and Technology, and Munich Institute of Biomedical Engineering, Technical University of Munich, Munich, Germany
| | - T Lasser
- Department of Informatics, School of Computations, Information, and Technology, and Munich Institute of Biomedical Engineering, Technical University of Munich, Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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Kaufmann B, Kui L, Reca A, Leszczynska A, Kim AD, Booshehri LM, Wree A, Friess H, Hartmann D, Broderick L, Hoffman HM, Feldstein AE. Cell-specific Deletion of NLRP3 Inflammasome Identifies Myeloid Cells as Key Drivers of Liver Inflammation and Fibrosis in Murine Steatohepatitis. Cell Mol Gastroenterol Hepatol 2022; 14:751-767. [PMID: 35787975 PMCID: PMC9424559 DOI: 10.1016/j.jcmgh.2022.06.007] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide. The NLRP3 inflammasome, a platform for caspase-1 activation and release of interleukin 1β, is increasingly recognized in the induction of inflammation and liver fibrosis during NAFLD. However, the cell-specific contribution of NLRP3 inflammasome activation in NAFLD remains unknown. METHODS To investigate the role of NLRP3 inflammasome activation in hepatocytes, hepatic stellate cells (HSCs) and myeloid cells, a conditional Nlrp3 knock-out mouse was generated and bred to cell-specific Cre mice. Both acute and chronic liver injury models were used: lipopolysaccharide/adenosine-triphosphate to induce in vivo NLRP3 activation, choline-deficient, L-amino acid-defined high-fat diet, and Western-type diet to induce fibrotic nonalcoholic steatohepatitis (NASH). In vitro co-culture studies were performed to dissect the crosstalk between myeloid cells and HSCs. RESULTS Myeloid-specific deletion of Nlrp3 blunted the systemic and hepatic increase in interleukin 1β induced by lipopolysaccharide/adenosine-triphosphate injection. In the choline-deficient, L-amino acid-defined high-fat diet model of fibrotic NASH, myeloid-specific Nlrp3 knock-out but not hepatocyte- or HSC-specific knock-out mice showed significant reduction in inflammation independent of steatosis development. Moreover, myeloid-specific Nlrp3 knock-out mice showed ameliorated liver fibrosis and decreased HSC activation. These results were validated in the Western-type diet model. In vitro co-cultured studies with human cell lines demonstrated that HSC can be activated by inflammasome stimulation in monocytes, and this effect was significantly reduced if NLRP3 was downregulated in monocytes. CONCLUSIONS The study provides new insights in the cell-specific role of NLRP3 in liver inflammation and fibrosis. NLRP3 inflammasome activation in myeloid cells was identified as crucial for the progression of NAFLD to fibrotic NASH. These results may have implications for the development of cell-specific strategies for modulation of NLRP3 activation for treatment of fibrotic NASH.
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Affiliation(s)
- Benedikt Kaufmann
- Department of Pediatrics, University of California San Diego, La Jolla, California; Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lin Kui
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Agustina Reca
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | | | - Andrea D Kim
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Laela M Booshehri
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Alexander Wree
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, Berlin, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lori Broderick
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Hal M Hoffman
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Ariel E Feldstein
- Department of Pediatrics, University of California San Diego, La Jolla, California.
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17
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Moiseenko VE, Kovtun YV, Lozin AV, Pavlichenko RO, Shapoval AN, Grigor’eva LI, Kozulya MM, Maznichenko SM, Korovin VB, Kramskoy ED, Zamanov NV, Siusko YV, Baron DI, Krasiuk AY, Romanov VS, Garkusha IE, Wauters T, Alonso A, Brakel R, Dinklage A, Hartmann D, Kazakov Y, Laqua H, Ongena J, Stange T. Plasma Production in ICRF in the Uragan-2M Stellarator in Hydrogen–Helium Gas Mixture. J Fusion Energ 2022. [DOI: 10.1007/s10894-022-00326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Assfalg V, Miller G, Stocker F, van Meel M, Groenevelt T, Tieken I, Ankerst D, Renders L, Novotny A, Hartmann D, Jell A, Rahmel A, Wahba R, Mühlfeld A, Bouts A, Ysebaert D, Globke B, Jacobs-Tulleneers-Thevissen D, Piros L, Stippel D, Heller K, Eisenberger U, van Laecke S, Weimer R, Rosenkranz AR, Berger S, Fischer L, Kliem V, Vondran F, Sester U, Schneeberger S, Harth A, Kuypers D, Függer R, Arnol M, Christiaans M, Weinmann-Menke J, Krüger B, Hilbrands L, Banas B, Hakenberg O, Minnee R, Schwenger V, Heyne N, van Zuilen A, Reindl-Schwaighofer R, Lopau K, Hüser N, Heemann U. Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis. Transplantation 2022; 106:1215-1226. [PMID: 34608103 DOI: 10.1097/tp.0000000000003964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND At Eurotransplant (ET), kidneys are transferred to "rescue allocation" (RA), whenever the standard allocation (SA) algorithms Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP) fail. We analyzed the outcome of RA. METHODS Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 after SA from 71 centers across all ET countries from 2006 to 2018. RESULTS Numbers of DDRTs after RA increased over the time, especially in Germany. RA played a minor role in ESP versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 outcomes were significantly different when comparing RA with SA within the ESP program. CONCLUSIONS Facing increased waiting times and mortality on dialysis due to donor shortage, this study reveals encouragingly positive DDRT outcomes following RA. This supports the extension of RA to more patients and as an alternative tool to enable transplantation in patients in countries with prohibitively long waiting times or at risk of deterioration.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Tiny Groenevelt
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Donna Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alexander Novotny
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alissa Jell
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Axel Rahmel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Roger Wahba
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anja Mühlfeld
- Department of Nephrology, Universitätsklinikum Aachen, Aachen, Germany
| | - Antonia Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital & University of Antwerp, Edegem, Antwerpen, Belgium
| | - Brigitta Globke
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - László Piros
- Department of Transplantation and Surgery, School of Medicine, Semmelweis University, Budapest, Hungary
| | - Dirk Stippel
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Katharina Heller
- Medizinische Klinik 4, Universitätsklinikum Erlangen-Nürnberg, Transplantation szentrum Erlangen-Nürnberg, Erlangen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Rolf Weimer
- Department of Internal Medicine, Nephrology and Renal Transplantation, University Clinic of Giessen and Marburg (UKGM), Giessen, Germany
| | - Alexander R Rosenkranz
- Universitätsklinik für Innere Medizin, Nephrologie, Medizinische Universität Graz, Graz, Austria
| | - Stefan Berger
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Kliem
- Division of Nephrology, Department of Internal Medicine, Transplantationszentrum Hannoversch Münden, Münden, Germany
| | - Florian Vondran
- Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Harth
- Medizinische Klinik I, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Innere Medizin II, Nephrologie, Uniklinik Witten/Herdecke, Köln, Germany
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum Elisabethinen Linz, Linz, Austria
| | - Miha Arnol
- Department of Nephrology and Renal Transplantation, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maarten Christiaans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julia Weinmann-Menke
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Nephrologie und Nierentransplantation, Mainz, Germany
| | - Bernd Krüger
- Department of Nephrology, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernhard Banas
- Department of Nephrology, Universitätsklinikum Regensburg, Universitäres Transplantationszentrum, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Robert Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Vedat Schwenger
- Department of Nephrology, Klinikum der Landeshauptstadt Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, Tübingen University Hospital, Tübingen, Germany
| | - Arjan van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Kai Lopau
- Division of Nephrology, Department of Internal Medicine 1, University hospital Wuerzburg, Würzburg, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
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Brugger M, Laschinger M, Lampl S, Schneider A, Manske K, Esfandyari D, Hüser N, Hartmann D, Steiger K, Engelhardt S, Wohlleber D, Knolle PA. High precision-cut liver slice model to study cell-autonomous anti-viral defense of hepatocytes within their microenvironment. JHEP Rep 2022; 4:100465. [PMID: 35462860 PMCID: PMC9019249 DOI: 10.1016/j.jhepr.2022.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 10/25/2022] Open
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Abstract
IMPORTANCE Telomeres protect DNA from damage. Because they shorten with each mitotic cycle, leukocyte telomere length (LTL) serves as a mitotic clock. Reduced LTL has been associated with multiple human disorders. OBJECTIVE To determine the association between LTL and overall as well as disease-specific mortality and morbidity. DESIGN, SETTING, AND PARTICIPANTS This multicenter, community-based cohort study conducted from March 2006 to December 2010 included longitudinal follow-up (mean [SD], 12 [2] years) for 472 432 English participants from the United Kingdom Biobank (UK Biobank) and analyzed morbidity and mortality. The data were analyzed in 2021. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and odds ratios for mortality and morbidity associated with a standard deviation change in LTL, adjusted for age, sex, body mass index (calculated as weight in kilograms divided by height in meters squared), and ethnicity. RESULTS This study included a total of 472 432 English participants, of whom 54% were women (mean age, 57 years). Reduced LTL was associated with increased overall (HR, 1.08; 95% CI, 1.07-1.09), cardiovascular (HR, 1.09; 95% CI, 1.06-1.12), respiratory (HR, 1.40; 95% CI, 1.34-1.45), digestive (HR, 1.26; 95% CI, 1.19-1.33), musculoskeletal (HR, 1.51; 95% CI, 1.35-1.92), and COVID-19 (HR, 1.15; 95% CI, 1.07-1.23) mortality, but not cancer-related mortality. A total of 214 disorders were significantly overrepresented and 37 underrepresented in participants with shorter LTL. Respiratory (11%), digestive/liver-related (14%), circulatory (18%), and musculoskeletal conditions (6%), together with infections (5%), accounted for most positive associations, whereas (benign) neoplasms and endocrinologic/metabolic disorders were the most underrepresented entities. Malignant tumors, esophageal cancer, and lymphoid and myeloid leukemia were significantly more common in participants with shorter LTL, whereas brain cancer and melanoma were less prevalent. While smoking and alcohol consumption were associated with shorter LTL, additional adjustment for both factors, as well as cognitive function/major comorbid conditions, did not significantly alter the results. CONCLUSIONS AND RELEVANCE This cohort study found that shorter LTL was associated with a small risk increase of overall mortality, but a higher risk of mortality was associated with specific organs and diseases.
