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Sayk F, Hauswaldt S, Knobloch JK, Rupp J, Nitschke M. Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy. Front Public Health 2024; 12:1364664. [PMID: 38699424 PMCID: PMC11064650 DOI: 10.3389/fpubh.2024.1364664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts.
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Affiliation(s)
- Friedhelm Sayk
- Department of Medicine I, Division of Gastroenterology and Nephrology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Susanne Hauswaldt
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Johannes K. Knobloch
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Martin Nitschke
- Department of Medicine I, Division of Gastroenterology and Nephrology, University Hospital Schleswig-Holstein, Lübeck, Germany
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Engelke C, Graf M, Maass C, Tews HC, Kraus M, Ewers T, Sayk F, Solbach P, Zimpel C, Tharun L, Marquardt JU, Kirstein MM. Prospective study of computer-aided detection of colorectal adenomas in hospitalized patients. Scand J Gastroenterol 2023; 58:1194-1199. [PMID: 37191195 DOI: 10.1080/00365521.2023.2212309] [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: 02/24/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Adenoma detection with polypectomy during total colonoscopy reduces the incidence of colorectal cancer (CRC) and colorectal cancer-associated mortality. The adenoma detection rate (ADR) is an established quality indicator, which is associated with a decreased risk for interval cancer. An increase in ADR could be demonstrated for several artificially intelligent, real-time computer-aided detection (CADe) systems in selected patients. Most studies concentrated on outpatient colonoscopies. This sector often lacks funds for applying costly innovations like CADe. Hospitals are more likely to implement CADe and information about the impact of CADe in the distinct patient cohort of hospitalized patients is scarce. METHODS In this prospective, randomized-controlled study, we compared colonoscopies performed with or without computer-aided detection (CADe) system (GI Genius, Medtronic) performed at University Medical Center Schleswig-Holstein, Campus Luebeck. The primary endpoint was ADR. RESULTS Overall, 232 patients were randomized with n = 122 patients in the CADe arm and n = 110 patients in the control arm. Median age was 66 years (interquartile range 51-77). Indication for colonoscopy was most often workup for gastrointestinal symptoms (88.4%) followed by screening, post-polypectomy and post-CRC surveillance (each 3.9%). Withdrawal time was significantly prolonged (11 vs. 10 min, p = 0.039), without clinical relevance. Complication rate was not different between the arms (0.8% vs. 4.5%; p = 0.072). The ADR was significantly increased in the CADe arm compared to the control (33.6% vs. 18.1%, p = 0.008). ADR increase was particularly strong for the detection in elderly patients aged ≥50 years (OR 6.3, 95% CI 1.7 - 23.1, p = 0.006). CONCLUSION The use of CADe is safe and increases ADR in hospitalized patients.
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Affiliation(s)
- Carsten Engelke
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Mattis Graf
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Carlos Maass
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Hauke C Tews
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Martin Kraus
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Thomas Ewers
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Friedhelm Sayk
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Philipp Solbach
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Carolin Zimpel
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Lars Tharun
- Institute of Pathology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Jens U Marquardt
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Martha M Kirstein
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
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Dore R, Watson L, Hollidge S, Krause C, Sentis SC, Oelkrug R, Geißler C, Johann K, Pedaran M, Lyons G, Lopez-Alcantara N, Resch J, Sayk F, Iwen KA, Franke A, Boysen TJ, Dalley JW, Lorenz K, Moran C, Rennie KL, Arner A, Kirchner H, Chatterjee K, Mittag J. Resistance to thyroid hormone induced tachycardia in RTHα syndrome. Nat Commun 2023; 14:3312. [PMID: 37286550 DOI: 10.1038/s41467-023-38960-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Mutations in thyroid hormone receptor α1 (TRα1) cause Resistance to Thyroid Hormone α (RTHα), a disorder characterized by hypothyroidism in TRα1-expressing tissues including the heart. Surprisingly, we report that treatment of RTHα patients with thyroxine to overcome tissue hormone resistance does not elevate their heart rate. Cardiac telemetry in male, TRα1 mutant, mice indicates that such persistent bradycardia is caused by an intrinsic cardiac defect and not due to altered autonomic control. Transcriptomic analyses show preserved, thyroid hormone (T3)-dependent upregulation of pacemaker channels (Hcn2, Hcn4), but irreversibly reduced expression of several ion channel genes controlling heart rate. Exposure of TRα1 mutant male mice to higher maternal T3 concentrations in utero, restores altered expression and DNA methylation of ion channels, including Ryr2. Our findings indicate that target genes other than Hcn2 and Hcn4 mediate T3-induced tachycardia and suggest that treatment of RTHα patients with thyroxine in high dosage without concomitant tachycardia, is possible.
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Affiliation(s)
- Riccardo Dore
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Laura Watson
- National Institute Health and Care Research Cambridge Clinical Research Facility, Addenbrooke's Hospital, Cambridge, UK
| | - Stefanie Hollidge
- MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Christin Krause
- Institute for Human Genetics, Department of Epigenetics & Metabolism, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sarah Christine Sentis
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Rebecca Oelkrug
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Cathleen Geißler
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Kornelia Johann
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Mehdi Pedaran
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Greta Lyons
- Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
| | - Nuria Lopez-Alcantara
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Julia Resch
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Friedhelm Sayk
- Internal Medicine I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Karl Alexander Iwen
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Internal Medicine I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Germany
| | - Teide Jens Boysen
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Germany
| | - Jeffrey W Dalley
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, UK
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Kristina Lorenz
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Straße 9, 97078, Wuerzburg, Germany
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Bunsen-Kirchhoff-Str. 11, 44139, Dortmund, Germany
| | - Carla Moran
- Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
- Beacon Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - Kirsten L Rennie
- MRC Epidemiology Unit and Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Anders Arner
- Department of Clinical Sciences, Lund University, c/o Igelösa Life Science AB, Igelösa 373, 225 94, Lund, Sweden
| | - Henriette Kirchner
- Institute for Human Genetics, Department of Epigenetics & Metabolism, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Krishna Chatterjee
- Wellcome-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
| | - Jens Mittag
- Institute for Endocrinology and Diabetes, Center of Brain Behavior & Metabolism, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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Sayk F, Grasshoff L. [Acute hepatic porphyrias]. Med Klin Intensivmed Notfmed 2023; 118:21-29. [PMID: 36598516 DOI: 10.1007/s00063-022-00978-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 01/05/2023]
Abstract
Acute porphyrias are caused by rare hereditary disorders of hepatic heme biosynthesis. Episodes of accumulating neurotoxic metabolites lead to multisystemic symptoms such as visceral pain, autonomic dysregulation, neurocognitive impairment, hyponatremia, and occasionally motor paralysis. In addition to protracted non-emergency courses, acute life-threatening crises can occur, often triggered by infection, medication, fasting, or hormonal stimuli. Since the clinical presentation is nonspecific and multifaceted, many patients have gone through a long odyssey until they receive a diagnosis. Acute attacks often lead to presenting initially to the emergency department, where acute hepatic porphyria (AHP) is easily overlooked in the differential diagnosis. Establishing the diagnosis requires a high level of genuine suspicion (e.g., cluster of signs and symptoms along with certain patterns of health care resource utilization). The initial diagnostic work-up requires the measurement of metabolites in the urine. Emergency management consists of infusions of glucose and heme arginate along with symptomatic therapy. However, porphyrinogenic agents must be strictly avoided ( www.drugs-porphyria.org ). After initial diagnosis, a thorough work-up should be done at a porphyria center (confirming the diagnosis, education, genetic counselling) and issuance of an emergency identification card is mandatory. If the frequency of relapses is high, new targeted prophylactic therapies have proven effective. Patients with known porphyria require special attention in any acute medical condition in order to avoid porphyrinogenic triggers and to exclude threatening differential diagnosis (e.g., sepsis) by consistent basic diagnostics.
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Affiliation(s)
- Friedhelm Sayk
- Medizinische Klinik I, Allgemeine Innere Medizin, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Lars Grasshoff
- Medizinische Klinik I, Allgemeine Innere Medizin, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Mitzlaff K, Sayk F, Solbach P. Jaundice and Weight Gain After Autologous Stem Cell Transplantation in a 28-Year-Old Patient With Diffuse Large B-Cell Lymphoma. Gastroenterology 2023; 164:32-33. [PMID: 35963364 DOI: 10.1053/j.gastro.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Katharina Mitzlaff
- Department of Medicine I, University Hospital Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | - Friedhelm Sayk
- Department of Medicine I, University Hospital Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | - Philipp Solbach
- Department of Medicine I, University Hospital Schleswig Holstein-Campus Lübeck, Lübeck, Germany.
