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Schoeb D, Suarez-Ibarrola R, Hein S, Dressler FF, Adams F, Schlager D, Miernik A. Use of Artificial Intelligence for Medical Literature Search: Randomized Controlled Trial Using the Hackathon Format. Interact J Med Res 2020; 9:e16606. [PMID: 32224481 PMCID: PMC7154940 DOI: 10.2196/16606] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/24/2019] [Accepted: 12/15/2019] [Indexed: 12/17/2022] Open
Abstract
Background Mapping out the research landscape around a project is often time consuming and difficult. Objective This study evaluates a commercial artificial intelligence (AI) search engine (IRIS.AI) for its applicability in an automated literature search on a specific medical topic. Methods To evaluate the AI search engine in a standardized manner, the concept of a science hackathon was applied. Three groups of researchers were tasked with performing a literature search on a clearly defined scientific project. All participants had a high level of expertise for this specific field of research. Two groups were given access to the AI search engine IRIS.AI. All groups were given the same amount of time for their search and were instructed to document their results. Search results were summarized and ranked according to a predetermined scoring system. Results The final scoring awarded 49 and 39 points out of 60 to AI groups 1 and 2, respectively, and the control group received 46 points. A total of 20 scientific studies with high relevance were identified, and 5 highly relevant studies (“spot on”) were reported by each group. Conclusions AI technology is a promising approach to facilitate literature searches and the management of medical libraries. In this study, however, the application of AI technology lead to a more focused literature search without a significant improvement in the number of results.
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Affiliation(s)
- Dominik Schoeb
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Hein
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franz Friedrich Dressler
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Adams
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Schlager
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Medical Center - Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Choi E, Adams F, Palagi S, Gengenbacher A, Schlager D, Müller PF, Gratzke C, Miernik A, Fischer P, Qiu T. A High-Fidelity Phantom for the Simulation and Quantitative Evaluation of Transurethral Resection of the Prostate. Ann Biomed Eng 2019; 48:437-446. [PMID: 31535249 PMCID: PMC6928096 DOI: 10.1007/s10439-019-02361-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/01/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
Transurethral resection of the prostate (TURP) is a minimally invasive endoscopic procedure that requires experience and skill of the surgeon. To permit surgical training under realistic conditions we report a novel phantom of the human prostate that can be resected with TURP. The phantom mirrors the anatomy and haptic properties of the gland and permits quantitative evaluation of important surgical performance indicators. Mixtures of soft materials are engineered to mimic the physical properties of the human tissue, including the mechanical strength, the electrical and thermal conductivity, and the appearance under an endoscope. Electrocautery resection of the phantom closely resembles the procedure on human tissue. Ultrasound contrast agent was applied to the central zone, which was not detectable by the surgeon during the surgery but showed high contrast when imaged after the surgery, to serve as a label for the quantitative evaluation of the surgery. Quantitative criteria for performance assessment are established and evaluated by automated image analysis. We present the workflow of a surgical simulation on a prostate phantom followed by quantitative evaluation of the surgical performance. Surgery on the phantom is useful for medical training, and enables the development and testing of endoscopic and minimally invasive surgical instruments.
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Affiliation(s)
- Eunjin Choi
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Fabian Adams
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefano Palagi
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Anina Gengenbacher
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Philippe-Fabian Müller
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Peer Fischer
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.,Institute for Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
| | - Tian Qiu
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany. .,Institute for Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.
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Adams F, Pschenitza M, Rieger B. Yttrium‐Catalyzed Synthesis of Bipyridine‐Functionalized AB‐Block Copolymers: Micellar Support for Photocatalytic Active Rhenium‐Complexes. ChemCatChem 2018. [DOI: 10.1002/cctc.201801009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- F. Adams
- WACKER-Lehrstuhl für Makromolekulare Chemie Catalysis Research Center Department of ChemistryTechnische Universität München Lichtenbergstr. 4 Garching bei München 85748 Germany
| | - M. Pschenitza
- WACKER-Lehrstuhl für Makromolekulare Chemie Catalysis Research Center Department of ChemistryTechnische Universität München Lichtenbergstr. 4 Garching bei München 85748 Germany
| | - B. Rieger
- WACKER-Lehrstuhl für Makromolekulare Chemie Catalysis Research Center Department of ChemistryTechnische Universität München Lichtenbergstr. 4 Garching bei München 85748 Germany
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Wilhelm K, Miernik A, Hein S, Schlager D, Adams F, Benndorf M, Fritz B, Langer M, Hesse A, Schoenthaler M, Neubauer J. Validating Automated Kidney Stone Volumetry in CT and Mathematical Correlation with Estimated Stone Volume Based on Diameter. J Endourol 2018; 32:659-664. [DOI: 10.1089/end.2018.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Konrad Wilhelm
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Hein
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Schlager
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Adams
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Benndorf
- Department of Radiology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Fritz
- Department of Radiology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mathias Langer
- Department of Radiology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Martin Schoenthaler
- Clinic of Urology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Neubauer
- Department of Radiology, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Qiu T, Adams F, Palagi S, Melde K, Mark A, Wetterauer U, Miernik A, Fischer P. Wireless Acoustic-Surface Actuators for Miniaturized Endoscopes. ACS Appl Mater Interfaces 2017; 9:42536-42543. [PMID: 29148713 PMCID: PMC5730945 DOI: 10.1021/acsami.7b12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Endoscopy enables minimally invasive procedures in many medical fields, such as urology. However, current endoscopes are normally cable-driven, which limits their dexterity and makes them hard to miniaturize. Indeed, current urological endoscopes have an outer diameter of about 3 mm and still only possess one bending degree-of-freedom. In this article, we report a novel wireless actuation mechanism that increases the dexterity and that permits the miniaturization of a urological endoscope. The novel actuator consists of thin active surfaces that can be readily attached to any device and are wirelessly powered by ultrasound. The surfaces consist of two-dimensional arrays of microbubbles, which oscillate under ultrasound excitation and thereby generate an acoustic streaming force. Bubbles of different sizes are addressed by their unique resonance frequency, thus multiple degrees-of-freedom can readily be incorporated. Two active miniaturized devices (with a side length of around 1 mm) are demonstrated: a miniaturized mechanical arm that realizes two degrees-of-freedom, and a flexible endoscope prototype equipped with a camera at the tip. With the flexible endoscope, an active endoscopic examination is successfully performed in a rabbit bladder. The results show the potential medical applicability of surface actuators wirelessly powered by ultrasound penetrating through biological tissues.