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Affiliation(s)
- Carolin V Schneider
- The Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kai Markus Schneider
- Perelman School of Medicine, Department of Microbiology, University of Pennsylvania, Philadelphia
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | | | - Daniel Hartmann
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel J Rader
- The Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
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Hartmann D, Martignoni M. Neues zur Therapie von Lebermalignomen. InFo Hämatol Onkol 2022. [PMCID: PMC8807005 DOI: 10.1007/s15004-022-8949-y] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Hartmann
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Marc Martignoni
- Klinikum rechts der Isar / TU München, Klinik und Poliklinik für Chirurgie, Ismaninger Str. 22, 81675 München, Deutschland
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22
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Wang J, Wang Y, Steffani M, Stöß C, Ankerst D, Friess H, Hüser N, Hartmann D. Novel Risk Classification Based on Pyroptosis-Related Genes Defines Immune Microenvironment and Pharmaceutical Landscape for Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14020447. [PMID: 35053610 PMCID: PMC8773536 DOI: 10.3390/cancers14020447] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Growing evidence has indicated that pyroptosis functions in the development of cancer. Nonetheless, specific roles of pyroptosis-related genes in tumor progression, immune response, prognosis, and immunotherapy have not been thoroughly elucidated. After a comprehensive evaluation of pyroptosis genes, unsupervised clustering was performed to generate three distinct clusters from hepatocellular carcinoma (HCC) samples. Three distinct pyroptosis-related molecular subtypes comprising three gene clusters that had differential prognostic effects on patient survival were then identified. Immune characteristics analyses revealed diversified immune cell infiltration among the subtypes. Two clusters served as immune-hot phenotypes associated with significantly poorer survival compared to a remaining third immune-cold cluster. Among these, the immune-hot clusters were characterized by abundant adaptive immune cell infiltration, active CD4+ and CD8+ T cells, high total leukocyte counts and tumor growth status, and lower Th17 cell and M2 macrophage densities. Then, risk scores indicated that low-risk patients were more sensitive to anti-tumor therapy. Subsequently, we found a significant correlation between pyroptosis and prognosis in HCC and that pyroptosis genes drive the heterogeneity of the tumor microenvironment. The risk scoring system, based on pyroptosis-related differentially expressed genes, was established to evaluate the individual outcomes and contribute to new insights into the molecular characterization of pyroptosis-related subtypes.
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Affiliation(s)
- Jianye Wang
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Ying Wang
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Liesel Beckman Str. 1, 85354 Freising, Germany;
| | - Marcella Steffani
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Christian Stöß
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Donna Ankerst
- Departments of Mathematics and Life Science Systems, Technical University of Munich, Boltzmannstr. 3, 85748 Garching, Germany;
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
- Correspondence: ; Tel.: +49-89-4140-5886; Fax: +49-89-4140-4780
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Sudacka M, Adler M, Durning SJ, Edelbring S, Frankowska A, Hartmann D, Hege I, Huwendiek S, Sobočan M, Thiessen N, Wagner FL, Kononowicz AA. Why is it so difficult to implement a longitudinal clinical reasoning curriculum? A multicenter interview study on the barriers perceived by European health professions educators. BMC Med Educ 2021; 21:575. [PMID: 34772405 PMCID: PMC8588939 DOI: 10.1186/s12909-021-02960-w] [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] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/27/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Effective clinical reasoning is a core competency of health professionals that is necessary to assure patients' safety. Unfortunately, adoption of longitudinal clinical reasoning curricula is still infrequent. This study explores the barriers that hinder the explicit teaching of clinical reasoning from a new international perspective. METHODS The context of this study was a European project whose aim is to develop a longitudinal clinical reasoning curriculum. We collected data in semi-structured interviews with responders from several European countries who represent various health professions and have different backgrounds, roles and experience. We performed a qualitative content analysis of the gathered data and constructed a coding frame using a combined deductive/inductive approach. The identified themes were validated by parallel coding and in group discussions among project members. RESULTS A total of 29 respondents from five European countries participated in the interviews; the majority of them represent medicine and nursing sciences. We grouped the identified barriers into eight general themes: Time, Culture, Motivation, Clinical Reasoning as a Concept, Teaching, Assessment, Infrastructure and Others. Subthemes included issues with discussing errors and providing feedback, awareness of clinical reasoning teaching methods, and tensions between the groups of professionals involved. CONCLUSIONS This study provides an in-depth analysis of the barriers that hinder the teaching of explicit clinical reasoning. The opinions are presented from the perspective of several European higher education institutions. The identified barriers are complex and should be treated holistically due to the many interconnections between the identified barriers. Progress in implementation is hampered by the presence of reciprocal causal chains that aggravate this situation. Further research could investigate the perceptual differences between health professions regarding the barriers to clinical reasoning. The collected insights on the complexity and diversity of these barriers will help when rolling out a long-term agenda for overcoming the factors that inhibit the implementation of clinical reasoning curricula.
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Affiliation(s)
- Małgorzata Sudacka
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
| | | | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Samuel Edelbring
- Learning and Professional Development Group, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ada Frankowska
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Daniel Hartmann
- Medical Education Sciences, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Inga Hege
- Medical Education Sciences, Medical Faculty, University of Augsburg, Augsburg, Germany
- Institute for Medical Education, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Monika Sobočan
- Centre for Medical Education, Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Division of Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Nils Thiessen
- EDU - a degree smarter, Digital Education Holdings Ltd., Kalkara, Malta
| | | | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Witti MJ, Hartmann D, Wershofen B, Zottmann JM. Building interprofessional and interinstitutional bridges in health care education. Med Educ 2021; 55:1309-1310. [PMID: 34455623 DOI: 10.1111/medu.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
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Hartmann D. [Ex vivo confocal laser scanning microscopy for melanocytic lesions and autoimmune diseases]. Hautarzt 2021; 72:1058-1065. [PMID: 34705067 DOI: 10.1007/s00105-021-04906-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ex vivo confocal laser scanning microscopy (CLSM) enables bedside histology and offers the surgeon a direct intraoperative tissue examination. OBJECTIVES To determine whether this innovative, ultra-fast diagnostic tool can be expanded beyond nonmelanoma skin cancer, particularly basal cell carcinoma, to other indications including melanocytic lesions and autoimmune diseases. MATERIALS AND METHODS Review of literature and summary of the current knowledge and experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases. RESULTS Up to date experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases is limited but promising. Current knowledge on melanocytic lesions in ex vivo CLSM and their examples together with classic ex vivo CLSM features are presented. Previous results on the use of ex vivo CLSM in autoimmune dermatoses are presented, and future application possibilities of ex vivo CLSM are discussed. CONCLUSIONS The method is particularly suitable for the rapid examination of basal cell carcinomas during Mohs surgery but could also be used in the future for the intraoperative examination of melanocytic and autoimmune skin lesions.
