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Abstract
The differential diagnosis of fever, especially in the context of autoimmune diseases is broad. Accordingly, the spectrum of diagnostic procedures is extensive and the therapeutic consequences are partly contradictory. Fever is basically the manifestation of an increased cell proliferation, such as classically seen in tumors, infections or autoimmune inflammation. Systemic lupus erythematosus (SLE) is one of the most multifaceted rheumatological diseases. Fever is one component of the new classification criteria which help to classify and possibly diagnose SLE. The differential work-up of fever is a special challenge for clinicians particularly in the context of the initial diagnosis of SLE or another autoimmune disease and also in the course of the disease in patients with autoimmune diseases. Based on a case report this article discusses differential diagnostic considerations and proposes a concrete differential diagnostic procedure. The patient's history is highlighted as an extremely important source of relevant information. Without claiming completeness various factors are listed, which help to differentiate fever as a consequence of SLE activity versus fever as a consequence of an infection.
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Affiliation(s)
- H-M Lorenz
- Klinik für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland. .,ACURA-Rheumazentrum Baden-Baden, Baden-Baden, Deutschland.
| | - L Pieterse
- Klinik für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - T Rüter
- Internistische Rheumatologie, Rotes-Kreuz-Krankenhaus Bremen, Bremen, Deutschland
| | - F Lorenz
- Abteilung für Psychiatrie, Klinikum Augsburg, Augsburg, Deutschland
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Urbaneck I, Lorenz F, Materzok I, Maletzki L, Pietzner M, Budde K, Nauck M, Felix SB, Doerr M, Bahls M. P6277The impact of exercise training in combination with statin use on skeletal muscle mitochondrial oxidative phosphorylation and metabolomics in obese rats. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Exercise training (ET) and statin treatment both alter skeletal muscle function.
Purpose
We investigated the effects of a combined exercise and statin use on skeletal muscle mitochondrial oxidative phosphorylation (OxPhos) and metabolic alterations in obese rats.
Methods
Eight-week-old male Wistar rats were used. A total of 14 animals received standard chow, while 46 rats were fed a high-fat diet (HFD) for 20 weeks. After 8 weeks, the rats were randomized into 6 groups: sedentary (n=8), ET (n=6), sedentary with HFD (n=11), ET with HFD (n=11), statin with HFD (n=13) and ET with HFD and statins (n=11). Simvastatin (10mg/d/kg) was added to the drinking water. ET was performed for 12 weeks, 5 days/week for 1 h/day at 18 m/min in a motorized running wheel. OxPhos was assessed by complex-specific antibodies and targeted metabolomics using the Biocrates p180 kit. All experiments were done on frozen samples of the M. gastrocnemicus. An ANOVA with fixed effects for diet, exercise, statin treatment and statin-exercise interaction was used to identify significantly different metabolites.
Results
Statin use was associated with significantly lower cholesterol levels, but did not affect exercise duration and intensity compared to none-use. In sedentary animals, HFD increased OxPhos complex II (succinate dehydrogenase), complex IV (cytochrome-c-oxidase) and V (ATP synthase) while statin treatment diminished this increase in all complexes. HFD increased complex IV independent of statin treatment but had no effect on complex II and V in ET rats. Complex IV was increased due to ET only in HFD fed rats compared to rats on normal chow but decreased in contrast to sedentary animals on a HFD. With regards to metabolomics, we found 57 metabolites which were influenced by HFD while no metabolites were identified with a significant effect for ET. A significant statin-exercise interaction was found for three lysophosphatidylcholines (lysoPC a C26.0, lysoPC a C26.1, lysoPC a C24.0), one phosphatidylcholine (PC aa C42.6) and one sphingomyelin (SM C16.1). HFD decreased the concentration of all mentioned metabolites compared to standard chow fed animals. Likewise, ET increased the concentration of metabolites compared to sedentary animals on HFD. Statin treatment led to an increase, while statin in combination with ET did not rescue this effect.
Conclusion
HFD induced severely impaired skeletal muscle OxPhos independent of ET and statin treatment. Our findings suggest a limiting rate of NADH production in the tricarboxylic acid cycle as a potential mechanism. However, ET prevented the increase in cytochrome-c-oxidation while statins blocked the HFD induced increase in ATP synthase. Our metabolomics results imply that future research should consider the lipotoxic effects of a HFD when assessing skeletal muscle alterations due to ET or statins. Of particular interest could be the 5 metabolites that have been shown to be impacted by a statin-exercise interaction.