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Affiliation(s)
- Tian Qiu
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
| | - Fabian Adams
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
- Department of Urology, University Medical
Centre Freiburg, 79106 Freiburg, Germany
| | - Stefano Palagi
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
| | - Kai Melde
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
| | - Andrew Mark
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
| | - Ulrich Wetterauer
- Department of Urology, University Medical
Centre Freiburg, 79106 Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical
Centre Freiburg, 79106 Freiburg, Germany
| | - Peer Fischer
- Max Planck Institute
for Intelligent Systems, 70569 Stuttgart, Germany
- Institute of Physical
Chemistry, University of Stuttgart, 70569 Stuttgart, Germany
- E-mail:
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Casanova F, Adingupu DD, Adams F, Gooding KM, Looker HC, Aizawa K, Dove F, Elyas S, Belch JJF, Gates PE, Littleford RC, Gilchrist M, Colhoun HM, Shore AC, Khan F, Strain WD. The impact of cardiovascular co-morbidities and duration of diabetes on the association between microvascular function and glycaemic control. Cardiovasc Diabetol 2017; 16:114. [PMID: 28915818 PMCID: PMC5603035 DOI: 10.1186/s12933-017-0594-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/08/2017] [Accepted: 09/04/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Good glycaemic control in type 2 diabetes (T2DM) protects the microcirculation. Current guidelines suggest glycaemic targets be relaxed in advanced diabetes. We explored whether disease duration or pre-existing macrovascular complications attenuated the association between hyperglycaemia and microvascular function. METHODS 743 participants with T2DM (n = 222), cardiovascular disease (CVD = 183), both (n = 177) or neither (controls = 161) from two centres in the UK, underwent standard clinical measures and endothelial dependent (ACh) and independent (SNP) microvascular function assessment using laser Doppler imaging. RESULTS People with T2DM and CVD had attenuated ACh and SNP responses compared to controls. This was additive in those with both (ANOVA p < 0.001). In regression models, cardiovascular risk factors accounted for attenuated ACh and SNP responses in CVD, whereas HbA1c accounted for the effects of T2DM. HbA1c was associated with ACh and SNP response after adjustment for cardiovascular risk factors (adjusted standardised beta (β) -0.096, p = <0.008 and -0.135, p < 0.001, respectively). Pre-existing CVD did not modify this association (β -0.099; p = 0.006 and -0.138; p < 0.001, respectively). Duration of diabetes accounted for the association between HbA1c and ACh (β -0.043; p = 0.3), but not between HbA1c and SNP (β -0.105; p = 0.02). CONCLUSIONS In those with T2DM and CVD, good glycaemic control is still associated with better microvascular function, whereas in those with prolonged disease this association is lost. This suggests duration of diabetes may be a better surrogate for "advanced disease" than concomitant CVD, although this requires prospective validation.
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Affiliation(s)
- F Casanova
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - D D Adingupu
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Adams
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - K M Gooding
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - H C Looker
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - K Aizawa
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Dove
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - S Elyas
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - J J F Belch
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - P E Gates
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - R C Littleford
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - M Gilchrist
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - H M Colhoun
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - A C Shore
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK
| | - F Khan
- Vascular and Inflammatory Diseases Research Unit, Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
| | - W D Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Rd, Exeter, EX2 5AX, UK.
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Schlager D, Maas M, Hein S, Adams F, Schoenthaler M, Spittau B, Wetterauer U, Miernik A. Is Endoscopic Vasectomy Just a Dream: An ex vivo Study on Feasibility and Reliability of Endoluminal Occlusion of Porcine Vas Deferens. Urol Int 2017; 99:467-475. [PMID: 28813710 DOI: 10.1159/000478790] [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: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM Surgical vasectomy remains the gold standard for fertility control in men. Endoluminal occlusion of the seminal ducts, thus avoiding an external incision, may become an appealing alternative to this approach. As our group has shown, nontraumatic endoscopic inspection of the seminal ducts is feasible in the human cadaver. We investigated the feasibility and reliability of occlusion using several commercially available medical sealing agents in the porcine vas deferens (VD). METHODS AND MAIN OUTCOME MEASURES Tests were conducted using 25 porcine spermatic ducts (10 cm length) ex vivo. The explanted specimens were fixed and cannulated using the Seldinger technique. We administered 5 different agents (n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with a platinum vascular coil, Tissucol Duo S®, Gelita Spon® and AFP Plug®) endoluminally. Tightness was evaluated after 5, 15, 60, 360, 720, and 1,440 min for each of the five grades, respectively, using a solution of methylene blue and saline injected under controlled pressure of 300 mm Hg followed by histological examination. RESULTS All agents were administered into the porcine seminal ducts (4 out of 5 via a ureteric catheter). Gelita Spon® and Tissucol Duo S® did not occlude the lumen sufficiently, whereas n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with coil, Tissucol Duo and AFP Plug® performed satisfactorily. In particular, cyanoacrylate combined with a coil was able to close the seminal duct tightly and for a long time. Histological findings confirmed this sealant's gapless adhesion. AFP Plug® application revealed similarly good results. However, its form needs to be optimized to ensure its suitability for endoscopic use. CONCLUSION Various developments regarding minimally invasive fertility control methods have been underway for decades. Further miniaturization of endoscopy and novel materials may pave the way for endoscopic fertility control in males in the future. We demonstrated the potential of commercially available medical sealing agents to reliably occlude the porcine VD.
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Affiliation(s)
- Daniel Schlager
- Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Adams F, Schoelly R, Schlager D, Schoenthaler M, Schoeb DS, Wilhelm K, Hein S, Wetterauer U, Miernik A. Algorithm-Based Motion Magnification for Video Processing in Urological Laparoscopy. J Endourol 2017; 31:583-587. [PMID: 28330382 DOI: 10.1089/end.2016.0882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Minimally invasive surgery is in constant further development and has replaced many conventional operative procedures. If vascular structure movement could be detected during these procedures, it could reduce the risk of vascular injury and conversion to open surgery. The recently proposed motion-amplifying algorithm, Eulerian Video Magnification (EVM), has been shown to substantially enhance minimal object changes in digitally recorded video that is barely perceptible to the human eye. We adapted and examined this technology for use in urological laparoscopy. MATERIALS AND METHODS Video sequences of routine urological laparoscopic interventions were recorded and further processed using spatial decomposition and filtering algorithms. The freely available EVM algorithm was investigated for its usability in real-time processing. In addition, a new image processing technology, the CRS iimotion Motion Magnification (CRSMM) algorithm, was specifically adjusted for endoscopic requirements, applied, and validated by our working group. RESULTS Using EVM, no significant motion enhancement could be detected without severe impairment of the image resolution, motion, and color presentation. The CRSMM algorithm significantly improved image quality in terms of motion enhancement. In particular, the pulsation of vascular structures could be displayed more accurately than in EVM. CONCLUSIONS Motion magnification image processing technology has the potential for clinical importance as a video optimizing modality in endoscopic and laparoscopic surgery. Barely detectable (micro)movements can be visualized using this noninvasive marker-free method. Despite these optimistic results, the technology requires considerable further technical development and clinical tests.