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Meusel M, Pätz T, Gruber K, Kupp S, Jensch PJ, Saraei R, Fürschke A, Sayk F, Eitel I, Wolfrum S. PrEdictive value of coMbined pre-test proBability and blOod gas anaLysis In pulmonary emboliSM-the EMBOLISM study. Intern Emerg Med 2022; 17:2245-2252. [PMID: 35976533 PMCID: PMC9652271 DOI: 10.1007/s11739-022-03075-w] [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: 06/07/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
In patients with suspected pulmonary embolism (PE), the number of unnecessary computed tomography pulmonary angiography (CTPA) scans remains high, especially in patients with low pre-test probability (PTP). So far, no study showed any additional benefit of capillary blood gas analysis (BGA) in diagnostic algorithms for PE. In this retrospective analysis of patients with suspected PE and subsequent CTPA, clinical data, D-dimer levels and BGA parameters (including standardized PaO2) were analyzed. Logistic regression analyses were performed to identify independent predictors for PE and reduce unnecessary CTPA examinations in patients with low PTP according to Wells score. Of 1538 patients, PE was diagnosed in 433 patients (28.2%). The original Wells score (odds ratio: 1.381 [95% CI 1.300-1.467], p < 0.001) and standardized PaO2 (odds ratio: 0.987 [95% CI 0.978-0.996], p = 0.005) were independent predictors for PE. After cohort adjustment for low PTP a D-dimer cut-off < 1.5 mg/L (278 patients (18.1%) with 18 PE (6.5%)) was identified in which a standardized PaO2 > 65 mmHg reduced the number of unnecessary CTPA by 31.9% with a 100% sensitivity. This approach was further validated in additional 53 patients with low PTP. In this validation group CTPA examinations were reduced by 32.7%. No patient with PE was missed. With our novel algorithm combining BGA testing with low PTP according to Wells score, we were able to increase the D-Dimer threshold to 1.5 mg/L and reduce CTPA examinations by approximately 32%.
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Affiliation(s)
- Moritz Meusel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Toni Pätz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Kim Gruber
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Sebastian Kupp
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Philipp-Johannes Jensch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roza Saraei
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alexander Fürschke
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Friedhelm Sayk
- Department of Internal Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Sebastian Wolfrum
- Emergency Department, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Mosler T, Marquardt JU, Sayk F. [65/f-Fever and acute left lower quadrant abdominal pain : Preparation for the medical specialist examination: part 139]. Internist (Berl) 2022; 63:224-229. [PMID: 35316340 DOI: 10.1007/s00108-022-01305-z] [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] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- T Mosler
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - J U Marquardt
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - F Sayk
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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Meusel M, Voß J, Krapalis A, Machleidt F, Vonthein R, Hallschmid M, Sayk F. Intranasal orexin A modulates sympathetic vascular tone - a pilot study in healthy male humans. J Neurophysiol 2022; 127:548-558. [PMID: 35044844 DOI: 10.1152/jn.00452.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Previous research suggests that the neuropeptide orexin A contributes to sympathetic blood pressure (BP) control inasmuch as hypothalamic injection of orexin A increases sympathetic vasomotor tone and arterial BP in rodents. In humans with narcolepsy, a disorder associated with loss of orexin-producing neurons, vasoconstrictive muscle sympathetic nerve activity (MSNA) is reduced. Since intranasally administered oligopeptides like orexin are known to modulate brain function, we investigated the effect of intranasal orexin A on vascular sympathetic baroreflex function in healthy humans. METHODS In a balanced, double-blind cross-over study, orexin A (500 nmol) and placebo, respectively, were intranasally administered to 10 lean healthy males (age, 25.8±4.6 years). MSNA was assessed microneurographically before and 30-45 minutes after either substance administration. Additionally, baroreflex was challenged via graded infusions of vasoactive drugs before and after substance administration. Baroreflex function was defined as the correlation of BP with MSNA and heart rate. RESULTS Intranasal orexin A compared to placebo induced a significant increase in resting MSNA from prior to post administration (Δ-burst rate, orexin A vs. placebo: +5.8±0.8 vs. +2.1±0.6; p=0.007; total activity (169±11.5% vs. 115±5.0%; p=0.002). BP, heart rate and sympathovagal balance to the heart, as represented by HRV, as well as baroreflex sensitivity during the vasoactive challenge were not altered. CONCLUSION Intranasally administered orexin A acutely induced vasoconstrictory sympathoactivation in healthy male humans. This result suggests that orexin A mediates upward resetting of the vascular baroreflex setpoint at centers superordinate to the mere baroreflex-feedback-loop.
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Affiliation(s)
- Moritz Meusel
- Department of Internal Medicine II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jacqueline Voß
- Dept. of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Alexander Krapalis
- Dept. of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Felix Machleidt
- Department of Infectious Diseases and Respiratory Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhard Vonthein
- Institute for Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Manfred Hallschmid
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
| | - Friedhelm Sayk
- Dept. of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
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Kampmeyer D, Sayk F. [Euglycemic ketoacidosis - rare condition on the rise]. Dtsch Med Wochenschr 2021; 146:1265-1269. [PMID: 34553351 DOI: 10.1055/a-1332-3750] [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: 10/20/2022]
Abstract
SGLT2 inhibitors have been developed as antidiabetics. Large randomized prospective studies have shown prognostic benefit in patients with heart and/or renal insufficiency regarding cardiovascular and general endpoints - even in absence of type 2 diabetes mellitus. This extends the indication to large groups of multimorbid patients. SGLT2 inhibitors induce ketogenesis comparable to fasting conditions. This may - in presence of additional catabolic factors - deteriorate into life-threatening ketoacidosis - probably due to increased reabsorption of ketone bodies from urine as well as the blockage of SGLT2 receptors on α-cells of the pancreas. Euglycaemic ketoacidosis (eKA) under SGLT2 inhibition occurs in about 2:1000 years of treatment. The diagnosis is challenging: in eKA, blood sugar levels are often normal, and ketone detection in urinalysis can be falsely negative, while glucosuria is excessive compared to euglycemic blood-glucose. The management corresponds to classical diabetic ketoacidosis, but special features of blood glucose target, hydration and potassium management should be considered. SGLT2 inhibitors should be paused if a longer fasting period is expected ("sick-day-break"). Due to the soaring number of prescriptions, a significant increase in the prevalence of eKA is expected. Immediate diagnosis and therapy are essential in emergency and intensive care medicine.
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Mitzlaff K, Sayk F, Marquardt JU. [72/m-Lower abdominal pain and fever : Preparation for the medical specialist examination: part 49]. Internist (Berl) 2021; 62:341-346. [PMID: 33824993 DOI: 10.1007/s00108-021-01013-0] [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] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- K Mitzlaff
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - F Sayk
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - J U Marquardt
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
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Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
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Meusel M, Herrmann M, Machleidt F, Franzen K, Vonthein R, Sayk F. Intranasal oxytocin has sympathoexcitatory effects on vascular tone in healthy males. Am J Physiol Regul Integr Comp Physiol 2020; 320:R162-R172. [PMID: 33296278 DOI: 10.1152/ajpregu.00062.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Oxytocin appears to be involved in the neuroendocrine regulation of sympathetic blood pressure (BP) homeostasis. In animals, intracerebral administration of oxytocin induces BP-relevant sympathetic activation. In humans, central nervous effects of oxytocin on BP regulation remain unclear. Intranasal administration supposedly delivers oligopeptides such as oxytocin directly to the brain. We investigated the effects of intranasal oxytocin on sympathetic vascular baroreflex function in humans using microneurographic techniques. In a balanced, double-blind crossover design, oxytocin or placebo was administered intranasally to 12 lean, healthy males (age 25 ± 4 yr). Muscle sympathetic nerve activity (MSNA) was assessed microneurographically before (presubstance), 30-45 min (postsubstance I), and 105-120 min (postsubstance II) after oxytocin administration. Baroreflex was challenged via graded infusions of vasoactive drugs, and correlation of BP with MSNA and heart rate (HR) defined baroreflex function. Experiments were conducted in the afternoon after a 5-h fasting period. After oxytocin, resting MSNA (burst rate and total activity) showed significant net increases from pre to postsubstance II compared with placebo [Δincrease = +4.3 ± 1.2 (oxytocin) vs. +2.2 ± 1.4 bursts/min (placebo), ANOVA; P < 0.05; total activity = 184 ± 11.5% (oxytocin) vs. 121 ± 14.3% (placebo), ANOVA; P = 0.01). This was combined with a small but significant net increase in resting diastolic BP, whereas systolic and mean arterial BP or HR as well as baroreflex sensitivity at vasoactive drug challenge were not altered. Intranasally administered oxytocin induced vasoconstrictory sympathoactivation in healthy male humans. The concomitant increase of diastolic BP was most likely attributable to increased vascular tone. This suggests oxytocin-mediated upward resetting of the vascular baroreflex set point at centers superordinate to the mere baroreflex-feedback loop.