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Affiliation(s)
- I Urbaneck
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - F Lorenz
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - I Materzok
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - L Maletzki
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - M Pietzner
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - K Budde
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - M Nauck
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - S B Felix
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - M Doerr
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - M Bahls
- Universitaetsmedizin Greifswald, Greifswald, Germany
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Materzok I, Lorenz F, Bahls M, Strohbach A, Doerr M, Felix S, Busch R. P3482Pravastatin but not atorvastatin influences endothelial cell mechanotaxis via APJ signaling. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lorenz F, Bulanda A, Kleinotiene G, Markuszewska-Kuczyńska A, Machaczka M. Analysis of ferritinemia and serum soluble interleukin-2 receptor α concentration in type 1 Gaucher disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.achaem.2013.07.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lorenz F, Paris M. EP-1240: Different gating methods and possible pitfalls for clinical implementation. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33546-5] [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: 10/23/2022]
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Kirchner J, Goltz JP, Lorenz F, Obermann A, Kirchner EM, Kickuth R. Reply to the letter to the Editor by Laney et al: The association between tobacco burden and “dirty chest” is unlikely to follow a linear dose-response pattern. Br J Radiol 2012. [DOI: 10.1259/bjr/70035763] [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: 11/05/2022] Open
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Kirchner J, Goltz JP, Lorenz F, Obermann A, Kirchner EM, Kickuth R. The "dirty chest"--correlations between chest radiography, multislice CT and tobacco burden. Br J Radiol 2011; 85:339-45. [PMID: 21937617 DOI: 10.1259/bjr/62694750] [Citation(s) in RCA: 8] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as "dirty chest". As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies. METHODS In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification. RESULTS 63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of <1/1, 29 (34%) had an ILO profusion score of <2/2 and 2 (2%) had an ILO score of ≥ 2/2. There was a significant positive linear correlation between the increase of overall lung markings on chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (p<0.05).The most common findings in CT were thickening of bronchial walls (64%) and the presence of emphysema (62%) and of intralobular opacities (61%). Ground-glass opacities were seen in only 7% of our patients. CONCLUSION Bronchial wall thickening and intralobular opacities as seen in CT showed a positive linear correlation with the increase of overall lung markings on chest radiography.
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Affiliation(s)
- J Kirchner
- Department of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus, Hagen, Germany.
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Boggula R, Lorenz F, Mueller L, Birkner M, Wertz H, Stieler F, Steil V, Lohr F, Wenz F. Experimental validation of a commercial 3D dose verification system for intensity-modulated arc therapies. Phys Med Biol 2010; 55:5619-33. [DOI: 10.1088/0031-9155/55/19/001] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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9
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Boggula R, Lorenz F, Abo-Madyan Y, Lohr F, Wolff D, Boda-Heggemann J, Hesser J, Wenz F, Wertz H. A new strategy for online adaptive prostate radiotherapy based on cone-beam CT. Z Med Phys 2009; 19:264-76. [DOI: 10.1016/j.zemedi.2009.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/28/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Stieler F, Wolff D, Lohr F, Steil V, Abo-Madyan Y, Lorenz F, Wenz F, Mai S. A fast radiotherapy paradigm for anal cancer with volumetric modulated arc therapy (VMAT). Radiat Oncol 2009; 4:48. [PMID: 19852856 PMCID: PMC2774855 DOI: 10.1186/1748-717x-4-48] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 10/25/2009] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/PURPOSE Radiotherapy (RT) volumes for anal cancer are large and of moderate complexity when organs at risk (OAR) such as testis, small bowel and bladder are at least partially to be shielded. Volumetric intensity modulated arc therapy (VMAT) might provide OAR-shielding comparable to step-and-shoot intensity modulated radiotherapy (IMRT) for this tumor entity with better treatment efficiency. MATERIALS AND METHODS Based on treatment planning CTs of 8 patients, we compared dose distributions, comformality index (CI), homogeneity index (HI), number of monitor units (MU) and treatment time (TTT) for plans generated for VMAT, 3D-CRT and step-and-shoot-IMRT (optimized based on Pencil Beam (PB) or Monte Carlo (MC) dose calculation) for typical anal cancer planning target volumes (PTV) including inguinal lymph nodes as usually treated during the first phase (0-36 Gy) of a shrinking field regimen. RESULTS With values of 1.33 +/- 0.21/1.26 +/- 0.05/1.3 +/- 0.02 and 1.39 +/- 0.09, the CI's for IMRT (PB-Corvus/PB-Hyperion/MC-Hyperion) and VMAT are better than for 3D-CRT with 2.00 +/- 0.16. The HI's for the prescribed dose (HI36) for 3D-CRT were 1.06 +/- 0.01 and 1.11 +/- 0.02 for VMAT, respectively and 1.15 +/- 0.02/1.10 +/- 0.02/1.11 +/- 0.08 for IMRT (PB-Corvus/PB-Hyperion/MC-Hyperion). Mean TTT and MU's for 3D-CRT is 220s/225 +/- 11MU and for IMRT (PB-Corvus/PB-Hyperion/MC-Hyperion) is 575s/1260 +/- 172MU, 570s/477 +/- 84MU and 610s748 +/- 193MU while TTT and MU for two-arc-VMAT is 290s/268 +/- 19MU. CONCLUSION VMAT provides treatment plans with high conformity and homogeneity equivalent to step-and-shoot-IMRT for this mono-concave treatment volume. Short treatment delivery time and low primary MU are the most important advantages.