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Affiliation(s)
- Fabian Adams
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany .,2 Department for Intelligent Systems, Micro, Nano, and Molecular Systems Lab, Max Planck Institute , Stuttgart, Germany
| | - Reto Schoelly
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany .,3 Department of Microsystems Engineering, University of Freiburg , Freiburg, Germany
| | - Daniel Schlager
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Martin Schoenthaler
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Dominik S Schoeb
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Konrad Wilhelm
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Simon Hein
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Ulrich Wetterauer
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
| | - Arkadiusz Miernik
- 1 Department of Urology, University Medical Center Freiburg , Freiburg, Germany
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Schlager D, Maas M, Hein S, Adams F, Schoenthaler M, Wetterauer U, Diemer T, Weidner W, Miernik A. Flexible Vesiculovasoscopy Using a Microoptical System in a Human Cadaver Model: An Experimental Approach for Atraumatic Endoscopy of the Seminal Tract. J Endourol 2016; 30:934-8. [PMID: 27166434 DOI: 10.1089/end.2016.0264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The most common pathologies of the seminal tract are persistent hematospermia, seminal vesicle stones, and seminal duct obstruction. Endoscopic diagnostic work-up of the seminal tract is impeded by complex anatomy and lack of technical equipment. To date, there is no standardized endoscopic approach. The purpose of this study was to investigate the applicability and feasibility of a flexible microoptical device for atraumatic endoscopy of the seminal tract in a male human cadaver. MATERIALS AND METHODS The transurethral endoscopic examination was performed on a male cadaver. No premortal interventions or diseases of the genitourinary tract had been reported. The seminal orifice was identified via cystoscopy and accessed by the Seldinger technique using a hydrophilic guidewire and ureteral catheter. Retrograde endoscopic inspection of the distal seminal tract was performed using a miniaturized flexible endoscope. An antegrade endoscopic inspection of the seminal tract was carried out via high scrotal access to the vas deferens. RESULTS Structures of the seminal tract, such as the ejaculatory duct, seminal vesicles, and distal portion of the ductus deferentes, were visualized using the miniaturized endoscope. Image quality allowed identification of anatomical structures and characterization of tissue properties. The technical limitations we observed involved the system's maneuverability. CONCLUSIONS Initial results of this novel endoscopic approach to the seminal tract using a flexible microoptical system are encouraging. However, considerable anatomical limitations of the targeted organs necessitate further refinements of the technical equipment. This approach might improve diagnostics and treatment of genitourinary diseases. Future surgical techniques may include intraseminal laser therapy or endoocclusion to monitor fertility in men.
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Affiliation(s)
- Daniel Schlager
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Moritz Maas
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Simon Hein
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Fabian Adams
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Martin Schoenthaler
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Ulrich Wetterauer
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
| | - Thorsten Diemer
- 2 Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen , Giessen, Germany
| | - Wolfgang Weidner
- 2 Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen , Giessen, Germany
| | - Arkadiusz Miernik
- 1 Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg , Freiburg, Germany
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Hein S, Miernik A, Wilhelm K, Schlager D, Schoeb DS, Adams F, Vach W, Schoenthaler M. Endoscopically Determined Stone Clearance Predicts Disease Recurrence Within 5 Years After Retrograde Intrarenal Surgery. J Endourol 2016; 30:644-9. [PMID: 27021947 DOI: 10.1089/end.2016.0101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess stone-related events (SREs) requiring retreatment in a series of 100 consecutive patients treated by retrograde intrarenal surgery (RIRS) for renal stones and to evaluate potential risk factors thereof. PATIENTS AND METHODS The primary outcome was incidence of SRE (medical or surgical treatment). Secondary outcomes included side of SRE, time to SRE, and late complications. Analysis of potential risk factors included high-risk stone formers (HRSFs), obesity, high stone burden, and lower pole stones. In addition, we evaluated endoscopically determined small residual fragments (SRF) of <1 mm (i.e., fragments too small for retrieval) as an independent risk factor. RESULTS Eighty-five of the 99 patients were followed up for a mean of 59 months (31-69), among whom 26 (30.1%) had SRE. Thirty-four of the 85 (40%) patients were HRSFs, 22 of whom experienced SRE (both sides) during follow-up (64.7%, p < 0.001). Eight of the 17 patients (47.1%) with SRF experienced ipsilateral side SRE compared with 13 (19.1%) of the 68 without SRF (p = 0.022, hazard ratio 2.823, 95% confidence interval [95% CI] 1.16, 6.85). Risk for ipsilateral SRE was unaffected by the presence of SRF among HRSFs (p = 0.561). Of low-risk patients with SRF, 33.3% experienced ipsilateral SRE, while those without SRF experienced no ipsilateral SRE (p < 0.001). CONCLUSION Endoscopically determined stone clearance predicts disease recurrence within 5 years after RIRS. Even SRF are an important risk factor for future stone-related (ipsilateral) events; therefore, patients with residual fragments of any size should not be labeled "stone free" and endoscopic stone treatment should aim at complete stone clearance.
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Affiliation(s)
- Simon Hein
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Arkadiusz Miernik
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Konrad Wilhelm
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Daniel Schlager
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dominik Stefan Schoeb
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Adams
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Werner Vach
- 2 Center for Medical Biometry and Medical Informatics, University of Freiburg , Freiburg, Germany
| | - Martin Schoenthaler
- 1 Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Adams F, Qiu T, Fritz B, Pollak S, Miernik A, Wetterauer U, Fischer P. 358 Experimental 3D-printed kidney model based on medical imaging data of human cadavers for educational and surgery planning purposes. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adams F, Altenbuchner PT, Werz PDL, Rieger B. Multiresponsive micellar block copolymers from 2-vinylpyridine and dialkylvinylphosphonates with a tunable lower critical solution temperature. RSC Adv 2016. [DOI: 10.1039/c6ra17160e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tailor-made, multi-responsive micellar AB and ABB′ block copolymers show a pH-sensitivity and a tunable LCST within an expanded temperature range.
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Affiliation(s)
- F. Adams
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85747 Garching bei München
- Germany
| | - P. T. Altenbuchner
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85747 Garching bei München
- Germany
| | - P. D. L. Werz
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85747 Garching bei München
- Germany
| | - B. Rieger
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85747 Garching bei München
- Germany
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Wilhelm K, Schoenthaler M, Hein S, Adams F, Schlager D, Kuehhas FE, Sevcenco S, Pache G, Langer M, Bulla S, Miernik A. Reply. Urology 2016; 86:1102-3. [PMID: 26719112 DOI: 10.1016/j.urology.2015.06.055] [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: 11/27/2022]
Affiliation(s)
- Konrad Wilhelm
- Department of Urology, University Medical Center, Freiburg, Germany
| | | | - Simon Hein
- Department of Urology, University Medical Center, Freiburg, Germany
| | - Fabian Adams
- Department of Urology, University Medical Center, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Center, Freiburg, Germany
| | | | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Wien, Austria
| | - Gregor Pache
- Department of Radiology, University Medical Center, Freiburg, Germany
| | - Mathias Langer
- Department of Radiology, University Medical Center, Freiburg, Germany
| | - Stefan Bulla
- Department of Radiology, University Medical Center, Freiburg, Germany
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Schoenthaler M, Miernik A, Wilhelm K, Schlager D, Schoeb DS, Adams F, Dahm P, Hein S. Level of evidence, sponsorship, conflict of interest policy and commercial impact of PubMed-listed clinical urolithiasis-related trials in 2014. BJU Int 2015; 117:787-92. [DOI: 10.1111/bju.13387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Arkadiusz Miernik
- Department of Urology; University Medical Centre Freiburg; Freiburg Germany
| | - Konrad Wilhelm
- Department of Urology; University Medical Centre Freiburg; Freiburg Germany
| | - Daniel Schlager
- Department of Urology; University Medical Centre Freiburg; Freiburg Germany
| | | | - Fabian Adams
- Department of Urology; University Medical Centre Freiburg; Freiburg Germany
| | - Philipp Dahm
- Department of Urology; University of Minnesota; Minneapolis MN USA
| | - Simon Hein
- Department of Urology; University Medical Centre Freiburg; Freiburg Germany
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Hein S, Miernik A, Wilhelm K, Adams F, Schlager D, Herrmann TRW, Rassweiler JJ, Schoenthaler M. Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them. World J Urol 2015; 34:771-8. [PMID: 26497824 DOI: 10.1007/s00345-015-1713-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/12/2015] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Residual fragments are common after stone treatment. Little is known about clinical outcomes relevant to the patient. This comprehensive review of the literature highlights the impact of residual fragments, modes of detection, and treatment strategies to avoid residual fragments in shock wave therapy, ureteroscopy, and percutaneous nephrolithotomy. METHODS A comprehensive review of current literature was performed using PubMed(®), MEDLINE(®), Embase™, Ovid(®), Google Scholar™, and the Cochrane Library. Publications relevant to the subject were retrieved and critically appraised. RESULTS Residual fragments after treatment for urinary stones have a significant impact on a patient's well-being and future course. (Ultra-) low-dose non-contrast computed tomography detects small residuals most reliably. In shock wave lithotripsy, adherence to basic principles helps to improve results. Various techniques and devices facilitate complete stone clearance in conventional and miniaturized percutaneous nephrolithotomy and (flexible) ureteroscopy. Promising new technologies in shock waves, lasers, and robotics (and potentially microrobotics) are on the horizon. CONCLUSIONS Residual fragments are relevant to patients. Contemporary treatment of urolithiasis should aim at complete stone clearance.