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Affiliation(s)
- M Meusel
- Department of Internal Medicine II, University Heart Center Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - M Herrmann
- Department of Internal Medicine II, University Heart Center Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - F Machleidt
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - K Franzen
- Department of Internal Medicine III, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - R Vonthein
- Institute for Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - F Sayk
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
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Sayk F, Twesten C, Adametz I, Franzen K, Vonthein R, Dodt C, Meusel M. Angiotensin II-mediated nondipping during sleep in healthy humans: effects on baroreflex function at subsequent daytime. Am J Physiol Regul Integr Comp Physiol 2020; 318:R813-R821. [DOI: 10.1152/ajpregu.00355.2019] [Citation(s) in RCA: 2] [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: 02/06/2023]
Abstract
Blood pressure dipping at night is mediated by sleep-inherent, active downregulation of sympathetic vascular tone. Concomitantly, activity of the renin-angiotensin system is reduced, which might contribute to the beneficial effect of baroreflex downward resetting on daytime blood pressure homeostasis. To evaluate whether experimental nondipping mediated by angiotensin II during sleep would alter blood pressure and baroreflex function the next day in healthy humans, angiotensin-II or placebo (saline) was infused for a 7-h period at night, preventing blood pressure dipping in 11 sleeping normotensive individuals (5 males, balanced, crossover design). Baroreflex function was assessed about 1 h upon awakening and stop of infusion via microneurographic recordings of muscle sympathetic nerve activity (MSNA), showing that resting MSNA was significantly increased following angiotensin II nondipping compared with placebo ( P = 0.029), whereas blood pressure and heart rate remained unchanged. Baroreflex sensitivity in response to vasoactive drug challenge was preserved, and neuroendocrine markers of fluid balance and electrolytes did not differ between conditions. Ambulatory blood pressure during subsequent daytime was not altered. Data were compared with analog experiments previously performed within the same subjects during awake daytime (ANCOVA). We conclude that angiotensin-II mediated nocturnal nondipping did not induce blood pressure elevation at subsequent daytime in healthy humans but was linked to increased vasoconstrictive sympathetic activity. This is in contrast to a prolonged increase in blood pressure in corresponding daytime experiments of the same individuals. Evidently, sleep strongly preserves normotensive blood pressure homeostasis in healthy humans.
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Affiliation(s)
- Friedhelm Sayk
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christoph Twesten
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Isabel Adametz
- Institute of Radiology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Klaas Franzen
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Christoph Dodt
- Department of Emergency Medicine, München-Bogenhausen Hospital, München, Germany
| | - Moritz Meusel
- Department of Cardiology and Angiology, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Milkau M, Sayk F. [Emergency management of angioedema]. Med Klin Intensivmed Notfmed 2020; 116:65-68. [PMID: 32185423 DOI: 10.1007/s00063-020-00672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Milkau
- Medizinische Klinik I, Sektion Pneumologie, Sana Kliniken Lübeck GmbH, Kronsforder Allee 71-73, 23560, Lübeck, Deutschland. .,Sektion interdisziplinäre Intensivmedizin, Sana Kliniken Lübeck GmbH, Lübeck, Deutschland.
| | - F Sayk
- Medizinische Klinik I, Sektion Pneumologie, Sana Kliniken Lübeck GmbH, Kronsforder Allee 71-73, 23560, Lübeck, Deutschland
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15
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Wilms B, Chamorro R, Hallschmid M, Trost D, Forck N, Schultes B, Mölle M, Sayk F, Lehnert H, Schmid SM. Timing Modulates the Effect of Sleep Loss on Glucose Homeostasis. J Clin Endocrinol Metab 2019; 104:2801-2808. [PMID: 30807636 DOI: 10.1210/jc.2018-02636] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/20/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Chronobiological factors may modulate the impact of sleep loss on glucose homeostasis. However, these interactions have not been systematically assessed in humans. OBJECTIVE To assess the effect of sleep loss during the late vs early night on glucose homeostasis. DESIGN Fifteen normal-weight men participated in three conditions of a randomized, balanced crossover study comprising two conditions with shortened sleep (i.e., 4 hours of sleep during the first or the second half of the night) and a control condition with 8 hours of sleep. Glucose, insulin, cortisol, and glucagon were measured. Insulin sensitivity and secretion were assessed with a Botnia clamp. RESULTS Compared with regular sleep duration, sleep loss reduced insulin sensitivity (M-value; P = 0.031) irrespective of early- or late-night timing (P = 0.691). The disposition index (i.e., the β-cell response adjusted for insulin sensitivity) also tended to be impaired by short sleep (P = 0.056) but not by sleep timing (P = 0.543). In contrast, sleep loss in the second half but not the first half of the night induced reductions in morning glucagon and cortisol levels (P < 0.031) followed by a transient increase in cortisol (P < 0.044). CONCLUSIONS Although sleep deprivation acutely reduced insulin sensitivity irrespective of its nocturnal timing, sleep loss in the early morning compromised α-cell and hypothalamic-pituitary-adrenal axis activity to a greater extent than sleep loss in the first half of the night. This pattern suggests that the timing of sleep restriction can partly potentiate its deleterious metabolic effects.
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Affiliation(s)
- Britta Wilms
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior & Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Rodrigo Chamorro
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior & Metabolism, University of Lübeck, Lübeck, Germany
- Department of Nutrition, University of Chile, Santiago, Chile
| | - Manfred Hallschmid
- German Center for Diabetes Research, Munich-Neuherberg, Germany
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany
| | - Denisa Trost
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Nelli Forck
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Bernd Schultes
- eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Matthias Mölle
- Center of Brain, Behavior & Metabolism, University of Lübeck, Lübeck, Germany
| | | | - Hendrik Lehnert
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior & Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Sebastian M Schmid
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior & Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
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Meusel M, Herrmann M, Machleidt F, Franzen KF, Krapalis AF, Sayk F. GHRH-mediated GH release is associated with sympathoactivation and baroreflex resetting: a microneurographic study in healthy humans. Am J Physiol Regul Integr Comp Physiol 2019; 317:R15-R24. [PMID: 31042402 DOI: 10.1152/ajpregu.00033.2018] [Citation(s) in RCA: 3] [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: 02/04/2023]
Abstract
Previous research suggested substantial interactions of growth hormone (GH) and sympathetic nervous activity. This cross talk can be presumed both during physiological (e.g., slow-wave sleep) and pathological conditions of GH release. However, microneurographic studies of muscle sympathetic nerve activity (MSNA) and assessment of baroreflex function during acute GH-releasing hormone (GHRH)-mediated GH release were not conducted so far. In a balanced, double-blind crossover design, GHRH or placebo (normal saline) were intravenously administered to 11 healthy male volunteers. MSNA was assessed microneurographically and correlated with blood pressure (BP) and heart rate (HR) at rest before (pre-) and 30-45 (post-I) and 105-120 min (post-II) after respective injections. Additionally, baroreflex function was assessed via graded infusion of vasoactive drugs. GHRH increased GH serum levels as intended. Resting MSNA showed significant net increases of both burst rate and total activity from pre- to post-I and post-II following GHRH injections compared with placebo (ANOVA for treatment and time, burst rate: P = 0.028; total activity: P = 0.045), whereas BP and HR were not altered. ANCOVA revealed that the dependent variable MSNA was not affected by the independent variables mean arterial BP (MAP) or HR (MAP: P = 0.006; HR: P = 0.003). Baroreflex sensitivity at baroreflex challenge was not altered. GHRH-mediated GH release is associated with a significant sympathoactivation at central nervous sites superordinate to the simple baroreflex feedback loop because GH induced a baroreflex resetting without altering baroreflex sensitivity.