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Affiliation(s)
- D Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.
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26
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Elgass K, Hartmann D, Siebenmorgen J, Kalkbrenner T, Weisshart K. Breakthrough instruments and products: Lattice Lightsheet 7-Non-invasive imaging of the subcellular dynamics of life. Rev Sci Instrum 2021; 92:109501. [PMID: 34717425 DOI: 10.1063/5.0069728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Light sheet fluorescence microscopy has become an established method for fast and sensitive imaging of living specimens with minimum phototoxicity and photobleaching. By adding lattice structures to the light sheet, the ZEISS Lattice Lightsheet 7 makes this technique available for live cell imaging at subcellular resolution while also allowing microscopists to use their standard sample carriers.
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Affiliation(s)
- K Elgass
- Carl Zeiss Microscopy GmbH, Carl-Zeiss-Promenade 10, 07745 Jena, Germany
| | - D Hartmann
- Carl Zeiss Microscopy GmbH, Carl-Zeiss-Promenade 10, 07745 Jena, Germany
| | - J Siebenmorgen
- Carl Zeiss Microscopy GmbH, Carl-Zeiss-Promenade 10, 07745 Jena, Germany
| | - T Kalkbrenner
- Carl Zeiss Microscopy GmbH, Carl-Zeiss-Promenade 10, 07745 Jena, Germany
| | - K Weisshart
- Carl Zeiss Microscopy GmbH, Carl-Zeiss-Promenade 10, 07745 Jena, Germany
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Perner J, Hatalova T, Cabello-Donayre M, Urbanova V, Sojka D, Frantova H, Hartmann D, Jirsova D, Pérez-Victoria JM, Kopacek P. Haem-responsive gene transporter enables mobilization of host haem in ticks. Open Biol 2021; 11:210048. [PMID: 34465215 PMCID: PMC8437232 DOI: 10.1098/rsob.210048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/04/2023] Open
Abstract
Ticks, notorious blood-feeders and disease-vectors, have lost a part of their genetic complement encoding haem biosynthetic enzymes and are, therefore, dependent on the acquisition and distribution of host haem. Solute carrier protein SLC48A1, aka haem-responsive gene 1 protein (HRG1), has been implicated in haem transport, regulating the availability of intracellular haem. HRG1 transporter has been identified in both free-living and parasitic organisms ranging from unicellular kinetoplastids, nematodes, up to vertebrates. However, an HRG1 homologue in the arthropod lineage has not yet been identified. We have identified a single HRG1 homologue in the midgut transcriptome of the tick Ixodes ricinus, denoted as IrHRG, and have elucidated its role as a haem transporter. Data from haem biosynthesis-deficient yeast growth assays, systemic RNA interference and the evaluation of gallium protoporphyrin IX-mediated toxicity through tick membrane feeding clearly show that IrHRG is the bona fide tetrapyrrole transporter. We argue that during evolution, ticks profited from retaining a functional hrg1 gene in the genome because its protein product facilitates host haem escort from intracellularly digested haemoglobin, rendering haem bioavailable for a haem-dependent network of enzymes.
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Affiliation(s)
- J. Perner
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - T. Hatalova
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - M. Cabello-Donayre
- Institute of Parasitology and Biomedicine ‘López-Neyra’, CSIC, (IPBLN-CSIC), Granada, Spain
| | - V. Urbanova
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - D. Sojka
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - H. Frantova
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - D. Hartmann
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - D. Jirsova
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - J. M. Pérez-Victoria
- Institute of Parasitology and Biomedicine ‘López-Neyra’, CSIC, (IPBLN-CSIC), Granada, Spain
| | - P. Kopacek
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, Ceske Budejovice, Czech Republic
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28
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Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler EC. Line-field confocal optical coherence tomography for the in vivo real-time diagnosis of different stages of keratinocyte skin cancer: a preliminary study. J Eur Acad Dermatol Venereol 2021; 35:2388-2397. [PMID: 34415646 DOI: 10.1111/jdv.17603] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of keratinocyte cancers (KC) strictly depends on their differentiation and invasiveness. Non-invasive diagnostic techniques can support the diagnosis in real time, avoiding unnecessary biopsies. This study aimed to preliminarily define main imaging criteria and histological correlations of actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) using the novel device line-field confocal optical coherence tomography (LC-OCT). METHODS Dermoscopy and LC-OCT images of 73 histopathologically confirmed lesions (46 AKs, 11 BD and 16 SCCs) were included in the study. Exemplary lesions (10 AKs, 5 BD and 5 SCCs) were additionally investigated with optical coherence tomography and reflectance confocal microscopy. RESULTS Most common LC-OCT findings of KC in the descriptive statistics were hyperkeratosis/parakeratosis, disruption of stratum corneum, broadened epidermis, basal and suprabasal keratinocyte atypia, dilated vessels/neoangiogenesis and elastosis/collagen alterations. In the univariate multinomial logistic regression, a preserved DEJ was less common in SCC compared with AK and BD, BD displayed marked keratinocyte atypia involving all epidermal layers (bowenoid pattern), while SCC showed ulceration, increased epidermal thickness, keratin plugs, acantholysis, not visible/interrupted DEJ and epidermal bright particles. LC-OCT increased the diagnostic confidence by 24.7% compared with dermoscopy alone. CONCLUSIONS Our study describes for the first time specific LC-OCT features of different stages of KC and their histopathological correlates, focusing on keratinocyte morphology and architecture of the epidermis and DEJ. LC-OCT may open new scenarios in the bedside diagnosis, treatment planning and follow-up of KC.
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Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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29
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Vural S, Kerl K, Doğan PE, Vollmer S, Puchta U, He M, Arakawa Y, Heper AO, Karal A, Hartmann D, Boyvat A, Prinz JC, Arakawa A. Lesional activation of T c 17 cells in Behçet's disease and psoriasis supports HLA-class I-mediated autoimmune responses. Br J Dermatol 2021; 185:1209-1220. [PMID: 34254298 DOI: 10.1111/bjd.20643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet's disease (BD) presents with lymphocytic and neutrophilic vasculitis of unknown aetiology. HLA-B*51 ERAP1 and IL12R/IL23R are genetic risk factors. IL-23 regulates IL-17A, which controls recruitment and activation of neutrophils. OBJECTIVES To determine pathological changes in BD skin lesions related to the complex genetic predisposition METHODS: We characterised the expression of IL-17A and IL-23A in various cell types by immunohistological double staining of sections from papulopustular skin lesions (PPL) of acute attacks of BD and lesions of psoriasis vulgaris (PV), another HLA-class I-associated T-cell mediated autoimmune disease in which excessive T-cell derived IL-17A production promotes neutrophil activation. RESULTS We found that in BD lesions, as in psoriasis, actively expanding CD8+ T cells were the predominant source of IL-17A. IL-17A+ CD8+ T (Tc17) cells outnumbered infiltrating IL-17A+ CD4+ T cells. Unlike the epidermal localisation of CD8+ T cells in psoriasis, Tc17 cells in BD lesions infiltrated mainly the perivascular tissue and also the blood vessel walls of dermis and subcutaneous tissue. They colocalised with a marked IL-23A expression by CD11c+ dendritic cells (DCs) and CD68+ macrophages. IL-17A expression was associated with extensive recruitment of neutrophils around blood vessels that formed neutrophil extracellular traps (NETs). CONCLUSIONS In BD, the genetic predisposition may mediate antigen-specific activation and differentiation of a Tc 17 response, possibly targeting endothelial antigens. Neutrophils recruited by IL-17A in this process may enhance tissue damage by extensive NET formation (NETosis). Thus, the IL-23/IL-17 axis presumably controls neutrophilic inflammation in BD vasculitis in the context of a predominant antigen-specific CD8+ T-cell response.