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Affiliation(s)
- Simon Hein
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Konrad Wilhelm
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Fabian Adams
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Thomas R W Herrmann
- Department of Urology and Urooncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens J Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20 - 26, 74078, Heilbronn, Germany
| | - Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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16
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Wilhelm K, Schoenthaler M, Hein S, Adams F, Schlager D, Kuehhas FE, Sevcenco S, Pache G, Langer M, Bulla S, Miernik A. Focused Dual-energy CT Maintains Diagnostic and Compositional Accuracy for Urolithiasis Using Ultralow-dose Noncontrast CT. Urology 2015; 86:1097-102. [PMID: 26383612 DOI: 10.1016/j.urology.2015.06.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/05/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a new energy and radiation dose-reduced protocol for noncontrast computed tomography (NCCT) with dual-energy CT (DECT) analysis and its potential for the compositional analysis of uric acid (UA)- or non-uric acid (N-UA)-containing calculi. METHODS A retrospective evaluation was carried out in 61 patients who underwent dose-reduced DECT (tube A: 140 kV/55 mAs; tube B: 80 kV/303 mAs) with a tube current 38.8% lower than that set by the manufacturer. A protocol combining low-dose CT and targeted DE scans was used. Urinary stones were detected and classified as UA- or N-UA-containing or mixed based on DE software results. The accuracy of the compositional analysis was controlled by correlation with conventional infrared-based analysis. RESULTS The compositional stone differentiation was correct in 58 of 61 (95.1%) patients. The sensitivity of detecting pure UA-containing and pure N-UA-containing stones was 100%. The specificity of detecting UA- and pure N-UA-containing stones was 100% and 78.57%, respectively, as 3 of 7 mixed urinary stones (small fragments <4 mm) were classified as N-UA calculi. The total radiation dose in patients with body mass index <25 and >25 kg/m(2) was 1.2 and 2.5 mSv, respectively. CONCLUSION Lowering the DECT tube current by up to 38% of the manufacturer's recommendations allows a reduced radiation dose without impairing detection accuracy and stone compositional analysis. Compared with previous studies, this protocol might significantly decrease patient radiation exposure without affecting the quality of results.
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Affiliation(s)
- Konrad Wilhelm
- Department of Urology, University Medical Center, Freiburg, Germany.
| | | | - Simon Hein
- Department of Urology, University Medical Center, Freiburg, Germany
| | - Fabian Adams
- Department of Urology, University Medical Center, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Center, Freiburg, Germany
| | | | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Wien, Austria
| | - Gregor Pache
- Department of Radiology, University Medical Center, Freiburg, Germany
| | - Mathias Langer
- Department of Radiology, University Medical Center, Freiburg, Germany
| | - Stefan Bulla
- Department of Radiology, University Medical Center, Freiburg, Germany
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Shore AC, Colhoun HM, Natali A, Palombo C, Östling G, Aizawa K, Kennbäck C, Casanova F, Persson M, Gooding K, Gates PE, Khan F, Looker HC, Adams F, Belch J, Pinnoli S, Venturi E, Morizzo C, Goncalves I, Ladenvall C, Nilsson J. Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study. J Intern Med 2015; 278:291-302. [PMID: 25752315 DOI: 10.1111/joim.12359] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 12/16/2022]
Abstract
BACKGROUND There is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. METHODS Vascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. RESULTS Carotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction. CONCLUSIONS Measures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D.
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Affiliation(s)
- A C Shore
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - H M Colhoun
- Medical Research Institute, University of Dundee, Dundee, UK
| | - A Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - G Östling
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - K Aizawa
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - C Kennbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Casanova
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - M Persson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - K Gooding
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - P E Gates
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - F Khan
- Medical Research Institute, University of Dundee, Dundee, UK
| | - H C Looker
- Medical Research Institute, University of Dundee, Dundee, UK
| | - F Adams
- Medical Research Institute, University of Dundee, Dundee, UK
| | - J Belch
- Medical Research Institute, University of Dundee, Dundee, UK
| | - S Pinnoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Venturi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Morizzo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - I Goncalves
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - C Ladenvall
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - J Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Affiliation(s)
- F Adams
- Division of Neuropsychiatric Oncology, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
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Ardelt PU, Ebbing J, Adams F, Reiss C, Arap W, Pasqualini R, Bachmann A, Wetterauer U, Riedmiller H, Kneitz B. An anti-ubiquitin antibody response in transitional cell carcinoma of the urinary bladder. PLoS One 2015; 10:e0118646. [PMID: 25742283 PMCID: PMC4351094 DOI: 10.1371/journal.pone.0118646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/08/2015] [Indexed: 12/05/2022] Open
Abstract
Background To use combinatorial epitope mapping (“fingerprinting”) of the antibody response to identify targets of the humoral immune response in patients with transitional cell carcinoma (TCC) of the bladder. Methods A combinatorial random peptide library was screened on the circulating pool of immunoglobulins purified from an index patient with a high risk TCC (pTa high grade plus carcinoma in situ) to identify corresponding target antigens. A patient cohort was investigated for antibody titers against ubiquitin. Results We selected, isolated, and validated an immunogenic peptide motif from ubiquitin as a dominant epitope of the humoral response. Patients with TCC had significantly higher antibody titers against ubiquitin than healthy donors (p<0.007), prostate cancer patients (p<0.0007), and all patients without TCC taken together (p<0.0001). Titers from superficial tumors were not significantly different from muscle invasive tumors (p = 0.0929). For antibody response against ubiquitin, sensitivity for detection of TCC was 0.44, specificity 0.96, positive predictive value 0.96 and negative predictive value 0.41. No significant titer changes were observed during the standard BCG induction immunotherapy. Conclusions This is the first report to demonstrate an anti-ubiquitin antibody response in patients with TCC. Although sensitivity of antibody production was low, a high specificity and positive predictive value make ubiquitin an interesting candidate for further diagnostic and possibly immune modulating studies.