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Affiliation(s)
- Moritz Meusel
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Magdalena Herrmann
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Felix Machleidt
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Klaas F Franzen
- Department of Internal Medicine III, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Alexander F Krapalis
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Friedhelm Sayk
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany.,Department of Intensive Care Medicine, Sana-Kliniken, Luebeck, Germany
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Franzen KF, Willig J, Cayo Talavera S, Meusel M, Sayk F, Reppel M, Dalhoff K, Mortensen K, Droemann D. E-cigarettes and cigarettes worsen peripheral and central hemodynamics as well as arterial stiffness: A randomized, double-blinded pilot study. Vasc Med 2018; 23:419-425. [PMID: 29985113 DOI: 10.1177/1358863x18779694] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The introduction of electronic cigarettes has led to widespread discussion on the cardiovascular risks compared to conventional smoking. We therefore conducted a randomized cross-over study of the acute use of three tobacco products, including a control group using a nicotine-free liquid. Fifteen active smokers were studied during and after smoking either a cigarette or an electronic cigarette with or without nicotine (eGo-T CE4 vaporizer). Subjects were blinded to the nicotine content of the electronic cigarette and were followed up for 2 hours after smoking a cigarette or vaping an electronic cigarette. Peripheral and central blood pressures as well as parameters of arterial stiffness were measured by a Mobil-O-Graph® device. The peripheral systolic blood pressure rose significantly for approximately 45 minutes after vaping nicotine-containing liquid ( p<0.05) and for approximately 15 minutes after smoking a conventional cigarette ( p<0.01), whereas nicotine-free liquids did not lead to significant changes during the first hour of follow-up. Likewise, heart rate remained elevated approximately 45 minutes after vaping an electronic cigarette with nicotine-containing liquid and over the first 30 minutes after smoking a cigarette in contrast to controls. Elevation of pulse wave velocity was independent from mean arterial pressure as well as heart rate in the electronic cigarette and cigarette groups. In this first of its kind trial, we observed changes in peripheral and central blood pressure and also in pulse wave velocity after smoking a cigarette as well as after vaping a nicotine-containing electronic cigarette. These findings may be associated with an increased long-term cardiovascular risk.
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Affiliation(s)
- Klaas Frederik Franzen
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Johannes Willig
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Silja Cayo Talavera
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Moritz Meusel
- 2 Medizinische Klinik II, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | | | - Michael Reppel
- 4 Practice for Cardiology and Angiology Landsberg, Landsberg, Germany
| | - Klaus Dalhoff
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany.,5 German Center for Lung Research (DZL), ARCN, Kiel/Luebeck/Großhansdorf/Borstel, Germany
| | | | - Daniel Droemann
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany.,5 German Center for Lung Research (DZL), ARCN, Kiel/Luebeck/Großhansdorf/Borstel, Germany
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Abstract
Thyroid storm and myxedema coma are the most severe clinical forms of thyroid dysfunction. While both hyper- and hypothyroidsm are common diseases, thyroid storm and myxedema coma are rare. Due to their unspecific signs and symptoms they are often difficult to diagnose. Both disorders are medical emergencies, which still show a significant mortality. The following article summarizes diagnostic tools and treatment options for these disorders.
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Sayk F, Grusnick, HM, Weil J. Oxygen-Resistant "Cyanosis" After Sun Exposure. Dtsch Arztebl Int 2018. [PMID: 29478439 PMCID: PMC5832894 DOI: 10.3238/arztebl.2018.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Friedhelm Sayk
- *Interdisziplinäre Intensivmedizin, Sana Kliniken Lübeck, ,
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Abstract
Endocrine emergencies during pregnancy may be life-threatening events for both mother and fetus. Besides pregnancy-associated endocrine disorders, several pre-existing endocrinopathies such as type-1 diabetes and Grave's disease or adrenal failure may acutely deteriorate during pregnancy. Since "classical" signs are often modified by pregnancy, early diagnosis and management may be hampered. In addition, laboratory tests show altered physiologic ranges and pharmacologic options are limited while therapeutic goals are mostly tighter than in the non-pregnant patient. Though subclinical endocrinopathies are more frequent and worth consideration due to their related adverse sequelae, this article focuses on endocrine emergencies complicating pregnancy.
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Affiliation(s)
- Birgit Harbeck
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | | | - Sven Danneberg
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | - Morten Schütt
- a Department of Medicine I , University of Lübeck , Lübeck , Germany and
| | - Friedhelm Sayk
- b Department of Medicine II , University of Lübeck , Lübeck , Germany
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Sayk F. Abdominal Pain and Periumbilical Discoloration. Dtsch Arztebl Int 2016; 113:679. [PMID: 27788755 DOI: 10.3238/arztebl.2016.0679] [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: 11/27/2022]
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Suefke S, Sayk F, Nitschke M. Hemoadsorption in Infection-Associated Rhabdomyolysis. Ther Apher Dial 2016; 20:531-533. [PMID: 26991687 DOI: 10.1111/1744-9987.12410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/17/2015] [Accepted: 12/21/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Sven Suefke
- University of Lübeck, Medical Clinic 1, Lübeck, Germany.
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Sayk F, Twesten C, Wobbe I, Meusel M, Dodt C. Angiotensin-II-mediated Nondipping during nocturnal sleep increases morning sympathetic activity but not blood pressure in healthy humans. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.326] [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: 11/29/2022]
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25
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Sayk F, Reiter J, Krapalis A, Machleidt F, Meusel M, Hallschmid M. Intranasally administered orexin A does not activate sympathetic baroreflex function in healthy humans. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.095] [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: 11/29/2022]
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Sayk F, Wobbe I, Twesten C, Meusel M, Wellhöner P, Derad I, Dodt C. Prolonged blood pressure elevation following continuous infusion of angiotensin II-a baroreflex study in healthy humans. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1406-14. [PMID: 26400183 DOI: 10.1152/ajpregu.00111.2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023]
Abstract
ANG II interacts with the sympathetic nervous system at central nervous blood pressure-regulating structures, including the baroreflex. It is unknown whether prolonged BP elevation mediated by high ANG II plasma levels could induce a persistent shift of the central nervous baroreflex setpoint, lasting beyond the short ANG II plasmatic half time of a few seconds, thereby consolidating elevated BP and/or increased SNA in healthy humans. In a blinded crossover design, ANG II or placebo (saline) was infused for a 6-h period in 12 resting normotensive students (6 males, 6 females) raising BP to borderline hypertensive levels. Between 60 and 120 min after the infusion period, muscle sympathetic nerve activity (MSNA) was assessed microneurographically and correlated with oscillometric BP measurements and heart rate at supine rest (baseline) and during pharmacologic baroreceptor challenge. Infusion of ANG II increased BP to borderline-hypertensive levels, as intended, whereas heart rate remained unaltered. At baroreflex assessment (i.e., 60-120 min after end of infusion period), systolic BP was significantly higher compared with placebo (Δ8.4 ± 3.1 mmHg; P < 0.05), whereas diastolic values were nearly equal between conditions. Baseline MSNA was neither decreased nor increased, and baroreflex sensitivity to vasoactive drug challenge was not altered. Our results show that elevation of ANG II plasma levels over 6 h was able to increase systolic, but not diastolic, BP far beyond blood-mediated ANG II effects. MSNA or heart rate did not counter-regulate this BP elevation, indicating that ANG II had sustainably reset the central nervous BP threshold of sympathetic baroreflex function to accept elevated BP input signals without counter-regulatory response.
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Affiliation(s)
- Friedhelm Sayk
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany;
| | - Isabel Wobbe
- Institute of Radiology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; and
| | - Christoph Twesten
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Moritz Meusel
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Wellhöner
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Inge Derad
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christoph Dodt
- Department of Emergency Medicine, München-Bogenhausen Hospital, München, Germany
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Derad I, Obermann B, Katalinic A, Eisemann N, Knobloch JKM, Sayk F, Wellhöner P, Lehnert H, Solbach W, Süfke S, Steinhoff J, Nitschke M. Hypertension and mild chronic kidney disease persist following severe haemolytic uraemic syndrome caused by Shiga toxin-producing Escherichia coli O104:H4 in adults. Nephrol Dial Transplant 2015; 31:95-103. [PMID: 26180049 DOI: 10.1093/ndt/gfv255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/31/2015] [Accepted: 05/20/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shiga toxin-producing, enteroaggregative Escherichia coli was responsible for the 2011 outbreak of haemolytic uraemic syndrome (HUS). The present single-centre, observational study describes the 1-year course of the disease with an emphasis on kidney function. Outcome data after 1 year are associated with treatment and patient characteristics at onset of HUS. METHODS Patients were treated according to a standardized approach of supportive care, including a limited number of plasmapheresis. On top of this treatment, patients with severe HUS (n = 35) received eculizumab, a humanized anti-C5 monoclonal antibody inhibiting terminal complement activation. The per-protocol decision--to start or omit an extended therapy with eculizumab accompanied by azithromycin--separated the patients into two groups and marked Day 0 of the prospective study. Standardized visits assessed the patients' well-being, kidney function, neurological symptoms, haematological changes and blood pressure. RESULTS Fifty-six patients were regularly seen during the follow-up. All patients had survived without end-stage renal disease. Young(er) age alleviated restoring kidney function after acute kidney injury even in severe HUS. After 1 year, kidney function was affected with proteinuria [26.7%; 95% confidence interval (CI) 13.8-39.6], increased serum creatinine (4.4%, CI 0.0-10.4), increased cystatin C (46.7%, CI 32.1-61.3) and reduced (<90 mL/min) estimated glomerular filtration rate (46.7%, CI 32.1-61.3). Nine of the 36 patients without previous hypertension developed de novo hypertension (25%, CI 10.9-39.1). All these patients had severe HUS. CONCLUSIONS Although shiga toxin-producing Escherichia coli (STEC)-HUS induced by O104:H4 was a life-threatening acute disease, follow-up showed a good recovery of organ function in all patients. Whereas kidney function recovered even after longer duration of dialysis, chronic hypertension developed after severe HUS with neurological symptoms and could not be prevented by the extended therapy.