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Affiliation(s)
- S Vural
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany.,Department of Dermatology, Koç University School of Medicine, Istanbul, 34010, Turkey
| | - K Kerl
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - P E Doğan
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - S Vollmer
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - U Puchta
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - M He
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - Y Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A O Heper
- Department of Pathology, Ankara University, 06100, Ankara, Turkey
| | - A Karal
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Boyvat
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - J C Prinz
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
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Endler M, Baldzuhn J, Beidler C, Bosch HS, Bozhenkov S, Buttenschön B, Dinklage A, Fellinger J, Feng Y, Fuchert G, Gao Y, Geiger J, Grulke O, Hartmann D, Jakubowski M, König R, Laqua H, Lazerson S, McNeely P, Naujoks D, Neuner U, Otte M, Pasch E, Sunn Pedersen T, Perseo V, Puig Sitjes A, Rahbarnia K, Rust N, Schmitz O, Spring A, Stange T, von Stechow A, Turkin Y, Wang E, Wolf R. Wendelstein 7-X on the path to long-pulse high-performance operation. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stöss C, Steffani M, Pergolini I, Hartmann D, Radenkovic D, Novotny A, Friess H, Müller MW. Impact of the COVID-19 Pandemic on Surgical Oncology in Europe: Results of a European Survey. Dig Surg 2021; 38:259-265. [PMID: 34058733 PMCID: PMC8247801 DOI: 10.1159/000515186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The first COVID-19 pandemic wave hit most of the health-care systems worldwide. The present survey aimed to provide a European overview on the COVID-19 impact on surgical oncology. METHODS This anonymous online survey was accessible from April 24 to May 11, 2020, for surgeons (n = 298) who were contacted by the surgical society European Digestive Surgery. The survey was completed by 88 surgeons (29.2%) from 69 different departments. The responses per department were evaluated. RESULTS Of the departments, 88.4% (n = 61/69) reported a lower volume of patients in the outpatient clinic; 69.1% (n = 47/68) and 75.0% (n = 51/68) reported a reduction in hospital bed and the operating room capacity, respectively. As a result, the participants reported an average reduction of 29.3% for all types of oncological resections surveyed in this questionnaire. The strongest reduction was observed for oncological resections of hepato-pancreatico-biliary (HPB) cancers. Of the interviewed surgeons, 68.7% (n = 46/67) agreed that survival outcomes will be negatively impacted by the pandemic. CONCLUSION The first COVID-19 pandemic wave had a significant impact on surgical oncology in Europe. The surveyed surgeons expect an increase in the number of unresectable cancers as well as poorer survival outcomes due to cancellations of follow-ups and postponements of surgeries.
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Affiliation(s)
- Christian Stöss
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcella Steffani
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ilaria Pergolini
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dejan Radenkovic
- Clinic of Digestive Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alexander Novotny
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,*Helmut Friess,
| | - Michael W. Müller
- Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany,Clinical Centre Ludwigsburg-Bietigheim, Clinic of General and Visceral Surgery, Ludwigsburg-Bietigheim, Germany
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Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler E. Line-field optical coherence tomography: In vivo diagnosis of basal cell carcinoma subtypes compared to histopathology. Clin Exp Dermatol 2021; 46:1471-1481. [PMID: 34047380 DOI: 10.1111/ced.14762] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in the general population. Treatments vary from Mohs surgery to topical therapy, depending on the subtype. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have gained a foothold in daily clinical practice to optimize diagnosis and subtype-oriented treatment. The new device Line-field confocal OCT (LC-OCT) allows imaging at high resolution and depth but its use is not yet been investigated in larger studies. OBJECTIVES To evaluate the main LC-OCT criteria for the diagnosis and subtyping of BCC in comparison to histopathology, OCT and RCM. METHODS Fifty-two histopathologically confirmed BCCs were evaluated for imaging criteria. Their frequency, predictive values and ROC curves were calculated. A multinominal regression with stepwise variables selection to distinguish BCC subtypes was performed. RESULTS Nodular BCCs were mainly characterized by atypical keratinocytes, altered DEJ, tumour nests in the dermis, dark clefting, prominent vascularisation and white hyperreflective stroma. Superficial BCCs showed a thickening of the epidermis due to a series of tumour lobules with clear connection to the DEJ (string of pearls pattern). Infiltrative BCCs were characterized by elongated hyporeflective tumour strands, surrounded by bright collagen (shoal of fish). The overall BCC subtype agreement between LC-OCT and conventional histology was 90.4 % (95% CI: 79.0, 96.8). CONCLUSION LC-OCT allows the non-invasive, real time identification of BCCs and their subtypes in vertical, horizontal and 3D mode compared to histology, RCM and OCT. Further larger studies are needed to better explore the clinical applications of this promising device.
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Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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Steffani M, Merz C, Stöß C, Landau L, Hüser N, Hartmann D, Friess H, Theisen J, Novotny A. [Effects of the first COVID-19 wave on visceral surgery : A retrospective comparison of case numbers from a university hospital and a primary care hospital]. Chirurg 2021; 92:559-566. [PMID: 34009441 PMCID: PMC8132278 DOI: 10.1007/s00104-021-01434-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund Während der ersten COVID-19-Pandemiewelle führte die Aussetzung aller elektiven Eingriffe im Zeitraum vom 15.03. bis 15.05.2020 in Deutschland zu einem Rückgang an Operationen. Die Auswirkungen auf die Zahl spezifischer Operationen in der Viszeralchirurgie sind bislang nicht bekannt. Methoden In diese retrospektive Studie wurden 301 Patienten eingeschlossen, die eine Cholezystektomie bzw. Appendektomie an einem Universitätsklinikum oder Krankenhaus der Grund- und Regelversorgung zwischen dem 15.03.2020 und 05.05.2020 (vs. 2018 und 2019) erhielten. Analysiert wurden die Fallzahlen und der klinische Verlauf. Ergebnisse Die Aussetzung des Elektivprogramms führte zu einer signifikanten Reduktion elektiver Cholezystektomien und notfallmäßiger Appendektomien. Am Universitätsklinikum reduzierte sich die Anzahl der Appendektomien von 24 im Jahr 2018 um 33 % auf 16 im Jahr 2020, die Zahl der Cholezystektomien sank von 30 um 57 % auf 13. Am Grundversorger reduzierte sich die Zahl der Appendektomiepatienten von 23 im Jahr 2018 um 48 % auf 12 im Jahr 2020, die Zahl der Cholezystektomien stieg im Jahr 2018 auf 2019 an und sank anschließend um 30 % im Jahr 2020. Die Operationsdauer, Krankenhausverweildauer und der klinische Verlauf der Patienten unterschied sich nicht signifikant zu den Vorjahreszeiträumen. Diskussion Der Lockdown während der ersten COVID-19-Pandemiewelle führte zu einer deutlichen Reduktion häufiger viszeralchirurgischer Eingriffe. Um die medizinische Versorgung der gesamten Bevölkerung während einer Pandemie möglichst auf hohem Niveau zu erhalten, müssen aktuelle Möglichkeiten der operativen und konservativen Therapie, unter anderem abhängig von lokalen Infektionszahlen und den individuellen Komorbiditäten der Patienten, gegeneinander abgewogen werden.
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Affiliation(s)
- Marcella Steffani
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Constanze Merz
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Christian Stöß
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Lars Landau
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Norbert Hüser
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Hartmann
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Jörg Theisen
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Alexander Novotny
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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Dudek M, Pfister D, Donakonda S, Filpe P, Schneider A, Laschinger M, Hartmann D, Hüser N, Meiser P, Bayerl F, Inverso D, Wigger J, Sebode M, Öllinger R, Rad R, Hegenbarth S, Anton M, Guillot A, Bowman A, Heide D, Müller F, Ramadori P, Leone V, Garcia-Caceres C, Gruber T, Seifert G, Kabat AM, Mallm JP, Reider S, Effenberger M, Roth S, Billeter AT, Müller-Stich B, Pearce EJ, Koch-Nolte F, Käser R, Tilg H, Thimme R, Boettler T, Tacke F, Dufour JF, Haller D, Murray PJ, Heeren R, Zehn D, Böttcher JP, Heikenwälder M, Knolle PA. Author Correction: Auto-aggressive CXCR6 + CD8 T cells cause liver immune pathology in NASH. Nature 2021; 593:E14. [PMID: 33972788 DOI: 10.1038/s41586-021-03568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Dudek
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Dominik Pfister
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Sainitin Donakonda
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection Research, Munich, Germany
| | - Pamela Filpe
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Schneider
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Philippa Meiser
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bayerl
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer ResearchCenter Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Wigger
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Silke Hegenbarth
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Adrien Guillot
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Andrew Bowman
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Danijela Heide
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Florian Müller
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Pierluigi Ramadori
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Valentina Leone
- Institute of Virology, Technical University Munich and Helmholtz Zentrum Munich, Munich, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Cristina Garcia-Caceres
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim Gruber
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Agnieszka M Kabat
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Jan-Philipp Mallm
- Division of Chromatin Networks, Single-cell Open Lab, German Cancer Research Center, Heidelberg, Germany
| | - Simon Reider
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.,Christian Doppler Labor for Mucosal Immunology, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Susanne Roth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Edward J Pearce
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael Käser
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Thimme
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Jean-Francois Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dirk Haller
- Chair of Nutrition and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Peter J Murray
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Ron Heeren
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Jan P Böttcher
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Mathias Heikenwälder
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany. .,German Center for Infection Research, Munich, Germany. .,Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany.