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Affiliation(s)
- Peter U. Ardelt
- Department of Urology, University Hospital Basel, Basel, Switzerland
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
- * E-mail:
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Fabian Adams
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Cora Reiss
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Wadih Arap
- Division of Hematology/Oncology and Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Renata Pasqualini
- Division of Hematology/Oncology and Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | | | - Ulrich Wetterauer
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Hubertus Riedmiller
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
| | - Burkhard Kneitz
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
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Witham MD, Adams F, McSwiggan S, Kennedy G, Kabir G, Belch JJF, Khan F. Effect of intermittent vitamin D3 on vascular function and symptoms in chronic fatigue syndrome--a randomised controlled trial. Nutr Metab Cardiovasc Dis 2015; 25:287-294. [PMID: 25455721 DOI: 10.1016/j.numecd.2014.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 08/02/2014] [Revised: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Low 25-hydroxyvitamin D levels are common in patients with chronic fatigue syndrome; such patients also manifest impaired vascular health. We tested whether high-dose intermittent oral vitamin D therapy improved markers of vascular health and fatigue in patients with chronic fatigue syndrome. METHODS AND RESULTS Parallel-group, double-blind, randomised placebo-controlled trial. Patients with chronic fatigue syndrome according to the Fukuda (1994) and Canadian (2003) criteria were randomised to receive 100,000 units oral vitamin D3 or matching placebo every 2 months for 6 months. The primary outcome was arterial stiffness measured using carotid-femoral pulse wave velocity at 6 months. Secondary outcomes included flow-mediated dilatation of the brachial artery, blood pressure, cholesterol, insulin resistance, markers of inflammation and oxidative stress, and the Piper Fatigue scale. As many as 50 participants were randomised; mean age 49 (SD 13) years, mean baseline pulse wave velocity 7.8 m/s (SD 2.3), mean baseline office blood pressure 128/78 (18/12) mmHg and mean baseline 25-hydroxyvitamin D level 46 (18) nmol/L. 25-hydroxyvitamin D levels increased by 22 nmol/L at 6 months in the treatment group relative to placebo. There was no effect of treatment on pulse wave velocity at 6 months (adjusted treatment effect 0.0 m/s; 95% CI -0.6 to 0.6; p = 0.93). No improvement was seen in other vascular and metabolic outcomes, or in the Piper Fatigue scale at 6 months (adjusted treatment effect 0.2 points; 95% CI -0.8 to 1.2; p = 0.73). CONCLUSION High-dose oral vitamin D3 did not improve markers of vascular health or fatigue in patients with chronic fatigue syndrome. TRIAL REGISTRATION www.controlled-trials.com, ISRCTN59927814.
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Affiliation(s)
- M D Witham
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK.
| | - F Adams
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - S McSwiggan
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - G Kennedy
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - G Kabir
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - J J F Belch
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - F Khan
- Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
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Adams F, Bellairs G, Bird AR, Oguntibeju OO. Biochemical storage lesions occurring in nonirradiated and irradiated red blood cells: a brief review. Biomed Res Int 2015; 2015:968302. [PMID: 25710038 PMCID: PMC4325969 DOI: 10.1155/2015/968302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 12/20/2022]
Abstract
Red blood cells undergo a series of biochemical fluctuations during 35-42-day storage period at 1°C to 6°C. The sodium/potassium pump is immobilised causing a decrease in intracellular potassium with an increase in cytoplasmic sodium levels, glucose levels decline, and acidosis occurs as a result of low pH levels. The frailty of stored erythrocytes triggers the formation of haemoglobin-containing microparticles and the release of cell-free haemoglobin which may add to transfusion difficulties. Lipid peroxidation, oxidative stress to band 3 structures, and other morphological and structural molecular changes also occur leading to spheroechinocytes and osmotic fragility. These changes that transpire in the red cells during the storage period are referred to as "storage lesions." It is well documented that gamma irradiation exacerbates storage lesions and the reports of increased potassium levels leading to adverse reactions observed in neonates and infants have been of particular concern. There are, however, remarkably few systematic studies comparing the in vitro storage lesions of irradiated and nonirradiated red cell concentrates and it has been suggested that the impact of storage lesions on leucocyte reduced red blood cell concentrate (RBCC) is incomplete. The review examines storage lesions in red blood cells and their adverse effects in reference to blood transfusion.
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Affiliation(s)
- F. Adams
- Training Department, Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - G. Bellairs
- Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - A. R. Bird
- Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - O. O. Oguntibeju
- Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, Cape Town 7535, South Africa
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Altenbuchner PT, Adams F, Kronast A, Herdtweck E, Pöthig A, Rieger B. Stereospecific catalytic precision polymerization of 2-vinylpyridine via rare earth metal-mediated group transfer polymerization with 2-methoxyethylamino-bis(phenolate)-yttrium complexes. Polym Chem 2015. [DOI: 10.1039/c5py01146a] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
C
1-Symmetric 2-methoxyethylamino-bis(phenolate)-yttrium complexes for the stereospecific polymerization of 2-vinylpyridine.
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Affiliation(s)
- P. T. Altenbuchner
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85748 Garching bei München
- Germany
| | - F. Adams
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85748 Garching bei München
- Germany
| | - A. Kronast
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85748 Garching bei München
- Germany
| | - E. Herdtweck
- Chair of Inorganic Chemistry/Molecular Catalysis
- Catalysis Research Center
- Technische Universität München
- 85748 Garching bei München
- Germany
| | - A. Pöthig
- Chair of Inorganic Chemistry/Molecular Catalysis
- Catalysis Research Center
- Technische Universität München
- 85748 Garching bei München
- Germany
| | - B. Rieger
- WACKER-Lehrstuhl für Makromolekulare Chemie
- Technische Universität München
- 85748 Garching bei München
- Germany
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23
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Magdysyuk OV, Adams F, Liermann HP, Spanopoulos I, Trikalitis PN, Hirscher M, Morris RE, Duncan MJ, McCormick LJ, Dinnebier RE. Understanding the adsorption mechanism of noble gases Kr and Xe in CPO-27-Ni, CPO-27-Mg, and ZIF-8. Phys Chem Chem Phys 2014; 16:23908-14. [DOI: 10.1039/c4cp03298e] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Harris T, Kerry S, Victor C, Ekelund U, Woodcock A, Iliffe S, Whincup P, Beighton C, Ussher M, Limb E, David L, Brewin D, Adams F, Rogers A, Cook D. OP03 Does a complex intervention by primary care nurses increase walking in 60–75 year olds? Outcomes at three and twelve months from the PACE-Lift (Pedometer Accelerometer Consultation Evaluation – Lift) cluster randomised controlled trial. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miernik A, Sevcenco S, Kuehhas FE, Bach C, Buchholz N, Adams F, Wilhelm K, Schoenthaler M. Bringing excellence into urology: How to improve the future training of residents? Arab J Urol 2013; 12:15-20. [PMID: 26019915 PMCID: PMC4434502 DOI: 10.1016/j.aju.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 04/04/2013] [Revised: 05/31/2013] [Accepted: 06/08/2013] [Indexed: 11/22/2022] Open
Abstract
The problem The demographic development of society leads to an increased demand for physicians. Particularly in the surgical disciplines, there is a noticeably declining interest among graduates from medical schools worldwide. For reasons discussed in detail, this applies especially to urology. Solutions We indicate possibilities on how to counteract this trend, by improving the training for urology residents. Whereas some major changes for the better have already been introduced into the curricula in some countries, others will have to be further specified in the future. This article gives an overview of the requirements of a specific training programme, from a planning phase to its certification. Aspects such as the selection of candidates, the goals of a good training programme, and an implementation strategy are presented. Essential elements of a urology resident programme for effective coaching, improving medical skills (e.g. in surgical laboratories), knowledge revision, progress evaluation, and retrospection are discussed critically, giving an understanding of the crucial requirements of a good and attractive education in urology. Conclusion A structured and well organised training programme might attract additional medical students towards urology and contribute significantly to the further development of the speciality. This can be seen as an initiative to counteract the decline of urology as an attractive field of interest to upcoming generations of physicians, and therefore to ensure urological care of the highest quality that patients deserve.