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Affiliation(s)
- Inge Derad
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Birgit Obermann
- Institute for Medical Microbiology, University of Lübeck, Lübeck, Germany
| | | | - Nora Eisemann
- Department of Epidemiology, University of Lübeck, Lübeck, Germany
| | | | - Friedhelm Sayk
- Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
| | - Peter Wellhöner
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Werner Solbach
- Institute for Medical Microbiology, University of Lübeck, Lübeck, Germany
| | - Sven Süfke
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Jürgen Steinhoff
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Martin Nitschke
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
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Honselmann KC, Buthut F, Heuwer B, Karadag S, Sayk F, Kurowski V, Thiele H, Droemann D, Wolfrum S. Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis: Predictors of mortality and quality of life in patients with sepsis/pneumonia. J Crit Care 2015; 30:721-6. [PMID: 25818842 DOI: 10.1016/j.jcrc.2015.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 11/18/2014] [Revised: 02/16/2015] [Accepted: 03/06/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study is to evaluate long-term mortality and quality of life (QoL) of intensive care patients with pneumonia and/or sepsis 1 year after discharge and to identify potential predictors for these outcome measures. METHODS This retrospective cohort study analyzed all patients admitted to the intensive care unit (ICU) of a German university hospital with diagnosis of pneumonia and/or sepsis between 2008 and 2009. Quality of life was assessed by telephone interview or mail using the standardized EuroQol 5-dimension questionaire. RESULTS Of 1406 patients treated in the ICU within the observational period, 217 met the inclusion criteria. Whereas in-hospital mortality differed significantly between pneumonia (17%) and sepsis (46%) (P < .001), 1-year mortality was not statistically significant (51% and 65%, P = .057). A high Simplified Acute Physiology Score (SAPS) II value was associated with high in-hospital mortality but failed to predict 1-year mortality. Quality of life, measured 1 year after discharge by visual analog scale (VAS), was 50% ± 25%, which was significantly lower than in a matched control group (70% ± 20%; P < .001). A high SAPS II score on admission did not correlate with VAS but was an independent predictor of a low EuroQol 5-dimension index. CONCLUSIONS The high post-ICU mortality of patients with pneumonia and sepsis emphasizes the need to focus on long-term follow-up in ICU studies and demonstrates that even when sepsis signs are missing, critically ill patients due to pneumonia have high 1-year mortality. Simplified Acute Physiology Score II does not predict long-term mortality, but a low SAPS II on admission might be useful to identify patients with good physical status after 1 year. TAKE HOME MESSAGE Hospital mortality of patients treated for pneumonia and/or sepsis is high and increases significantly within the first year after discharge. The SAPS II predicts in-hospital mortality and the physical components of QoL but not long-term mortality. TWEET One-year mortality of ICU pneumonia patients is equally high as in sepsis patients. Simplified Acute Physiology Score II cannot predict long-term mortality but can predict QoL.
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Affiliation(s)
- Kim C Honselmann
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Franziska Buthut
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Bjoern Heuwer
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sevin Karadag
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Friedhelm Sayk
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Volkhardt Kurowski
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Holger Thiele
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Daniel Droemann
- Medical Clinic III, Pulmonology/Infectious Diseases, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sebastian Wolfrum
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany; Department of Emergency Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany.
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Sayk F, Reiter J, Krapalis A, Machleidt F, Meusel M, Hallschmid M, Lehnert H. Intranasally administered Orexin-A does not activate sympathetic baroreflex function in healthy humans. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1549071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Knobloch JKM, Niemann S, Kohl TA, Lindner U, Nitschke M, Sayk F, Solbach W. Whole-genome sequencing for risk assessment of long-term Shiga toxin-producing Escherichia coli. Emerg Infect Dis 2014; 20:732-3. [PMID: 24655930 PMCID: PMC3966390 DOI: 10.3201/eid2004.131782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Derad I, Sayk F, Lehnert H, Marshall L, Born J, Nitschke M. Intranasal Angiotensin II in Humans Reduces Blood Pressure When Angiotensin II Type 1 Receptors Are Blocked. Hypertension 2014; 63:762-7. [DOI: 10.1161/hypertensionaha.113.02860] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Intranasal administration of angiotensin II (ANGII) affects blood pressure in a mode different from intravenously administered ANGII via a direct access to the brain bypassing the blood–brain barrier. This clinical study investigated blood pressure regulation after intranasal ANGII administration in healthy humans, whereas systemic, blood-mediated effects of ANGII were specifically blocked. In a balanced crossover design, men (n=8) and women (n=8) were intranasally administered ANGII (400 μg) or placebo after ANGII type 1 receptors had been blocked by pretreatment with valsartan (80 mg; 12 and 6 hours before intranasal administration). Plasma levels of ANGII, aldosterone, renin, vasopressin, and norepinephrine were measured; blood pressure and heart rate were recorded continuously. Intranasal ANGII acutely decreased blood pressure without altering the heart rate. Plasma levels of vasopressin and norepinephrine remained unaffected. Plasma ANGII levels were increased throughout the recording period. Aldosterone levels increased despite the peripheral ANGII type 1 receptor blockade, indicating an aldosterone escape phenomenon. In conclusion, intranasal ANGII reduces blood pressure in the presence of selective ANGII type 1 receptor blockade. Intranasal ANGII administration represents a useful approach for unraveling the role of this peptide in blood pressure regulation in humans.
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Affiliation(s)
- Inge Derad
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
| | - Friedhelm Sayk
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
| | - Hendrik Lehnert
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
| | - Lisa Marshall
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
| | - Jan Born
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
| | - Martin Nitschke
- From the Department of Internal Medicine (I.D., F.S., H.L., M.N.) and Department of Neuroendocrinology (L.M.), University of Lübeck, Lübeck, Germany; and Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany (J.B.)
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Iwen KA, Scherer T, Heni M, Sayk F, Wellnitz T, Machleidt F, Preissl H, Häring HU, Fritsche A, Lehnert H, Buettner C, Hallschmid M. Intranasal insulin suppresses systemic but not subcutaneous lipolysis in healthy humans. J Clin Endocrinol Metab 2014; 99:E246-51. [PMID: 24423295 PMCID: PMC3913807 DOI: 10.1210/jc.2013-3169] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Insulin infused into the central nervous system of rats suppresses lipolysis in white adipose tissue, indicating a role of brain insulin in regulating systemic lipid metabolism. OBJECTIVE We investigated whether central nervous insulin delivery suppresses lipolysis in healthy humans. DESIGN Placebo-controlled, balanced within-subject comparisons were performed in both a main and an independent corroborative experiment. SETTING/PARTICIPANTS/INTERVENTION: Two groups of healthy volunteers were examined at the German University Clinics of Lübeck and Tübingen, respectively, with molecular analyses taking place at Mt Sinai School of Medicine (New York, New York). The 14 healthy male subjects of the main study and the 22 women and 5 men of the corroborative study each received 160 IU of human insulin intranasally. MAIN OUTCOME MEASURES In the main study, we measured systemic levels of free fatty acids (FFAs), triglycerides, and glycerol and the rate of appearance of deuterated glycerol as an estimate of lipolysis before and after intranasal insulin administration. We also analyzed the expression of key lipolytic enzymes in sc fat biopsies and measured blood glucose and glucoregulatory hormones. In the corroborative study, FFA concentrations were assessed before and after intranasal insulin administration. RESULTS In the main experiment, intranasal insulin suppressed circulating FFA concentrations and lipolysis (rate of appearance of deuterated glycerol) in the absence of significant changes in circulating insulin levels. Lipolytic protein expression in sc adipose tissue was not affected. The corroborative study confirmed that intranasal insulin lowers systemic FFA concentrations. CONCLUSIONS Our findings indicate that brain insulin controls systemic lipolysis in healthy humans by predominantly acting on non-sc adipose tissue.