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Affiliation(s)
- Florian Stieler
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Dirk Wolff
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Volker Steil
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
- Department of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Egypt
| | - Friedlieb Lorenz
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
| | - Sabine Mai
- Department of Radiation Oncology, University Medical Center Mannheim, University Heidelberg, Germany
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Fritzenwanger M, Lorenz F, Jung C, Fabris M, Thude H, Barz D, Figulla HR. Differential number of CD34+, CD133+ and CD34+/CD133+ cells in peripheral blood of patients with congestive heart failure. Eur J Med Res 2009; 14:113-7. [PMID: 19380281 PMCID: PMC3352059 DOI: 10.1186/2047-783x-14-3-113] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [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] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Endothelial progenitor cells (EPC) which are characterised by the simulateous expression of CD34, CD133 and vascular endothelial growth receptor 2 (VEGF 2) are involved in the pathophysiology of congestive heart failure (CHF) and their number and function is reduced in CHF. But so far our knowledge about the number of circulating hematopoietic stem/ progenitor cells (CPC) expressing the early hematopoietic marker CD133 and CD34 in CHF is spares and therefore we determined their number and correlated them with New York Heart Association (NYHA) functional class. METHODS CD34 and CD133 surface expression was quantified by flow cytometry in the peripheral venous blood of 41 healthy adults and 101 patients with various degrees of CHF. RESULTS CD34+, CD133+ and CD34+/CD133+ cells correlated inversely with age. Both the number of CD34+ and of CD34+/CD133+ cells inversely correlated with NYHA functional class. The number of CD133+ cells was not affected by NYHA class. Furthermore the number of CD133+ cells did not differ between control and CHF patients. CONCLUSION In CHF the release of CD34+, CD133+ and CD34+/CD133+ cells from the bone marrow seems to be regulated differently. Modulating the releasing process in CHF may be a tool in CHF treatment.
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Schneider F, Fuchs H, Lorenz F, Steil V, Ziglio F, Lohr F, Wenz F. Intravaginal Electronic Brachytherapy using a 50kv X-ray Source. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.181] [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: 11/26/2022]
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Boggula R, Lorenz F, Chen H, Gansemer C, Wertz H, Giuliacci A, Brusasco C, Mueller L, Wenz F. Commissioning of a System to Correlate Dose Measurements to Patients Anatomy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lorenz F, Nalichowski A, Rosca F, Killoran J, Wenz F, Zygmanski P. An independent dose calculation algorithm for MLC-based radiotherapy including the spatial dependence of MLC transmission. Phys Med Biol 2008; 53:557-73. [DOI: 10.1088/0031-9155/53/3/004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Boggula R, Wertz H, Lorenz F, Abo Madyan Y, Boda-Heggemann J, Schneider F, Polednik M, Hesser J, Lohr F, Wenz F. A Proposed Strategy to Implement CBCT Images for Replanning and Dose Calculations. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zygmanski P, Rosca F, Kadam D, Lorenz F, Nalichowski A, Court L, Chin L. Determination of depth and field size dependence of multileaf collimator transmission in intensity-modulated radiation therapy beams. J Appl Clin Med Phys 2007; 8:76-95. [PMID: 18449158 PMCID: PMC5722617 DOI: 10.1120/jacmp.v8i4.2693] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 05/08/2007] [Revised: 06/28/2007] [Accepted: 08/03/2007] [Indexed: 11/27/2022] Open
Abstract
Intensity‐modulated radiation therapy (IMRT) plans for the treatment of large and complex volumes may contain a relatively large contribution from multileaf collimator (MLC) transmission. In such cases, comprehensive characterization of direct and scatter MLC transmission is important. We designed a set of tests (open beam, closed static MLC, and dynamic MLC gap) to determine dosimetric MLC properties as a function of field size and depth at the central axis. We developed a generalized model of MLC transmission to account for direct MLC transmission, MLC scatter, beam hardening, and leaf‐end transmission (dosimetric gap). The model is consistent with the beam model used in IMRT optimization. We tested the model for extreme asymmetric fields relevant for large targets and for split IMRT fields. We applied our MLC