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35
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Dudek M, Pfister D, Donakonda S, Filpe P, Schneider A, Laschinger M, Hartmann D, Hüser N, Meiser P, Bayerl F, Inverso D, Wigger J, Sebode M, Öllinger R, Rad R, Hegenbarth S, Anton M, Guillot A, Bowman A, Heide D, Müller F, Ramadori P, Leone V, Garcia-Caceres C, Gruber T, Seifert G, Kabat AM, Mallm JP, Reider S, Effenberger M, Roth S, Billeter AT, Müller-Stich B, Pearce EJ, Koch-Nolte F, Käser R, Tilg H, Thimme R, Boettler T, Tacke F, Dufour JF, Haller D, Murray PJ, Heeren R, Zehn D, Böttcher JP, Heikenwälder M, Knolle PA. Auto-aggressive CXCR6 + CD8 T cells cause liver immune pathology in NASH. Nature 2021; 592:444-449. [PMID: 33762736 DOI: 10.1038/s41586-021-03233-8] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
Nonalcoholic steatohepatitis (NASH) is a manifestation of systemic metabolic disease related to obesity, and causes liver disease and cancer1,2. The accumulation of metabolites leads to cell stress and inflammation in the liver3, but mechanistic understandings of liver damage in NASH are incomplete. Here, using a preclinical mouse model that displays key features of human NASH (hereafter, NASH mice), we found an indispensable role for T cells in liver immunopathology. We detected the hepatic accumulation of CD8 T cells with phenotypes that combined tissue residency (CXCR6) with effector (granzyme) and exhaustion (PD1) characteristics. Liver CXCR6+ CD8 T cells were characterized by low activity of the FOXO1 transcription factor, and were abundant in NASH mice and in patients with NASH. Mechanistically, IL-15 induced FOXO1 downregulation and CXCR6 upregulation, which together rendered liver-resident CXCR6+ CD8 T cells susceptible to metabolic stimuli (including acetate and extracellular ATP) and collectively triggered auto-aggression. CXCR6+ CD8 T cells from the livers of NASH mice or of patients with NASH had similar transcriptional signatures, and showed auto-aggressive killing of cells in an MHC-class-I-independent fashion after signalling through P2X7 purinergic receptors. This killing by auto-aggressive CD8 T cells fundamentally differed from that by antigen-specific cells, which mechanistically distinguishes auto-aggressive and protective T cell immunity.
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Affiliation(s)
- Michael Dudek
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Dominik Pfister
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Sainitin Donakonda
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection Research, Munich, Germany
| | - Pamela Filpe
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Schneider
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Philippa Meiser
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bayerl
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer ResearchCenter Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Wigger
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Silke Hegenbarth
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Adrien Guillot
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Andrew Bowman
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Danijela Heide
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Florian Müller
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Pierluigi Ramadori
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Valentina Leone
- Institute of Virology, Technical University Munich and Helmholtz Zentrum Munich, Munich, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Cristina Garcia-Caceres
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim Gruber
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Agnieszka M Kabat
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Jan-Philipp Mallm
- Division of Chromatin Networks, Single-cell Open Lab, German Cancer Research Center, Heidelberg, Germany
| | - Simon Reider
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.,Christian Doppler Labor for Mucosal Immunology, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Susanne Roth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Edward J Pearce
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael Käser
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Thimme
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Jean-Francois Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dirk Haller
- Chair of Nutrition and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Peter J Murray
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Ron Heeren
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Jan P Böttcher
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Mathias Heikenwälder
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany. .,German Center for Infection Research, Munich, Germany. .,Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany.
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36
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Cheng Z, Lei Z, Jin X, Zhang Q, Si A, Yang P, Zhou J, Hartmann D, Hüser N, Shen F. Postoperative adjuvant transarterial chemoembolization for intrahepatic cholangiocarcinoma patients with microvascular invasion: a propensity score analysis. J Gastrointest Oncol 2021; 12:819-830. [PMID: 34012669 DOI: 10.21037/jgo-20-443] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Microvascular invasion (MVI) is an independent risk factor associated with tumor recurrence and poor survival in patients with intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy (PH). The potential impact of adjuvant TACE on the prognosis of patients with ICC involving MVI (ICC-MVI) remains uncertain. Our aim was to investigate the effectiveness of postoperative adjuvant transarterial chemoembolization (TACE) on ICC involving MVI. Methods Multicentric data consisted of 223 patients who underwent curative-intent PH for ICC-MVI from 2002-2015 were retrospectively analyzed. The impact of adjuvant TACE was evaluated using inverse probability of treatment weighting (IPTW) and propensity-score matched (PSM) analyses. Results No association between the TACE and the overall survival (OS) and recurrence rates was observed among the overall ICC-MVI patients. However, subgroup analyses revealed that adjuvant TACE favored OS (HR, 0.62; 95% CI, 0.39-0.99; P=0.047) and time to recurrence (TTR) (HR, 0.59; 95% CI, 0.36-0.97; P=0.037) among patients with elevated CA19-9 and those without lymphadenectomy (HR, 0.53; 95% CI, 0.30-0.93; P=0.027 for OS, and HR, 0.49; 95% CI, 0.28-0.87; P=0.015 for TTR, respectively). In the CA19-9 ≥39 U/L subgroup and Nx subgroup, adjuvant TACE was associated with higher 1-, 3-, and 5-year OS rates (P=0.033 and P=0.034, respectively) and lower corresponding recurrence rates (P=0.024 and P=0.023, respectively). Conclusions Among the ICC-MVI patients undergoing curative-intent PH, only those have elevated CA19-9 or who did not undergo lymphadenectomy might be suitable for adjuvant TACE.
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Affiliation(s)
- Zhangjun Cheng
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zhengqing Lei
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoling Jin
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Anfeng Si
- Department of Surgical Oncology, Qin Huai Medical District of Eastern Theater General Hospital, Nanjing, China
| | - Pinghua Yang
- Department of Minimally Invasive Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jiahua Zhou
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Feng Shen
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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37
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Hidalgo-Sastre A, Kuebelsbeck LA, Jochheim LS, Staufer LM, Altmayr F, Johannes W, Steiger K, Ronderos M, Hartmann D, Hüser N, Schmid RM, Holzmann B, von Figura G. Toll-like receptor 3 expression in myeloid cells is essential for efficient regeneration after acute pancreatitis in mice. Eur J Immunol 2021; 51:1182-1194. [PMID: 33521935 DOI: 10.1002/eji.202048771] [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: 05/28/2020] [Revised: 11/12/2020] [Accepted: 01/29/2021] [Indexed: 11/09/2022]
Abstract
Stringent regulation of the inflammatory response is crucial for normal tissue regeneration. Here, we analyzed the role of Toll-like receptor 3 (TLR3) in pancreatic regeneration after acute pancreatitis (AP). AP was induced by caerulein treatment in mice with global TLR3 deficiency (TLR3OFF ) or in mice re-expressing TLR3 exclusively in the myeloid cell lineage (TLR3Mye ). Compared to WT mice, TLR3OFF mice had a markedly increased formation of acinar-to-ductal metaplasia (ADM) that persisted until day 7 after initiation of AP. Pancreatic tissue of WT mice was completely regenerated after 5 days with no detectable ADM structures. The enhancing effect of TLR3-deficiency on ADM formation was closely linked with an increased and prolonged accumulation of macrophages in pancreata of TLR3OFF mice. Importantly, the phenotype of TLR3OFF mice was rescued in TLR3Mye mice, demonstrating the causative role of myeloid cell selective TLR3 signaling. Moreover, in vitro stimulation of macrophages through TLR3 initiated cell death by a caspase-8-associated mechanism. Therefore, these findings provide evidence that TLR3 signaling in myeloid cells is sufficient to limit inflammation and ADM formation and to promote regeneration after AP. Notably, resolution of inflammation after AP was associated with macrophage sensitivity to TLR3-mediated cell death.