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Balabanova Y, Klar S, Deleré Y, Wilking H, Faber MS, Lassen SG, Gilsdorf A, Dupke S, Nitschke M, Sayk F, Grunow R, Krause G. Serological evidence of asymptomatic infections during Escherichia coli O104:H4 outbreak in Germany in 2011. PLoS One 2013; 8:e73052. [PMID: 24039858 PMCID: PMC3767767 DOI: 10.1371/journal.pone.0073052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/17/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction The largest known outbreak caused by a rare hybrid strain of Shiga toxin-producing E.coli (STEC) and enteroaggregative E. coli (EAEC) (E.coli O104:H4) of serotype O104:H4 occurred in Germany in 2011. Fenugreek sprouts acted as a transmission vehicle and were widely consumed in the outbreak area at the time of the epidemic. In total 3,842 people developed a clinical illness caused by this strain; however the rates of asymptomatic infections remain unclear. We aimed to develop a serological assay for detection of E.coli O104 LPS specific antibodies and to establish the post-outbreak levels of seropositivity among people with documented exposure to contaminated sprouts. Results and Discussion Developed serological assays (ELISA with 84% sensitivity, 63% specificity and Western Blot with 100% sensitivity, 82.5% specificity) identified 33% (16/49) level of asymptomatic infection. Relatively small sample size and a significant time- lapse between the onset of symptoms and serum samples collection (appr. 8 weeks) might explain the assay variability. No association was found between clinical or demographic characteristics and assay positivity. Larger studies are needed to understand the complexity of human immune response and factors influencing development of clinical symptoms. Development of intra-outbreak research plans will substantially aid the conduct of more thorough scientific investigation during an outbreak period.
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Affiliation(s)
| | | | | | | | | | - Sofie Gillesberg Lassen
- Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | | | | | | | - Gérard Krause
- Robert Koch Institute, Berlin, Germany
- Helmholtz Centre for Infection Research, Braunschweig, Germany
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Machleidt F, Simon P, Krapalis AF, Hallschmid M, Lehnert H, Sayk F. Experimental hyperleptinemia acutely increases vasoconstrictory sympathetic nerve activity in healthy humans. J Clin Endocrinol Metab 2013; 98:E491-6. [PMID: 23393176 DOI: 10.1210/jc.2012-3009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity and arterial hypertension are tightly connected. Obese individuals show significant elevation of vasoconstrictory muscle sympathetic nerve activity (MSNA). Obesity-related hyperleptinemia might play a key role in mediating these effects. Leptin is synthesized in proportion to body fat mass and activates SNA in animal models. In humans, however, direct evidence linking hyperleptinemia to sympathetic activation has not yet been established. In the present study, we characterize the effects of acute hyperleptinemia on microneurographically recorded SNA in humans. METHODS In a balanced, double-blind crossover design, 12 healthy normal-weight males received an iv bolus of leptin or placebo. MSNA (bursts per minute) was continuously recorded using a microneurographic technique. Ten-minute periods were analyzed at resting periods before (t-100) and at 20 (t20), 60 (t60), and 140 (t140) minutes after substance administration. Blood pressure and heart rate (HR) were recorded simultaneously. RESULTS Baseline values of MSNA, blood pressure, and HR were comparable in both conditions (MSNA: t-100, 24.3 ± 1.6 vs 22.7 ± 1.7, not significant). After application of leptin, MSNA showed a significant increase (t20, 31.0 ± 1.9 vs. 24.9 ± 1.8, P = .05) that persisted until the end of the experiment (t60, P = .008; t140, P = .004). There were no significant changes in blood pressure and HR. CONCLUSIONS Acute experimental hyperleptinemia has significant central nervous excitatory effects on vasoconstrictory sympathetic outflow as measured by MSNA in healthy men. These results suggest that leptin acts as an important mediator linking obesity to elevated MSNA and potentially to the development of hypertension.
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Affiliation(s)
- Felix Machleidt
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, D-23538 Lübeck, Germany
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Abstract
In 2011, a large outbreak caused by a Shiga toxin producing E. coli (STEC) occurred in Northern Germany, with a satellite outbreak in Western France, including the highest number of hemolytic uremic syndrome (HUS) cases ever encountered during a STEC outbreak. The outbreak strain was characterized as an enteroaggregative E. coli of serotype O104:H4 expressing a phage-encoded Shiga toxin 2. The majority of STEC infections and HUS cases were observed in adults, with a preponderance of the female gender. The outbreak imposed huge challenges on clinicians, microbiologists, and epidemiologists but also provided important new insight for the understanding of STEC infection. Thus, novel therapeutic strategies in the treatment of HUS in adults and for decolonization of long-term STEC carriers were evaluated. This review highlights the unusual features of the recent O104:H4 outbreak and focuses on emerging new strategies in diagnostics and treatment of acute STEC-related disease, as well as STEC long-term carriage.
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Affiliation(s)
- Susanne Hauswaldt
- Campus Lübeck, Department of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Martin Nitschke
- Campus Lübeck, Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Friedhelm Sayk
- Campus Lübeck, Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Werner Solbach
- Campus Lübeck, Department of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Johannes K.-M. Knobloch
- Campus Lübeck, Department of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Vonberg RP, Höhle M, Aepfelbacher M, Bange FC, Belmar Campos C, Claussen K, Christner M, Cramer JP, Haller H, Hornef M, Fickenscher H, Fraedrich K, Knobloch JK, Kühbacher T, Manns MP, Nitschke M, Peters G, Pulz M, Rohde H, Roseland RT, Sayk F, Schaumburg F, Schöcklmann HO, Schubert S, Solbach W, Karch H, Suerbaum S. Duration of Fecal Shedding of Shiga Toxin–Producing Escherichia coli O104:H4 in Patients Infected During the 2011 Outbreak in Germany: A Multicenter Study. Clin Infect Dis 2013; 56:1132-40. [DOI: 10.1093/cid/cis1218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Menne J, Nitschke M, Stingele R, Abu-Tair M, Beneke J, Bramstedt J, Bremer JP, Brunkhorst R, Busch V, Dengler R, Deuschl G, Fellermann K, Fickenscher H, Gerigk C, Goettsche A, Greeve J, Hafer C, Hagenmüller F, Haller H, Herget-Rosenthal S, Hertenstein B, Hofmann C, Lang M, Kielstein JT, Klostermeier UC, Knobloch J, Kuehbacher M, Kunzendorf U, Lehnert H, Manns MP, Menne TF, Meyer TN, Michael C, Münte T, Neumann-Grutzeck C, Nuernberger J, Pavenstaedt H, Ramazan L, Renders L, Repenthin J, Ries W, Rohr A, Rump LC, Samuelsson O, Sayk F, Schmidt BMW, Schnatter S, Schöcklmann H, Schreiber S, von Seydewitz CU, Steinhoff J, Stracke S, Suerbaum S, van de Loo A, Vischedyk M, Weissenborn K, Wellhöner P, Wiesner M, Zeissig S, Büning J, Schiffer M, Kuehbacher T. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. BMJ 2012; 345:e4565. [PMID: 22815429 PMCID: PMC3400392 DOI: 10.1136/bmj.e4565] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome. DESIGN Multicentre retrospective case-control study. SETTING 23 hospitals in northern Germany. PARTICIPANTS 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome. MAIN OUTCOME MEASURES Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death. RESULTS 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P = 0.03), fewer deaths (0% v 5%, p = 0.029), required no abdominal surgery, and excreted E coli for a shorter duration. CONCLUSIONS Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.
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Affiliation(s)
- Jan Menne
- Medical School Hannover, Hannover, Germany
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Krapalis AF, Reiter J, Machleidt F, Iwen KA, Dodt C, Lehnert H, Sayk F. Ghrelin modulates baroreflex-regulation of sympathetic vasomotor tone in healthy humans. Am J Physiol Regul Integr Comp Physiol 2012; 302:R1305-12. [PMID: 22492814 DOI: 10.1152/ajpregu.00663.2011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ghrelin, a neuropeptide originally known for its growth hormone-releasing and orexigenic properties, exerts important pleiotropic effects on the cardiovascular system. Growing evidence suggests that these effects are mediated by the sympathetic nervous system. The present study aimed at elucidating the acute effect of ghrelin on sympathetic outflow to the muscle vascular bed (muscle sympathetic nerve activity, MSNA) and on baroreflex-mediated arterial blood pressure (BP) regulation in healthy humans. In a randomized double-blind cross-over design, 12 lean young men were treated with a single dose of either ghrelin 2 μg/kg iv or placebo (isotonic saline). MSNA, heart rate (HR), and BP were recorded continuously from 30 min before until 90 min after substance administration. Sensitivity of arterial baroreflex was repeatedly tested by injection of vasoactive substances based on the modified Oxford protocol. Early, i.e., during the initial 30 min after ghrelin injection, BP significantly decreased together with a transient increase of MSNA and HR. In the course of the experiment (>30 min), BP approached placebo level, while MSNA and HR were significantly lower compared with placebo. The sensitivity of vascular arterial baroreflex significantly increased at 30-60 min after intravenous ghrelin compared with placebo, while HR response to vasoactive drugs was unaltered. Our findings suggest two distinct phases of ghrelin action: In the immediate phase, BP is decreased presumably due to its vasodilating effects, which trigger baroreflex-mediated counter-regulation with increases of HR and MSNA. In the delayed phase, central nervous sympathetic activity is suppressed, accompanied by an increase of baroreflex sensitivity.