scatter estimation formula to clinically relevant cases and showed that MLC scatter is contributing an undesired background dose. This contribution is relatively large, especially in low‐dose regions. (For instance, a uniform extra dose may dramatically increase normal‐lung toxicity in thorax treatment.) For complex IMRT of large‐volume targets, we found direct MLC transmission dose to be as high as 30%, and MLC scatter, up to 10% within the target volume for the selected cases. We identified that the dose discrepancies between the IMRT planning system [Eclipse (Varian Medical Systems, Palo Alto, CA)] and ionization chamber measurements (inside and outside of the field) are attributable to an inadequate model of MLC transmission in the planning system (constant‐value model). In the present study, we measured MLC transmission properties for Varian 6EX (6 MV) and 21EXs (6 and 10 MV) linear accelerators; however, the experimental method and theoretical model are more general. PACS number: 87.53.‐j
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Affiliation(s)
- Piotr Zygmanski
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Florin Rosca
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dnyanesh Kadam
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Friedlieb Lorenz
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Adrian Nalichowski
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Laurence Court
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lee Chin
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
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Abstract
In complex intensity-modulated radiation therapy cases, a considerable amount of the total dose may be delivered through closed leaves. In such cases an accurate knowledge of spatial characteristics of multileaf collimator (MLC) transmission is crucial, especially for the treatment of large targets with split fields. Measurements with an ionization chamber, radiographic films (EDR2, EBT) and EPID are taken to characterize all relevant effects related to MLC transmission for various field sizes and depths. Here we present a phenomenological model to describe MLC transmission, whereby the main focus is the off-axis decrease of transmission for symmetric and asymmetric fields as well as on effects due to the tongue and groove design of the leaves, such as interleaf transmission and the tongue and groove effect. Data obtained with the four different methods are presented, and the utility of each measurement method to determine the necessary model parameters is discussed. With the developed model, it is possible to predict the relevant MLC effects at any point in the phantom for arbitrary jaw settings and depths.
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Affiliation(s)
- Friedlieb Lorenz
- Department of Radiation Oncology, Mannheim Medical Centre, University of Heidelberg, 68167 Mannheim, Germany
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18
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Abstract
We have developed an algorithm to calculate dose in a homogeneous phantom for radiotherapy fields defined by multi-leaf collimator (MLC) for both static and dynamic MLC delivery. The algorithm was developed to supplement the dose algorithms of the commercial treatment planning systems (TPS). The motivation for this work is to provide an independent dose calculation primarily for quality assurance (QA) and secondarily for the development of static MLC field based inverse planning. The dose calculation utilizes a pencil-beam kernel. However, an explicit analytical integration results in a closed form for rectangular-shaped beamlets, defined by single leaf pairs. This approach reduces spatial integration to summation, and leads to a simple method of determination of model parameters. The total dose for any static or dynamic MLC field is obtained by summing over all individual rectangles from each segment which offers faster speed to calculate two-dimensional dose distributions at any depth in the phantom. Standard beam data used in the commissioning of the TPS was used as input data for the algorithm. The calculated results were compared with the TPS and measurements for static and dynamic MLC. The agreement was very good (<2.5%) for all tested cases except for very small static MLC sizes of 0.6 cm x 0.6 cm (<6%) and some ion chamber measurements in a high gradient region (<4.4%). This finding enables us to use the algorithm for routine QA as well as for research developments.
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Affiliation(s)
- Friedlieb Lorenz
- Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, Mannheim, 68167 Germany.