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Affiliation(s)
- Ana Hidalgo-Sastre
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ludwig A Kuebelsbeck
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonie S Jochheim
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lina M Staufer
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felicitas Altmayr
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Widya Johannes
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Katja Steiger
- Technical University of Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Monica Ronderos
- Technical University of Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Daniel Hartmann
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Norbert Hüser
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Roland M Schmid
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Holzmann
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Guido von Figura
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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38
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Moseev D, Ochoukov R, Bobkov V, Dendy RO, Faugel H, Hartmann D, Kallmeyer JP, Lansky J, Laqua HP, Marsen S, McClements KG, Nielsen SK, Reintrog A, Salewski M, Schmidt BS, Schulz T, Stange T. Development of the ion cyclotron emission diagnostic for the W7-X stellarator. Rev Sci Instrum 2021; 92:033546. [PMID: 33820048 DOI: 10.1063/5.0040944] [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] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
An ion cyclotron emission (ICE) diagnostic is prepared for installation into the W7-X stellarator, with the aim to be operated in the 2022 experimental campaign. The design is based on the successful ICE diagnostic on the ASDEX Upgrade tokamak. The new diagnostic consists of four B-dot probes, mounted about 72° toroidally away (one module) from the neutral beam injector, with an unobstructed plasma view. Two of the B-dot probes are oriented parallel to the local magnetic field, aimed to detect fast magnetosonic waves. The remaining two probes are oriented poloidally, with the aim to detect slow waves. The radio frequency (RF) signals picked up by the probes are transferred via 50 Ω vacuum-compatible coaxial cables to RF detectors. Narrow band notch filters are used to protect the detectors from possible RF waves launched by the W7-X antenna. The signal will be sampled with a four-channel fast analog-to-digital converter with 14 bit depth and 1 GSample/s sampling rate. The diagnostic's phase-frequency characteristic is properly measured in order to allow measuring the wave vectors of the picked up waves.
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Affiliation(s)
- D Moseev
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - R Ochoukov
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - V Bobkov
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - R O Dendy
- Centre for Fusion, Space and Astrophysics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - H Faugel
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - D Hartmann
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - J-P Kallmeyer
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - J Lansky
- Hochschule Stralsund, Stralsund, Germany
| | - H P Laqua
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - S Marsen
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - K G McClements
- Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - S K Nielsen
- Department of Physics, Technical University of Denmark, Kgs., Lyngby, Denmark
| | - A Reintrog
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - M Salewski
- Department of Physics, Technical University of Denmark, Kgs., Lyngby, Denmark
| | - B S Schmidt
- Department of Physics, Technical University of Denmark, Kgs., Lyngby, Denmark
| | - T Schulz
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
| | - T Stange
- Max-Planck-Institut für Plasmaphysik, Greifswald, Garching, Germany
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Begus-Nahrmann Y, Hartmann D, Kraus J, Eshraghi P, Scheffold A, Grieb M, Rasche V, Schirmacher P, Lee HW, Kestler HA, Lechel A, Rudolph KL. Transient telomere dysfunction induces chromosomal instability and promotes carcinogenesis. J Clin Invest 2021; 131:145852. [PMID: 33393513 DOI: 10.1172/jci145852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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40
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Ruini C, Schuh S, Hartmann D, French L, Welzel J, Sattler E. Noninvasive real‐time imaging of mite skin infestations with line‐field confocal optical coherence tomography. Br J Dermatol 2020; 184:e3. [DOI: 10.1111/bjd.19318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Ruini
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University Munich Germany
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
| | - S. Schuh
- Department of Dermatology University Hospital Augsburg Augsburg Germany
| | - D. Hartmann
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University Munich Germany
| | - L. French
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University Munich Germany
| | - J. Welzel
- Department of Dermatology University Hospital Augsburg Augsburg Germany
| | - E. Sattler
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University Munich Germany
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Stöß C, Steffani M, Kohlhaw K, Rudroff C, Staib L, Hartmann D, Friess H, Müller MW. The COVID-19 pandemic: impact on surgical departments of non-university hospitals. BMC Surg 2020; 20:313. [PMID: 33272227 PMCID: PMC7711305 DOI: 10.1186/s12893-020-00970-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 08/19/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background During the first wave of the COVID-19 pandemic, German health care centres were restructured for the treatment of COVID-19 patients. This was accompanied by the suspension of the surgical programme. The aim of the survey was to determine the effects of COVID-19 on surgical care in non-university hospitals in Germany. Methods This cross-sectional study was based on an anonymous online survey, which was accessible from April 24th to May 10th, 2020 for surgeons of the Konvent der leitenden Krankenhauschirurgen (Convention of leading Hospital Surgeons) in Germany. The analysis comprised of 22.8% (n = 148/649) completed surveys. Results Communication and cooperation with authorities, hospital administration and other departments were largely considered sufficient. In the early phase of the COVID-19 pandemic, 28.4% (n = 42/148) of the respondents complained about a short supply of protective equipment available for the hospital staff. 7.4% (n = 11/148) of the participants stated that emergency operations had to be postponed or rescheduled. A decreased quantity of emergency surgical procedures and a decreased number of surgical emergency patients treated in the emergency room was reported in 43.9% (n = 65/148) and 63.5% (n = 94/148), respectively. Consultation and treatment of oncological patients in the outpatient clinic was decreased in 54.1% (n = 80/148) of the surveyed hospitals. To increase the capacity for COVID-19 patients, a reduction of bed and operating room occupancy of 50.8 ± 19.3% and 54.2 ± 19.1% were reported, respectively. Therefore, 90.5% (n = 134/148) of all participants expected a loss of revenue of 28.2 ± 12.9% in 2020. Conclusion The first wave of the COVID-19 pandemic had a significant impact on surgical care in Germany. The reduction in the bed and the operating room capacity may have lead to considerable delays in urgent and semi-elective surgical interventions. In addition to the risk of worsening patient care, we anticipate severe financial damage to the clinics in 2020 and beyond. National and supranational planning is urgently needed to ensure the surgical care of patients during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Christian Stöß
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St 22, 81675, Munich, Germany
| | - Marcella Steffani
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St 22, 81675, Munich, Germany
| | - Kay Kohlhaw
- Clinic of General, Visceral, MIS and Vascular Surgery, Clinical Centre Borna, Borna, Germany
| | - Claudia Rudroff
- Clinic of General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal, Cologne, Germany
| | - Ludger Staib
- Clinic of General and Visceral Surgery, Clinical Centre Esslingen, Esslingen, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St 22, 81675, Munich, Germany.
| | - Michael W Müller
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St 22, 81675, Munich, Germany.,Clinic of General and Visceral Surgery, Clinical Centre Ludwigsburg-Bietigheim, Ludwigsburg, Germany
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42
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Lampl S, Janas MK, Donakonda S, Brugger M, Lohr K, Schneider A, Manske K, Sperl LE, Kläger S, Küster B, Wettmarshausen J, Müller C, Laschinger M, Hartmann D, Hüser N, Perocchi F, Schmitt-Kopplin P, Hagn F, Zender L, Hornung V, Borner C, Pichlmair A, Kashkar H, Klingenspor M, Prinz M, Schreiner S, Conrad M, Jost PJ, Zischka H, Steiger K, Krönke M, Zehn D, Protzer U, Heikenwälder M, Knolle PA, Wohlleber D. Reduced mitochondrial resilience enables non-canonical induction of apoptosis after TNF receptor signaling in virus-infected hepatocytes. J Hepatol 2020; 73:1347-1359. [PMID: 32598967 DOI: 10.1016/j.jhep.2020.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Selective elimination of virus-infected hepatocytes occurs through virus-specific CD8 T cells recognizing peptide-loaded MHC molecules. Herein, we report that virus-infected hepatocytes are also selectively eliminated through a cell-autonomous mechanism. METHODS We generated recombinant adenoviruses and genetically modified mouse models to identify the molecular mechanisms determining TNF-induced hepatocyte apoptosis in vivo and used in vivo bioluminescence imaging, immunohistochemistry, immunoblot analysis, RNAseq/proteome/phosphoproteome analyses, bioinformatic analyses, mitochondrial function tests. RESULTS We found that TNF precisely eliminated only virus-infected hepatocytes independently of local inflammation and activation of immune sensory receptors. TNF receptor I was equally relevant for NF-kB activation in healthy and infected hepatocytes, but selectively mediated apoptosis in infected hepatocytes. Caspase 8 activation downstream of TNF receptor signaling was dispensable for apoptosis in virus-infected hepatocytes, indicating an unknown non-canonical cell-intrinsic pathway promoting apoptosis in hepatocytes. We identified a unique state of mitochondrial vulnerability in virus-infected hepatocytes as the cause for this non-canonical induction of apoptosis through TNF. Mitochondria from virus-infected hepatocytes showed normal biophysical and bioenergetic functions but were characterized by reduced resilience to calcium challenge. In the presence of unchanged TNF-induced signaling, reactive oxygen species-mediated calcium release from the endoplasmic reticulum caused mitochondrial permeability transition and apoptosis, which identified a link between extrinsic death receptor signaling and cell-intrinsic mitochondrial-mediated caspase activation. CONCLUSION Our findings reveal a novel concept in immune surveillance by identifying a cell-autonomous defense mechanism that selectively eliminates virus-infected hepatocytes through mitochondrial permeability transition. LAY SUMMARY The liver is known for its unique immune functions. Herein, we identify a novel mechanism by which virus-infected hepatocytes can selectively eliminate themselves through reduced mitochondrial resilience to calcium challenge.