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Affiliation(s)
- Arkadiusz Miernik
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany
| | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Bach
- Department of Urology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Noor Buchholz
- Department of Urology, Endourology & Stone Services, The Royal London Hospital, Bartshealth NHS Trust, London, UK
| | - Fabian Adams
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany
| | - Konrad Wilhelm
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany
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Abstract
OBJECTIVE To present a unique completely standardized sequence of steps performed before, during, and after flexible ureteroscopy (FURS) that achieves superior results for FURS treatment of renal calculi. MATERIALS AND METHODS The "Freiburg FURS technique" includes the following steps: (a) preoperative ureteral stenting; (b) placement of 2 hydrophilic wires; (c) semirigid ureteroscopy before FURS; (d) the use of a large access sheath (14F-16F) if multiple ureteral passages are expected; (e) the use of a 2-working channel flexible endoscope; (f) a modified active flushing system; and (g) an advanced holmium laser technique with complete stone extraction. We performed a prospective analysis of 153 consecutive FURS procedures for nephrolithiasis from August 2009 to July 2011. RESULTS Data analysis revealed an "immediate" stone-free rate of 96.7% (as confirmed by endoscopy, fluoroscopy, and ultrasonography), a medium of 2.3 stones, and a cumulative stone size of 10.5 mm (range 3-43). The operative time was 67 minutes (range 20-160). The use of an access sheath was required in 71% of the patients and the postoperative use of a double-J stent in 57% of patients. Complications (Clavien grade II and III) developed in 9.1% of patients (including 7 with minimal perforation that required ureteral stenting for 1 month, 3 with secondary flank pain/hydronephrosis requiring double-J stenting and hospitalization, and 4 with fever or urinary tract infections requiring antibiotic therapy. Follow-up examinations after 3 months showed no late complications. CONCLUSION The modified FURS technique provided clinically superior results with a low complication rate. However, the approach requires the use of considerable resources, both technical and surgical and financial.
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Affiliation(s)
- Arkadiusz Miernik
- Department of Urology, University Medical Center, Freiburg, Germany.
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Luedtke A, Boschmann M, Colpe C, Engeli S, Adams F, Birkenfeld AL, Haufe S, Rahn G, Luft FC, Schmidt HHJ, Jordan J. Thiazolidinedione response in familial lipodystrophy patients with LMNA mutations: a case series. Horm Metab Res 2012; 44:306-11. [PMID: 22274718 DOI: 10.1055/s-0031-1301284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Type 2 familial partial lipodystrophy (FPLD2) patients show impaired glucose and lipid metabolism resulting from lipodystrophic 'lipid pressure' and an intrinsic defect in skeletal muscle metabolism. Since mutated lamin A may interfere with peroxisome proliferator activator gamma (PPARγ) expression, we hypothesized that PPARγ stimulation improves fat distribution and metabolic abnormalities in these patients. 5 nondiabetic FPLD2 patients were treated with rosiglitazone over 12 months. We assessed body composition, body fat distribution, and skinfold thickness/subcutaneous tissue thickness. We also determined venous glucose, insulin, and free fatty acid (FFA) concentrations, and respiratory quotient (RQ) before and during oral glucose tolerance testing. Adipose tissue and muscle fasting and postprandial metabolism were studied by microdialysis. Within 12 months treatment, hip circumference increased from 93.6±2.78 cm to 96.2±2.3 cm (p<0.05). Rosiglitazone reduced fasting glucose levels and liver transaminases. Baseline and postprandial FFA concentrations were significantly lower after 12 months treatment. RQ and muscle interstitial pyruvate and lactate did not respond to treatment. We conclude that PPARγ stimulation with rosiglitazone modestly improves glucose metabolism in FPLD2 patients presumably through proximal adipose tissue expansion. The intrinsic muscular metabolic defect does not respond to rosiglitazone.
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Affiliation(s)
- A Luedtke
- Departments of Medicine and Anatomy and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
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Rosser RJ, Feder R, Ng A, Adams F, Caldarolo M, Celliers P, Cheng PC, Silva L, Parfeniuk D, Speer RJ. Biological specimens imaged by soft x-ray contact microscopy using a plasma source produced with a laboratory sized laser. J Microsc 2011. [DOI: 10.1111/j.1365-2818.1986.tb02792.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Espen P, Adams F, Maenhaut W. Analysis of Size-Fractionated Air Particulate Matter by Energy-Dispersive X-Ray Fluorescence Spectrometry. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bscb.19810900406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Adams F, Venkatesh B. Biomarkers of Acute Kidney Injury in Critical Illness. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Adams F, Liu XD. Characterization of three atmospheric aerosol episodes at a coastal site in China: Implications for regional transport of air pollution. Eur Phys J Conferences 2009. [DOI: 10.1140/epjconf/e2009-00922-y] [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: 11/18/2022] Open
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Dams R, Vanderborght B, Adams F. Experimental investigation of the atmospheric dispersion of antimony containing particulates around a non‐ferrous plant. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/09593338209384136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gottschalk S, Adams F, Luft FC, Jordan J, Boschmann M. Insulin-ähnliche Effekte im Skelettmuskel durch Wassertrinken. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Belykh SF, Palitsin VV, Veryovkin IV, Kovarsky AP, Chang RJH, Adriaens A, Dowsett MG, Adams F. New Cs sputter ion source with polyatomic ion beams for secondary ion mass spectrometry applications. Rev Sci Instrum 2007; 78:085101. [PMID: 17764349 DOI: 10.1063/1.2761021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A simple design for a cesium sputter ion source compatible with vacuum and ion-optical systems as well as with electronics of the commercially available Cameca IMS-4f instrument is reported. This ion source has been tested with the cluster primary ions of Si(n)(-) and Cu(n)(-). Our experiments with surface characterization and depth profiling conducted to date demonstrate improvements of the analytical capabilities of the secondary ion mass spectrometry instrument due to the nonadditive enhancement of secondary ion emission and shorter ion ranges of polyatomic projectiles compared to atomic ones with the same impact energy.