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Fogliata A, Nicolini G, Alber M, Åsell M, Clivio A, Dobler B, Larsson M, Lohr F, Lorenz F, Muzik J, Polednik M, Vanetti E, Wolff D, Wyttenbach R, Cozzi L. On the performances of different IMRT Treatment Planning Systems for selected paediatric cases. Radiat Oncol 2007; 2:7. [PMID: 17302972 PMCID: PMC1803794 DOI: 10.1186/1748-717x-2-7] [Citation(s) in RCA: 20] [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: 11/29/2006] [Accepted: 02/15/2007] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the performance of seven different TPS (Treatment Planning Systems: Corvus, Eclipse, Hyperion, KonRad, Oncentra Masterplan, Pinnacle and PrecisePLAN) when intensity modulated (IMRT) plans are designed for paediatric tumours. Methods Datasets (CT images and volumes of interest) of four patients were used to design IMRT plans. The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilm's tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient. Results were analysed in terms of dose distributions and dose volume histograms. Results For all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones). For OARs the range of scores was between 0.75 ± 0.15 (Eclipse) to 0.92 ± 0.18 (Pinnacle3 with physical optimisation). For target volumes, the score ranged from 0.05 ± 0.05 (Pinnacle3 with physical optimisation) to 0.16 ± 0.07 (Corvus). Conclusion A set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients.
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Affiliation(s)
- Antonella Fogliata
- Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland
| | - Giorgia Nicolini
- Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland
| | - Markus Alber
- Biomedical Physics, Radiooncology Dept, Uniklinik für Radioonkologie Tübingen, Tübingen, Germany
| | - Mats Åsell
- Nucletron Scandinavia AB, Uppsala, Sweden
| | - Alessandro Clivio
- Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland
| | - Barbara Dobler
- Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | | | - Frank Lohr
- Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | - Friedlieb Lorenz
- Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | - Jan Muzik
- Biomedical Physics, Radiooncology Dept, Uniklinik für Radioonkologie Tübingen, Tübingen, Germany
| | - Martin Polednik
- Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | - Eugenio Vanetti
- Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland
| | - Dirk Wolff
- Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | - Rolf Wyttenbach
- Ospedale Regionale Bellinzona e Valli, Radiology Dept, Bellinzona, Switzerland
| | - Luca Cozzi
- Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona, Switzerland
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20
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Dobler B, Lorenz F, Wertz H, Polednik M, Wolff D, Steil V, Lohr F, Wenz F. Intensity-Modulated Radiation Therapy (IMRT) with Different Combinations of Treatment-Planning Systems and Linacs. Strahlenther Onkol 2006; 182:481-8. [PMID: 16896595 DOI: 10.1007/s00066-006-1544-6] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/11/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare different combinations of intensity-modulated radiation therapy (IMRT) system components with regard to quality assurance (QA), especially robustness against malfunctions and dosimetry. MATERIAL AND METHODS Three different treatment-planning systems (TPS), two types of linacs and three multileaf collimator (MLC) types were compared: commissioning procedures were performed for the combination of the TPS Corvus 5.0 (Nomos) and KonRad v2.1.3 (Siemens OCS) with the linacs KD2 (Siemens) and Synergy (Elekta). For PrecisePLAN 2.03 (Elekta) measurements were performed for Elekta Synergy only. As record and verify (R&V) system Multi-Access v7 (IMPAC) was used. The use of the serial tomotherapy system Peacock (Nomos) was investigated in combination with the Siemens KD2 linac. RESULTS In the comparison of calculated to measured dose, problems were encountered for the combination of KonRad and Elekta MLC as well as for the Peacock system. Multi-Access failed to assign the collimator angle correctly for plans with multiple collimator angles per beam. Communication problems of Multi-Access with both linacs were observed, resulting in incorrect recording of the treatment. All reported issues were addressed by the manufacturers. CONCLUSION For the commissioning of IMRT systems, the whole chain from the TPS to the linac has to be investigated. Components that passed the commissioning in another clinical environment can have severe malfunctions when used in a new environment. Therefore, not only single components but the whole chain from planning to delivery has to be evaluated in commissioning and checked regularly for QA.