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Affiliation(s)
- Sandra Lampl
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Marianne K Janas
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Sainitin Donakonda
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Marcus Brugger
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Kerstin Lohr
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Annika Schneider
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Katrin Manske
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Laura E Sperl
- Institute of Structural Biology, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Susan Kläger
- Structural Membrane Biochemistry, Bavarian NMR Center at the Department of Chemistry and Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Bernhard Küster
- Structural Membrane Biochemistry, Bavarian NMR Center at the Department of Chemistry and Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | | | - Constanze Müller
- Research Unit Analytical Biogeochemistry, Helmholtz Zentrum München, Neuherberg, Germany
| | - Melanie Laschinger
- Clinic of Surgery, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Clinic of Surgery, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Norber Hüser
- Clinic of Surgery, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
| | - Fabiana Perocchi
- Research Unit Analytical Biogeochemistry, Helmholtz Zentrum München, Neuherberg, Germany; Munich Cluster for Systems Neurology, Munich, Germany
| | - Philippe Schmitt-Kopplin
- Research Unit Analytical Biogeochemistry, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Analytical Food Chemistry, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Franz Hagn
- Institute of Structural Biology, Helmholtz Zentrum Munich, Neuherberg, Germany; Structural Membrane Biochemistry, Bavarian NMR Center at the Department of Chemistry and Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Lars Zender
- Division of Gastroenterology and Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Veit Hornung
- Center for Integrated Protein Science (CIPSM), Gene Center and Department of Biochemistry, Ludwig-Maximilians-Universität München, München, Germany
| | - Christoph Borner
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Pichlmair
- Institute of Virology, Technical University of Munich, Munich, Germany
| | - Hamid Kashkar
- Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Institute for Microbiology and Hygiene, and Center of Molecular Medicine, University of Cologne, Cologne, Germany
| | - Martin Klingenspor
- Molecular Nutritional Medicine, Else Kröner-Fresenius Center, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Germany
| | - Sabrina Schreiner
- Institute of Virology, Helmholtz-Zentrum München, Neuherberg, Germany
| | - Marcus Conrad
- Institute of Metabolism and Cell Death, Helmhotz Zentrum MUnich, Neuherberg, Germany
| | - Philipp J Jost
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Zischka
- Institute of Molecular Toxicology and Pharmacology, Helmholtz Zentrum München/German Research Center for Environmental Health GmbH, Neuherberg, Germany; Institute of Toxicology and Environmental Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Martin Krönke
- Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Institute for Microbiology and Hygiene, and Center of Molecular Medicine, University of Cologne, Cologne, Germany
| | - Dietmar Zehn
- Institute of Physiology and Immunology, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, Munich, Germany; Institute of Virology, Helmholtz-Zentrum München, Neuherberg, Germany; German Center for Infection research (DZIF), Munich Partner Site, Germany
| | - Mathias Heikenwälder
- Institute of Chronic Inflammation and Cancer, German-Cancer-Research Center, Heidelberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany; Institute of Physiology and Immunology, Technical University of Munich, Freising-Weihenstephan, Germany.
| | - Dirk Wohlleber
- Institute of Molecular Immunology and Experimental Oncology, University Hospital München rechts der Isar; Technical University of Munich, Munich, Germany
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Hamesch K, Guldiken N, Aly M, Hüser N, Hartmann D, Rufat P, Ziol M, Remih K, Lurje G, Scheiner B, Trautwein C, Mandorfer M, Reiberger T, Mueller S, Bruns T, Nahon P, Strnad P. Serum keratin 19 (CYFRA21-1) links ductular reaction with portal hypertension and outcome of various advanced liver diseases. BMC Med 2020; 18:336. [PMID: 33176798 PMCID: PMC7661160 DOI: 10.1186/s12916-020-01784-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Keratins (Ks) represent tissue-specific proteins. K18 is produced in hepatocytes while K19, the most widely used ductular reaction (DR) marker, is found in cholangiocytes and hepatic progenitor cells. K18-based serum fragments are commonly used liver disease predictors, while K19-based serum fragments detected through CYFRA21-1 are established tumor but not liver disease markers yet. Since DR reflects the severity of the underlying liver disease, we systematically evaluated the usefulness of CYFRA21-1 in different liver disease severities and etiologies. METHODS Hepatic expression of ductular keratins (K7/K19/K23) was analyzed in 57 patients with chronic liver disease (cohort i). Serum CYFRA21-1 levels were measured in 333 Austrians with advanced chronic liver disease (ACLD) of various etiologies undergoing hepatic venous pressure gradient (HVPG) measurement (cohort ii), 231 French patients with alcoholic cirrhosis (cohort iii), and 280 hospitalized Germans with decompensated cirrhosis of various etiologies (cohort iv). RESULTS (i) Hepatic K19 levels were comparable among F0-F3 fibrosis stages, but increased in cirrhosis. Hepatic K19 mRNA strongly correlated with the levels of other DR-specific keratins. (ii) In ACLD, increased serum CYFRA21-1 associated with the presence of clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg) (OR = 5.87 [2.95-11.68]) and mortality (HR = 3.02 [1.78-5.13]; median follow-up 22 months). (iii) In alcoholic cirrhosis, elevated serum CYFRA21-1 indicated increased risk of death/liver transplantation (HR = 2.59 [1.64-4.09]) and of HCC (HR = 1.74 [1.02-2.96]) over the long term (median follow-up 73 months). (iv) In decompensated cirrhosis, higher serum CYFRA21-1 predicted 90-day mortality (HR = 2.97 [1.92-4.60]) with a moderate accuracy (AUROC 0.64), independently from established prognostic scores. CONCLUSIONS Hepatic K19 mRNA and serum CYFRA21-1 levels rise in cirrhosis. Increased CYFRA21-1 levels associate with the presence of CSPH and reliably indicate mortality in the short and long term independently of conventional liver biochemistry markers or scoring systems. Hence, the widely available serum CYFRA21-1 constitutes a novel, DR-related marker with prognostic implications in patients with different settings of advanced liver disease.
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Affiliation(s)
- Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Nurdan Guldiken
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mahmoud Aly
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Norbert Hüser
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, 81675, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, 81675, Munich, Germany
| | - Pierre Rufat
- AP-HP, Service d'Biostatistic Hopital Jean Verdier, Bondy, France
| | - Marianne Ziol
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006, Paris, France.,Centre de ressources biologiques du groupe hospitalier Paris-Seine-Saint-Denis, BB0033-00027, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France
| | - Katharina Remih
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital Aachen, Aachen, Germany.,Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum-Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Scheiner
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Tony Bruns
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany.,Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Pierre Nahon
- AP-HP, Service d'Hépatologie, Hopital Jean Verdier, Bondy, France.,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206, Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Stöß C, Haffer H, Steffani M, Pergolini I, Hartmann D, Nitsche U, Novotny A, Friess H, Müller MW. [Effects of the SARS-CoV-2 pandemic on surgery - a national cross-sectional study]. Chirurg 2020; 91:762-768. [PMID: 32776251 PMCID: PMC7416587 DOI: 10.1007/s00104-020-01256-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS From the beginning of the SARS-CoV‑2 pandemic the German healthcare system focused on the treatment of COVID-19 patients. This was accompanied by the suspension of all elective operations. The aim of this study was to investigate the impact of the SARS-CoV‑2 pandemic on general and visceral surgery in university hospitals in Germany. METHODS This cross-sectional study was based on an anonymous survey, which was accessible online from 3 April 2020 to 17 April 2020 for the surgical departments of university hospitals in Germany. In total 73% (n = 29/40) of the hospitals participated in the survey. RESULTS Cooperation with the authorities and the hospital administration was generally considered adequate; however, only 3% (1/29) and 7% (2/29) fully agreed with the statement that the health authorities at the federal and state level, respectively, were supportive of general and visceral surgery. The hospital directors expect an average loss of revenues of 28 ± 16%. There was an average reduction in beds or operating room capacity of 38% and 45%, respectively. In addition, 11% of the medical personnel in general and visceral surgery were reallocated to other departments. CONCLUSION The SARS-CoV‑2 pandemic has a significant impact on academic general and visceral surgery in Germany. The reduction in beds and operating room capacity can lead to considerable delays in urgent surgical interventions and financial burdens in 2020 and subsequent years.