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Affiliation(s)
- S F Belykh
- Department of Physics, University of Warwick, Warwick Conventry, UK
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Adams F, Boschmann M, Schaller K, Franke G, Gorzelniak K, Janke J, Klaus S, Luft FC, Heer M, Jordan J. Tyramine in the assessment of regional adrenergic function. Biochem Pharmacol 2006; 72:1724-9. [PMID: 17027670 DOI: 10.1016/j.bcp.2006.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 08/31/2006] [Accepted: 09/06/2006] [Indexed: 11/29/2022]
Abstract
Regional adrenergic function is difficult to assess in humans. Tyramine given through a microdialysis probe may be a useful tool in this regard. However, tyramine data is hard to interpret given the drug's complex mode of action. We characterized the response to tyramine, isoproterenol, and dopamine in adipose tissue with microdialysis probes in normal subjects. We measured glycerol concentrations to follow changes in lipolysis and monitored tissue perfusion with ethanol dilution. During perfusion with tyramine, dialysate glycerol concentration increased dose-dependently from 83+/-8 microM at baseline to 181+/-18 microM at 3.5 mM tyramine (p<0.001) followed by a fall down to 121+/-9 microM at 35 mM tyramine (p<0.001). Propranolol almost completely blocked this response. A similar lipolytic response was not observed in isolated human adipocytes. Dopamine <35 microM did not replicate the tyramine-induced lipolysis; however, dopamine >35 microM potently inhibited lipolysis. We conclude that tyramine-induced lipolysis is explained by a pre-synaptic mechanism. Tyramine applied through a microdialysis probe in concentrations up to 3.5 mM can be used to assess pre- and post-synaptic mechanisms regulating lipid mobilization.
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Affiliation(s)
- F Adams
- Universitary Medicine, Charité Campus Buch, Franz-Volhard Clinical Research Center and HELIOS Klinikum, Berlin, Germany.
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Boschmann M, Kreuzberg U, Engeli S, Adams F, Franke G, Klaua S, Scholze J, Weidinger G, Luft FC, Sharma AM, Jordan J. The effect of oral glucose loads on tissue metabolism during angiotensin II receptor and beta-receptor blockade in obese hypertensive subjects. Horm Metab Res 2006; 38:323-9. [PMID: 16718629 DOI: 10.1055/s-2006-925406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AT1 receptor blockers and ACE inhibitors decrease the risk for new onset diabetes mellitus. The phenomenon could be related to a direct angiotensin II effect on tissue metabolism. To address the issue, we recruited eighteen obese hypertensive patients. Patients were randomized to double-blind treatment with either valsartan (n = 8) or atenolol (n = 10) for thirteen weeks. They underwent an oral glucose tolerance test before and during active treatment, while metabolism was monitored through subcutaneous and intramuscular microdialysis and indirect calorimetry. After glucose ingestion, venous glucose and insulin concentrations increased rapidly while systemic free fatty acid concentrations were suppressed. Dialysate glucose and lactate concentrations increased briskly in adipose tissue and in skeletal muscle. Dialysate glycerol decreased profoundly in both tissues. Respiratory quotient increased markedly after glucose ingestion. These responses were identical at baseline and during active treatment either drug. We conclude that AT1 receptor blockade in obese hypertensive patients has no effect on interstitial glucose supply, lipolysis, and substrate oxidation. One possible explanation is that angiotensin II levels in obese hypertensives are not sufficient to elicit the metabolic changes that have been observed after direct angiotensin II application. The exact mechanism by which inhibition of the renin-angiotensin-aldosterone system decreases the diabetes risk remains unresolved and requires further study.
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Affiliation(s)
- M Boschmann
- Franz-Volhard Clinical Research Center, Charité Campus Buch and HELIOS Klinikum, Berlin, Berlin, Germany
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Abstract
Blood flow in subcutaneous adipose tissue is reduced in obese compared to lean subjects. Limitations in vascular supply might interfere with adipose tissue function as a metabolic and endocrine organ. We tested the hypothesis that nutritive blood flow and tissue metabolism depends on subcutaneous adipose tissue thickness even in normal-weight subjects. Sixteen young, healthy, normal-weight subjects (8 men, 8 women) were included in the study. Abdominal subcutaneous adipose thickness was assessed by skin-fold measurements. The microdialysis technique was applied for monitoring basal adipose tissue blood flow (ethanol dilution technique) and metabolism. An increase in skin-fold thickness from 15 to 45 mm and from 8 to 37 mm was associated with a linear increase in basal ethanol ratio from 0.19 to 0.63 and 0.25 to 0.75 and linear decreases in dialysate glucose concentrations from 1.95 to 0.24 mM and 1.68 to 0.29 mM, and 152 to 42 microM and 172 to 49 microM for glycerol concentrations in men and women, respectively (p < 0.05). Isoproterenol-stimulated blood flow also inversely correlated to skin-fold thickness (p < 0.05). We conclude that increased adipose tissue thickness is associated with reduced tissue perfusion and metabolism, even in lean subjects. Skin-fold thickness is an important confounding variable in metabolic studies, particularly in microdialysis experiments.
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Affiliation(s)
- F Adams
- Franz Volhard Clinic, Clinical Research Center and HELIOS Klinikum Berlin, Charité Campus Buch, Universitary Medicine Berlin, Wiltbergstrasse 50, Hs. 129, 13125 Berlin, Germany.
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Chtaïb M, Peremans A, Novis Y, Caudano R, Butaye L, Adams F, Lutgen P, Feyder G. Water interactions in Al/PET. SURF INTERFACE ANAL 2004. [DOI: 10.1002/sia.740151007] [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: 11/11/2022]
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Scheinkestel CD, Adams F, Mahony L, Bailey M, Davies AR, Nyulasi I, Tuxen DV. Impact of increasing parenteral protein loads on amino acid levels and balance in critically ill anuric patients on continuous renal replacement therapy. Nutrition 2003; 19:733-40. [PMID: 12921882 DOI: 10.1016/s0899-9007(03)00107-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We wanted to establish optimum protein and glucose intakes during total parenteral nutrition by using a constant caloric but changing protein intake in critically ill, ventilated, anuric patients on continuous renal replacement therapy and measuring amino acid and glucose losses across the hemofilter. METHODS Eleven consecutive, critically ill patients (eight male, age, 43.5 +/- 21.8 y; Acute Physiology and Chronic Health Evaluation II score, 20.5 +/- 7.0; Acute Physiology and Chronic Health Evaluation risk of death: 36.5% +/- 23.0 and 6 +/- 1 impaired organ systems) entered this study. Patients were fed by continuous infusion of a total parenteral mixture consisting of Synthamin (a mixture of essential and non-essential amino acids), 50% dextrose, and intralipid (long-chain triglycerides) to meet caloric requirements as predicted by Schofield's equation corrected by stress factors. The amount of protein infused was varied (1 to 2.5 g. kg(-1). d(-1)) by increments of 0.25 g. kg(-1). d(-1). Patients were stabilized on each feeding regimen for at least 24 h before paired samples of blood and dialysate were taken for amino acid and glucose measurements. Continuous renal replacement therapy was performed by using a blood pump with a blood flow of 100 to 175 mL/min. Dialysate was pumped in and out counter-currently to the blood flow at 2 L/h. A biocompatible polyacrylonitrile hemofilter was used in all cases. RESULTS With protein intakes below 2.5 g. kg(-1). d(-1), blood levels of 14% to 57% of the measured amino acids were below the lower limits of the normal range. At 2.5 g. kg(-1). d(-1), all measured amino acids were within the normal range. Amino acid balance became more positive as protein input increased (P = 0.0001). Glucose and amino acid losses were dependent on blood concentration. Overall, 17% (range, 13% to 24%) of infused amino acids and 4% of infused glucose were lost in the dialysate. CONCLUSIONS This study of critically ill, ventilated, anuric patients on continuous renal replacement therapy suggested that increases in protein and glucose are required to account for the increased losses across the hemofilter. A protein intake of 2.5 g. kg(-1). d(-1) appeared to optimize nitrogen balance and correct amino acid deficiencies.