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Affiliation(s)
- Alexander F Krapalis
- Univ. of Luebeck, Dept. of Internal Medicine I, Ratzeburger Allee 160, D-23538 Luebeck, Germany
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Nitschke M, Sayk F, Härtel C, Roseland RT, Hauswaldt S, Steinhoff J, Fellermann K, Derad I, Wellhöner P, Büning J, Tiemer B, Katalinic A, Rupp J, Lehnert H, Solbach W, Knobloch JKM. Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA 2012; 307:1046-52. [PMID: 22416100 DOI: 10.1001/jama.2012.264] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT An outbreak of Shiga toxin-producing enteroaggregative Escherichia coli (STEC O104:H4) infection with a high incidence of hemolytic uremic syndrome (HUS) occurred in Germany in May 2011. Antibiotic treatment of STEC infection is discouraged because it might increase the risk of HUS development. However, antibiotic therapy is widely used to treat enteroaggregative E coli infection. In the German outbreak, a substantial number of patients received prophylactic azithromycin treatment as part of a therapeutic regimen with the C5 antibody eculizumab. OBJECTIVE To analyze the duration of bacterial shedding in patients with STEC infection who did and did not receive oral azithromycin therapy. DESIGN, SETTING, AND PATIENTS At a single center in Lübeck, Germany, 65 patients with STEC infection, including patients with HUS as well as STEC-infected outpatients without manifestation of HUS, were investigated between May 15 and July 26, 2011, and were monitored for a mean of 39.3 days after onset of clinical symptoms. MAIN OUTCOME MEASURE Carriage of STEC after azithromycin therapy. RESULTS Twenty-two patients received oral azithromycin and 43 patients did not receive antibiotic treatment. Among antibiotic-treated patients, long-term STEC carriage (>28 days) was observed in 1 of 22 patients (4.5%; 95% CI, 0%-13.3%) compared with 35 of 43 patients (81.4%; 95% CI, 69.8%-93.0%) who were not treated with antibiotics (P < .001). All 22 patients receiving azithromycin treatment had at least 3 STEC-negative stool specimens after the completion of treatment, and no recurrence of STEC was observed in these patients. As proof of principle, 15 patients who initially were not treated with antibiotics and were long-term STEC carriers were treated with oral azithromycin given for 3 days and subsequently had negative stool specimens. CONCLUSION Treatment with azithromycin was associated with a lower frequency of long-term STEC O104:H4 carriage.
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Affiliation(s)
- Martin Nitschke
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Harbeck B, Schütt M, Sayk F. [Endocrine emergencies during pregnancy]. Med Klin Intensivmed Notfmed 2012; 107:110-7. [PMID: 22349529 DOI: 10.1007/s00063-011-0035-4] [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: 11/24/2011] [Accepted: 01/04/2012] [Indexed: 10/28/2022]
Abstract
Endocrine emergencies during pregnancy can become life-threatening for both mother and fetus. In addition to some pregnancy-linked endocrine disorders, several pre-existing forms of endocrinopathy, such as Grave's disease, type 1 diabetes and adrenal insufficiency might deteriorate acutely during pregnancy. Early diagnosis and management are challenging because the classical symptoms are often modified by pregnancy. Laboratory tests are subject to altered physiological ranges and pharmacological options are limited while therapeutic goals are stricter than in the non-pregnant patient. This article focuses on endocrine emergencies complicating pregnancy.
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Affiliation(s)
- B Harbeck
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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Wellhoener P, Vietheer A, Sayk F, Schaaf B, Lehnert H, Dodt C. Metabolic alterations in adipose tissue during the early phase of experimental endotoxemia in humans. Horm Metab Res 2011; 43:754-9. [PMID: 22009369 DOI: 10.1055/s-0031-1287854] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 10/16/2022]
Abstract
Adipose tissue plays an important role in energy homeostasis; however, there is only little knowledge about its metabolic activity during critical illness or sepsis. We assessed adipose tissue metabolic activity and local blood flow during experimental endotoxemia in otherwise healthy humans. In a prospective, placebo controlled and randomized experiment we measured changes in lactate, glycerol, and pyruvate concentrations in microdialysate samples of femoral adipose tissue after an intravenous bolus of lipopolysaccharide (LPS, 4 ng/kg). Intravenous endotoxin caused an early and constant increase in interstitial pyruvate, while formation of lactate in adipose tissue was not affected. In contrast, lactate levels in serum were elevated significantly after 90 min (p<0.05) and likewise, serum glycerol concentrations rose 90 min after LPS treatment (p<0.05) and 60 min earlier than in adipose tissue. Subcutaneous adipose tissue blood perfusion increased 2-fold while there was a strong decline in skin blood flow. Pyruvate accumulation in subcutaneous adipose tissue is an early marker of endotoxemia. While adipose tissue is a major source of serum glycerol and lactate in humans during physiological conditions, it contributes only little to increased serum lactate and glycerol levels during endotoxemia.
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Affiliation(s)
- P Wellhoener
- University Hospital Schleswig Holstein, Campus Luebeck, Department of Internal Medicine I, Luebeck, Germany.
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Rasch B, Dodt C, Sayk F, Mölle M, Born J. No elevated plasma catecholamine levels during sleep in newly diagnosed, untreated hypertensives. PLoS One 2011; 6:e21292. [PMID: 21695061 PMCID: PMC3117886 DOI: 10.1371/journal.pone.0021292] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 05/26/2011] [Indexed: 11/18/2022] Open
Abstract
The sympatho-adrenergic system is highly involved in regulating sleep, wake and arousal states, and abnormalities in this system are regarded as a key factor in the development and progression of arterial hypertension. While hypertension is associated with a hyperadrenergic state during wakefulness, the effect of hypertension on plasma-catecholamine levels during sleep is not yet known. Twelve young participants with newly diagnosed, untreated hypertension and twelve healthy controls slept for 7 hours in the sleep laboratory. Before and after sleep, subjects rested in a supine position for 3-h periods of wakefulness. We sampled blood at a fast rate (1/10 min) and monitored blood pressure and heart rate continuously. We show that plasma NE and E levels did not differ between hypertensives and normotensive during sleep as well as before and after sleep. Blood pressure was higher in hypertensives, reaching the largest group difference in the morning after sleep. Unlike in the normotensives, in the hypertensive participants the morning rise in blood pressure did not correlate with the rise in catecholamine levels at awakening. Our results suggest that hypertension in its early stages is not associated with a strong hyperadrenergic state during sleep. In showing a diminished control of blood pressure through sympatho-adrenergic signals in hypertensive participants, our data point towards a possible involvement of dysfunctional sleep-related blood pressure regulation in the development of hypertension.
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Affiliation(s)
- Björn Rasch
- Department of Neuroendocrinology, University of Lübeck, Lübeck, Germany
- Division of Biopsychology, University of Zürich, Zürich, Switzerland
| | - Christoph Dodt
- Department of Internal Medicine, University of Lübeck, Lübeck, Germany
- Division of Emergency Medicine, München-Bogenhausen Hospital, München, Germany
| | - Friedhelm Sayk
- Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - Matthias Mölle
- Department of Neuroendocrinology, University of Lübeck, Lübeck, Germany
| | - Jan Born
- Department of Neuroendocrinology, University of Lübeck, Lübeck, Germany
- Department of Medical Psychology and Neurobiology, University of Tübingen, Tübingen, Germany
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Bartels C, Malisius R, Sayk F, Bechtel M, Leyh R, Feller A, Sievers HH. Accelerated smooth muscle cell apoptosis in occluded aorto-coronary saphenous vein grafts. Int J Angiol 2011. [DOI: 10.1007/bf01637040] [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] Open
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Sayk F, Heutling D, Dodt C, Iwen KA, Wellhoner JP, Scherag S, Hinney A, Hebebrand J, Lehnert H. Sympathetic function in human carriers of melanocortin-4 receptor gene mutations. J Clin Endocrinol Metab 2010; 95:1998-2002. [PMID: 20147580 DOI: 10.1210/jc.2009-2297] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Melanocortinergic pathways clearly appear to be involved in obesity-associated sympathetic overactivity and its hemodynamic and thermoregulatory consequences. Individuals with dysfunctional mutations in the melanocortin-4 receptor gene (MC4R) are subject to obesity without developing hypertension. OBJECTIVE This study aimed at characterizing the impact of the MC4R on sympathetic nerve traffic relevant to the cardiovascular system in humans. PARTICIPANTS Participants included eight heterozygous carriers of MC4R mutations leading to a reduced function and control subjects matched for gender, age, and body mass index. MEASUREMENTS We investigated vasoconstrictive muscle sympathetic nerve activity (MSNA), a direct measure of central sympathetic nervous outflow. MSNA was recorded microneurographically from the peroneal nerve at supine rest and during apnea-induced sympathoexcitation. Sympathetic activity was correlated with serum leptin levels and hemodynamic and anthropometric data. RESULTS Individuals with MC4R impairment due to functional MC4R mutations were characterized by an inverse correlation between MSNA with body mass index and leptin levels, with the most obese subjects having the lowest MSNA. Resting MSNA, diastolic blood pressure, and heart rate tended to be lower in MC4R mutation carriers, and stimulated MSNA during apnea was significantly lower as compared with control subjects. CONCLUSION The fact that obese subjects with MC4R mutations show an inverse relationship between obesity and MSNA suggests that central sympathetic outflow to the vasculature might depend on functional melanocortinergic pathways. Their dysfunction could explain reduced sympathoexcitability, lower sympathetic nerve-induced lipolysis, and the fact that blood pressure is rarely elevated in this type of obesity.