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Affiliation(s)
- Christian Stöß
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Henryk Haffer
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Marcella Steffani
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Ilaria Pergolini
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Hartmann
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Ulrich Nitsche
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Alexander Novotny
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Michael W Müller
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Kaufmann B, Reca A, Wang B, Friess H, Feldstein AE, Hartmann D. Mechanisms of nonalcoholic fatty liver disease and implications for surgery. Langenbecks Arch Surg 2020; 406:1-17. [PMID: 32833053 PMCID: PMC7870612 DOI: 10.1007/s00423-020-01965-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/09/2020] [Indexed: 02/08/2023]
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in both adults and children worldwide. Understanding the pathogenic mechanisms behind NAFLD provides the basis for identifying risk factors, such as metabolic syndrome, pancreatoduodenectomy, and host genetics, that lead to the onset and progression of the disease. The progression from steatosis to more severe forms, such as steatohepatitis, fibrosis, and cirrhosis, leads to an increased number of liver and non-liver complications. Purpose NAFLD-associated end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) often require surgery as the only curative treatment. In particular, the presence of NAFLD together with the coexisting metabolic comorbidities that usually occur in these patients requires careful preoperative diagnosis and peri-/postoperative management. Bariatric surgery, liver resection, and liver transplantation (LT) have shown favorable results for weight loss, HCC, and ESLD in patients with NAFLD. The LT demand and the increasing spread of NAFLD in the donor pool reinforce the already existing lack of donor organs. Conclusion In this review, we will discuss the diverse mechanisms underlying NAFLD, its implications for surgery, and the challenges for patient management.
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Affiliation(s)
- Benedikt Kaufmann
- Department of Pediatric Gastroenterology, University of California San Diego (UCSD), La Jolla, CA, USA.,Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Agustina Reca
- Department of Pediatric Gastroenterology, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Baocai Wang
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Ariel E Feldstein
- Department of Pediatric Gastroenterology, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany.
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Abstract
Clinical Manifestations and Therapeutic Implications of Peritonitis Abstract. Peritonitis is a heterogenous disease, commonly classified into three types. Primary peritonitis, defined by the absence of another directly related intraabdominal abnormality, can often be treated conservatively and is thus distinguished from secondary peritonitis, which results from an independent diagnosis like the perforation or necrosis of an intraabdominal organ and usually requires surgical therapy. The more recently defined tertiary peritonitis is a form of secondary peritonitis that relapses or persists after 48 hours of adequate therapy with no surgically removable focus. This article addresses three important clinical manifestations of peritonitis and their therapeutic implications: spontaneous bacterial peritonitis as the mayor manifestation of primary peritonitis; postoperative peritonitis as a severe subform of secondary peritonitis; and peritoneal dialysis-associated peritonitis as a distinctive clinical picture.
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Affiliation(s)
- Felix Stocker
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland
| | - Daniel Reim
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland
| | - Daniel Hartmann
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland
| | - Alexander Novotny
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Deutschland
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Survival data on timing of resection of liver metastases in colorectal cancer patients. Data Brief 2020; 31:105973. [PMID: 32671166 PMCID: PMC7341369 DOI: 10.1016/j.dib.2020.105973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Between 2007 and 2016, 140 consecutive patients who underwent resection of colorectal cancer with simultaneous liver metastases at a single university hospital were retrospectively analysed. In order to gather information regarding potential survival differences for n = 68 simultaneous versus n = 72 staged resections of the colorectal primary tumor and the liver metastases, Clinical, histopathological, serological, and survival data were compared for those two patient groups. The rate of simultaneous tumor resections increased from approximately 25% in 2007 to >75% in 2016. There was no difference in tumor specific survival for patients with simultaneous vs. staged resection (p = 0.631). This effect continued after excluding patients with extrahepatic metastases (p = 0.440). Further, neoadjuvant treatment did not lead to differences in the tumor-specific survival (p = 0.123). Factors associated with an increased tumor-specific survival were low ASA score (p < 0.001), low number of tumor-affected lymph nodes (p < 0.001), histological grading G1/2 (p = 0.001), and a low number of liver metastases (p = 0.044). There was no significant survival difference for the primary tumor stage (pT), the Clavien-Dindo complication rate, the resection status (R0), and minor versus major hepatectomies.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Simultaneous Versus Staged Resection of Colorectal Cancer Liver Metastasis: A Retrospective Single-Center Study. J Surg Res 2020; 255:346-354. [PMID: 32599454 DOI: 10.1016/j.jss.2020.05.076] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/08/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND For patients with colorectal cancer and synchronous liver metastasis, either a simultaneous, or a two-staged resection of the primary tumor and the liver metastases is possible. There are currently no guidelines preferring one approach to the other. MATERIAL AND METHODS Consecutive patients who underwent hepatic resection at our university hospital from 2007-2016 were included. Clinical, histopathologic, serologic, and survival data were analyzed. The primary end point was tumor-specific survival for patients with simultaneous versus staged resections. RESULTS Of all 140 patients, 68 underwent simultaneous resection and 72 underwent staged resection. The characteristics of both groups were comparable. Patients with simultaneous resections had a shorter duration of cumulative operation time (299 versus 460 min; P = 0.003) and a shorter cumulative length of hospital stay (23 versus 43 d; P = 0.002). Perioperative mortality (P = 0.257) did not differ significantly; however, patients with simultaneous resections had higher rates of grade 2 complications according to Clavien-Dindo (P < 0.001). Tumor-specific 1-y survival was 85 ± 5% for simultaneous and 83 ± 5% for staged resection (P = 0.631). On multivariable analysis, pT4 (P = 0.038), pN3 (P = 0.003), and G3/4 (P = 0.041) of the primary tumor and postoperative complications (Clavien-Dindo 3/4/5, P = 0.003) were poor prognostic factors regarding tumor-specific survival. CONCLUSIONS This is one of the largest and most thoroughly documented retrospective single-center studies of consecutive patients with synchronous hepatic metastases. Simultaneous resection of colorectal cancer together with hepatic metastases is a safe procedure in selected patients and does not have a significant influence on long-term survival.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Stöß C, Laschinger M, Wang B, Lu M, Altmayr F, Hartmann D, Hüser N, Holzmann B. TLR3 promotes hepatocyte proliferation after partial hepatectomy by stimulating uPA expression and the release of tissue-bound HGF. FASEB J 2020; 34:10387-10397. [PMID: 32539223 DOI: 10.1096/fj.202000904r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/15/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
TLR3 is implicated in anti-viral immune responses, but may also act as a sensor of tissue damage in the absence of infection. Here, we provide evidence for an essential role of TLR3 in liver regeneration after an acute loss of tissue due to partial hepatectomy. Mice lacking TLR3 had a severe and sustained defect in the restoration of liver tissue with reduced liver-to-body weight ratios even after an extended recovery period of 2 weeks. Hepatocyte cell cycle progression into S phase was impaired in TLR3-deficient mice. Mechanistic analyses revealed that TLR3-deficient mice had markedly reduced systemic levels of active HGF, but had increased amounts of inactive tissue-bound HGF. Importantly, expression of uPA, which orchestrates the processing and release of HGF from the hepatic extracellular matrix, was reduced in regenerating livers of TLR3-deficient mice. In addition, expression of the HGF maturation factor HGFAC was transiently diminished in TLR3-deficient mice. In vitro, engagement of TLR3 directly stimulated expression of uPA by hepatic stellate cells. Thus, TLR3 supports liver regeneration through upregulation of uPA, which promotes the release of preformed HGF from extracellular matrix stores.
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Affiliation(s)
- Christian Stöß
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Baocai Wang
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Miao Lu
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felicitas Altmayr
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Holzmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
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50
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Affiliation(s)
- Markus Peck-Radosavljevic
- Internal Medicine & Gastroenterology including Centralized Emergency Service, Klinikum Klagenfurt am Wörtersee, Klagenfurt, Austria
| | - Silvio Danese
- IBD Centre, Department of Gastroenterology, IRCCS Humanitas Research Hospital and Hunimed Rozzano, Milan, Italy
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar Technische Universität Munich, Munich, Germany
| | - Adrian Saftoiu
- University of Medicine and Pharmacy Craiova, Research Centre of Gastroenterology and Hepatology Craiova, Romania.,Department of Gastroenterology, Ponderas Academic Hospital Bucharest, Bucharest, Romania
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