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Jones KW, Feng H, Lindquist WB, Adler PM, Thovert JF, Vekemans B, Vincze L, Szaloki I, Van Grieken R, Adams F, Riekel C. Study of the microgeometry of porous materials using synchrotron computed microtomography. ACTA ACUST UNITED AC 2003. [DOI: 10.1144/gsl.sp.2003.215.01.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractA series of measurements of the structure of a variety of porous materials has been made using synchrotron computed microtomography (SCMT). The work was carried out at the Brookhaven National Synchrotron Light Source (NSLS), the Argonne Advanced Photon Source (APS) and the European Synchrotron Radiation Facility (ESRF). The experiments at Brookhaven and Argonne were carried out on bending magnet beam lines using area detectors to obtain CT images based on determination of X-ray absorption coefficients. The work at the ESRF used an undulator beam line, a 13 KeV pencil X-ray beam of 2 µm and an energy dispersive X-ray detector to make tomographic sections of trace element distributions by X-ray fluorescence tomography. Most of the work was done with a pixel/voxel size ranging from 0.002 to 0.010 mm. We examined the structure of unconsolidated estuarine sediments, whose structure is relevant to transport of contaminants in rivers and estuaries. Fluorescent tomography with 2–3 µm resolution was used to ascertain whether or not metals were concentrated on the surface or throughout the volume of a single sediment particle. Sandstone samples were investigated to obtain a set of values describing their microstructures that could be useful in fluid flow calculations relevant to petroleum recovery or transport of environmental contaminants. Measurements were also made on sandstone samples that had been subjected to high-pressure compression to investigate the relation between the microgeometry and the magnitude of the applied pressure. Finally, a Wood’s metal-filled sample was scanned for demonstration of resolution enhancement and fluid flow studies.
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Affiliation(s)
- K. W. Jones
- Laboratory for Earth and Environmental Sciences, Brookhaven National Laboratory
Upton, New York 11973-5000, USA
| | - H. Feng
- Department of Earth and Environmental Studies, Montclair State University
Upper Montclair, New Jersey 07043, USA
| | - W. B. Lindquist
- Department of Applied Mathematics and Statistics, State University of New York
Stony Brook, New York 11794-3600, USA
| | - P. M. Adler
- Institut de Physique du Globe de Paris
F-75252 Paris Cedex 05, France
| | | | - B. Vekemans
- Department of Chemistry, University of Antwerp
B-2610 Wilrijk, Belgium
| | - L. Vincze
- Department of Chemistry, University of Antwerp
B-2610 Wilrijk, Belgium
| | - I. Szaloki
- Department of Chemistry, University of Antwerp
B-2610 Wilrijk, Belgium
| | - R. Van Grieken
- Department of Chemistry, University of Antwerp
B-2610 Wilrijk, Belgium
| | - F. Adams
- Department of Chemistry, University of Antwerp
B-2610 Wilrijk, Belgium
| | - C. Riekel
- European Synchrotron Radiation Facility
BP 220, F-38043 Grenoble Cedex, France
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De Ryck I, Adriaens A, Pantos E, Adams F. A comparison of microbeam techniques for the analysis of corroded ancient bronze objects. Analyst 2003. [DOI: 10.1039/b303588c] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The adipose tissue renin-angiotensin system has been implicated in the regulation of adipocyte growth and differentiation. We studied the influence of age, body weight, total body fat content, anatomical localization, and diet on the expression of angiotensinogen (AGT) and angiotensin II type 1 (AT 1 )-receptor genes in white adipose tissue of normal and postnatal overfed rats. Relative gene expression was measured in epididymal adipose tissue and liver of control and postnatal overfed (PNO) rats at the age of 4, 8, and 12 weeks using real time RT-PCR. Body fat content was determined by carcass analysis. Body weight and body fat content were only significantly greater in PNO rats when compared to control rats at the age of 4 weeks. At the age of 12 weeks, AGT expression was significantly decreased in both tissues. Furthermore, expression of the AT 1 -receptor gene was significantly decreased in liver but not in adipose tissue at 12 weeks of age. Postnatal overfeeding did not influence the expression levels of either gene at any time-point in either liver or adipose tissue. At the age of 24 weeks, AGT expression was significantly greater in epididymal than in subcutaneous adipose tissue, whereas no site-specific differences could be found for the AT 1 -receptor. We conclude that age and depot-specific mechanisms are of more importance for the expression of AGT and AT 1 -receptor genes during the first 12 weeks of age than a short period of overfeeding.
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Affiliation(s)
- F Adams
- German Institute of Human Nutrition, Potsdam, Germany.
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Abstract
Angiotensin II is synthesized locally in various tissues. However, the role of interstitial angiotensin II in the regulation of regional metabolism and tissue perfusion has not as yet been clearly defined. We characterized the effect of interstially applied angiotensin II in abdominal subcutaneous adipose tissue of young, normal-weight, healthy men (n = 8) and women (n = 6) using the microdialysis technique. Adipose tissue was perfused with 0.01, 0.1, and 1 micro M angiotensin II. Dialysate concentrations of ethanol, glycerol, glucose, and lactate were measured to assess changes in blood flow (ethanol dilution technique), lipolysis, and glycolysis, respectively. Baseline ethanol ratio and dialysate lactate were both significantly higher, whereas dialysate glucose was significantly lower in men vs. women. In men, ethanol ratio and dialysate glucose, lactate and glycerol did not change significantly during perfusion with angiotensin II. In women, however, angiotensin II induced a significant increase in ethanol ratio and dialysate lactate and a decrease in dialysate glucose close to values found for men and this response was almost maximal at the lowest angiotensin II concentration used. Dialysate glycerol did not change significantly. We conclude that baseline blood flow and glucose supply and metabolism is significantly higher in women than in men. In men, interstitial Ang II has only a minimal effect on adipose tissue blood flow and metabolism. In women, however, a high physiological concentration of interstitial angiotensin II can reduce blood flow down to values found in men. This is associated with an impaired glucose supply and metabolism. Additionally, Ang II inhibits lipolysis.
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Affiliation(s)
- M Boschmann
- German Institute of Human Nutrition, Potsdam, Germany.
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Van Espen P, Van't Dack L, Adams F, Van Grieken R. Effective sample weight from scatter peaks in energy-dispersive x-ray fluorescence. Anal Chem 2002. [DOI: 10.1021/ac50043a042] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Van Craen M, Natusch DFS, Adams F. Quantitative surface analysis of steel furnace dust particles by secondary ion mass spectrometry. Anal Chem 2002. [DOI: 10.1021/ac00248a029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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