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Affiliation(s)
- Friedhelm Sayk
- First Department of Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany
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Sayk F, Mahnken A, Stellmacher F, Dalhoff K, Merz H. [Cancer-to-cancer metastasis: amelanotic melanoma into renal cell carcinoma]. Dtsch Med Wochenschr 2010; 135:507-10. [PMID: 20221965 DOI: 10.1055/s-0030-1249195] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HISTORY AND PHYSICAL FINDINGS A 54-year old man was admitted because of motor aphasia, behavioral changes and weight loss and suffered from a widely disseminated cancer with unknown primary origin (CUP) syndrome. DIAGNOSIS The autopsy revealed that he was affected by two malignant neoplasms simultaneously: an amelanotic malignant melanoma metastasizing into a localized renal cell carcinoma. CONCLUSION Cancer-to-cancer metastasis is an exceedingly rare, but well documented phenomenon. This is the third reported case of a malignant melanoma as donor tumor spreading into a renal cell carcinoma. Well-vascularized and slowly growing renal tumors are typical recipients for cancer-to-cancer metastases. The amelanotic character of the melanoma exerted a special diagnostic challenge. Clinical and autopsy findings as well as the immunophenotypical features of the metastatic amelanotic melanoma (HMB-45, Melan-A/MART-1, S100) and the renal cell carcinoma are described with a review of the relevant literature.
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Affiliation(s)
- F Sayk
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
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Sayk F, Teckentrup C, Becker C, Heutling D, Wellhöner P, Lehnert H, Dodt C. Effects of selective slow-wave sleep deprivation on nocturnal blood pressure dipping and daytime blood pressure regulation. Am J Physiol Regul Integr Comp Physiol 2009; 298:R191-7. [PMID: 19907004 DOI: 10.1152/ajpregu.00368.2009] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nocturnal blood pressure (BP) decline or "dipping" is an active, central, nervously governed process, which is important for BP regulation during daytime. It is, however, not known whether the sleep process itself or, more specifically, slow-wave sleep (SWS) is important for normal dipping. Therefore, in the present study, healthy subjects (6 females, 5 males) were selectively deprived of SWS by EEG-guided acoustic arousals. BP and heart rate (HR) were monitored during experimental nights and the following day. Additionally, nocturnal catecholamine excretion was determined, and morning baroreflex function was assessed by microneurographic measurements of muscle sympathetic nerve activity (MSNA) and heart rate variability (HRV). Data were compared with a crossover condition of undisturbed sleep. SWS was successfully deprived leading to significantly attenuated mean arterial BP dipping during the first half (P < 0.05), but not during the rapid-eye-movement-dominated second half of total sleep; however, dipping still evolved even in the absence of SWS. No differences were found for nighttime catecholamine excretion. Moreover, daytime resting and ambulatory BP and HR were not altered, and morning MSNA and HRV did not differ significantly, indicating that baroreflex-mediated sympathoneural BP regulation was not affected by the preceding SWS deprivation. We conclude that in healthy humans the magnitude of nocturnal BP dipping is significantly affected by sleep depth. Deprivation of SWS during one night does not modulate the morning threshold and sensitivity of the vascular and cardiac baroreflex and does not alter ambulatory BP during daytime.
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Affiliation(s)
- Friedhelm Sayk
- First Dept. of Medicine, Univ. of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany.
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Sayk F, Iwen K, Lehnert H. Diabetes und Hypertonie. Dtsch Med Wochenschr 2009; 134:2296-301. [DOI: 10.1055/s-0029-1241944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schaaf B, Luitjens K, Goldmann T, van Bremen T, Sayk F, Dodt C, Dalhoff K, Droemann D. Mortality in human sepsis is associated with downregulation of Toll-like receptor 2 and CD14 expression on blood monocytes. Diagn Pathol 2009; 4:12. [PMID: 19371402 PMCID: PMC2672063 DOI: 10.1186/1746-1596-4-12] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [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: 03/09/2009] [Accepted: 04/16/2009] [Indexed: 11/10/2022] Open
Abstract
Pattern recognition receptors are a key component of the first line host defense against infection, recognizing specific microbial products. We hypothesize that monocyte hyporesponsiveness in human sepsis is associated with a downregulation of the pattern recognition receptors Toll-like receptor (TLR)-2 and TLR4.Protein expression of CD14, TLR2 and TLR4 on blood monocytes was examined using flow cytometry from 29 patients with sepsis and 14 healthy controls. In addition LPS stimulated TNF-alpha and IL-10 production was studied in a 24 hour whole blood assay.We found an increased expression of CD14, TLR2 and TLR4 in patients with sepsis compared to controls (p < 0.01). In patients with sepsis, death was associated with significant lower CD14 and TLR2 expression at admission (CD14: 25.7 +- 19.1 vs 39.1 +- 17.3 mean fluorescence intensity [MFI], p = 0.02; TLR2: 21.8 +- 9.4 vs. 30.9 +- 9.6, p = 0.01). At 72 hours the TLR2 expression on monocytes was associated with the IL-10 inducibility after LPS stimulation (r = 0.52, p = 0.02) and the CD14 expression with the IL-6, IL-10 and TNF inducibility.We conclude that septic patients are characterized by an increased expression of CD14, TLR2 and TLR4 on monocytes compared to controls. Death is associated with downregulation of TLR2 and CD14 expression on monocytes correlating with reduced cytokine inducibility. We suggest that CD14 and TLR2 are a key factor in monocyte hyporesponsibility during severe sepsis.
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Sayk F, Vietheer A, Schaaf B, Wellhoener P, Weitz G, Lehnert H, Dodt C. Endotoxemia causes central downregulation of sympathetic vasomotor tone in healthy humans. Am J Physiol Regul Integr Comp Physiol 2008; 295:R891-8. [DOI: 10.1152/ajpregu.90444.2008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Experimental endotoxemia as a model of the initial septic response affects the autonomic nervous system with profound cardiovascular sequelae. Whether the postsynaptic sympathoneural activity to the muscle vascular bed is altered in the early septic phase remains to be determined. The present study aimed to elucidate the early effects of LPS on muscle sympathetic nerve activity (MSNA) and cardiovascular regulation in healthy humans. Young, healthy volunteers randomly received either an LPS bolus (4 ng/kg body wt, n = 11) or placebo (saline; n = 7). Experimental baroreflex assessment (baseline measurements followed by infusion of vasoactive drugs nitroprusside/phenylephrine) was done prior to and 90 min following LPS or placebo challenge. MSNA, heart rate, blood pressure, and blood levels of catecholamines, TNF-α and IL-6 were measured sequentially. Endotoxin but not placebo-induced flu-like symptoms and elevated cytokine levels. In contrast to placebo, LPS significantly suppressed MSNA burst frequency 90 min after injection [mean ± SE: 12.1 ± 2.9 vs. 27.5 ± 3.3 burst/min (post- vs. pre-LPS); P < 0.005] but increased heart rate [78.4 ± 3.1 vs. 60.6 ± 2.0 beats/min (post- vs. pre-LPS); P < 0.001]. Baseline blood pressure was not altered, but baroreflex testing demonstrated a blunted MSNA response and uncoupling of heart rate modulation to blood pressure changes in the endotoxin group. We conclude that endotoxin challenge in healthy humans has rapid suppressive effects on postsynaptic sympathetic nerve activity to the muscle vascular bed and alters baroreflex function which may contribute to the untoward cardiovascular effects of sepsis.
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Sayk F, Roemer M, Dalhoff K, Schaaf B. [Miliary tuberculosis with intestinal involvement]. Dtsch Med Wochenschr 2008; 133:715-6. [PMID: 18363190 DOI: 10.1055/s-2008-1067312] [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: 10/22/2022]
Affiliation(s)
- F Sayk
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck
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