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Affiliation(s)
- Barbara Dobler
- Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
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21
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Rosca F, Lorenz F, Hacker FL, Chin LM, Ramakrishna N, Zygmanski P. An MLC-based linac QA procedure for the characterization of radiation isocenter and room lasers’ position. Med Phys 2006; 33:1780-7. [PMID: 16872085 DOI: 10.1118/1.2198171] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have designed and implemented a new stereotactic linac QA test with stereotactic precision. The test is used to characterize gantry sag, couch wobble, cone placement, MLC offsets, and room lasers' positions relative to the radiation isocenter. Two MLC star patterns, a cone pattern, and the laser line patterns are recorded on the same imaging medium. Phosphor plates are used as imaging medium due to their sensitivity to red light. The red light of room lasers erases some of the irradiation information stored on the phosphor plates enabling accurate and direct measurements for the position of room lasers and radiation isocenter. Using film instead of the phosphor plate as imaging medium is possible, however, it is less practical. The QA method consists of irradiating four phosphor plates that record the gantry sag between the 0 degrees and 180 degrees gantry angles, the position and stability of couch rotational axis, the sag between the 90 degrees and 270 degrees gantry angles, the accuracy of cone placement on the collimator, the MLC offsets from the collimator rotational axis, and the position of laser lines relative to the radiation isocenter. The estimated accuracy of the method is +/- 0.2 mm. The observed reproducibility of the method is about +/- 0.1 mm. The total irradiation/ illumination time is about 10 min per image. Data analysis, including the phosphor plate scanning, takes less than 5 min for each image. The method characterizes the radiation isocenter geometry with the high accuracy required for the stereotactic radiosurgery. In this respect, it is similar to the standard ball test for stereotactic machines. However, due to the usage of the MLC instead of the cross-hair/ball, it does not depend on the cross-hair/ball placement errors with respect to the lasers and it provides more information on the mechanical integrity of the linac/couch/laser system. Alternatively, it can be used as a highly accurate QA procedure for the nonstereotactic machines. Noteworthy is its ability to characterize the MLC position accuracy, which is an important factor in IMRT delivery.
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Affiliation(s)
- Florin Rosca
- Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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22
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Rosca F, Zygmanski P, Lorenz F, Hacker F, Chin L, Friesen S, Petsuksiri J, Shanmugham L, Ramakrishna N. SU-FF-T-390: A New Linac QA Procedure for the Characterization of Radiation Isocenter and Room Lasers Position. Med Phys 2005. [DOI: 10.1118/1.1998147] [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: 11/07/2022] Open
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23
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Rosca F, Zygmanski P, Lorenz F, Hacker F, Chin L, Friesen S, Petsuksiri J, Shanmugham L, Ramakrishna N. SU-FF-T-175: A New Linac QA Procedure for the Characterization of Gantry Radiation Isocenter. Med Phys 2005. [DOI: 10.1118/1.1997846] [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: 11/07/2022] Open
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24
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Hampl H, Sternberg C, Berweck S, Lange D, Lorenz F, Pohle C, Riedel E, Gogoll L, Hennig L. Regression of left ventricular hypertrophy in hemodialysis patients is possible. Clin Nephrol 2002; 58 Suppl 1:S73-96. [PMID: 12227731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Regression of left ventricular hypertrophy in hemodialysis patients is possible. Left ventricular hypertrophy represents the major risk factor for cardiac morbidity and mortality. Therefore, their regression is mandatory. Since the causes of uremia-associated left ventricular hypertrophy are multifactorial, various therapeutic options can be considered: optimal control of arterial hypertension and volume status, optimal correction of metabolic acidosis, best possible correction of hypoalbuminemia and severe secondary hyperparathyroidism, modern pharmacotherapeutic strategy for the treatment of heart failure (use of angiotensin-converting enzyme inhibitors in combination with angiotensin II receptor blockers and beta-blockers) and total correction of renal anemia. Following the proposed therapeutic strategies we could, by using echocardiography, distinguish in 100 hemodialysis patients the following 3 groups (on the average after 1.5 years): 36 patients with initially normal left ventricular mass index (LVMI (g/m2), F < 110; M < 130) maintained normal (group 1); in 31 patients with moderately increased LVMI full regression resulted (group 2); 33 patients with severely increased LVMI (group 3) had to be further divided into 2 sub-groups: 22 patients with significant improvement of LVMI, 11 patients with no, regression. For the first time we were able to show that it is possible to maintain initially normal LVMI during long-term treatment and to achieve complete regression and significant improvement of LVMI in our patients. However, since LVMI requires a long time to develop, a similarly long time must be estimated for its regression. However, 11 patients remained therapeutically resistant. In this group, severe heart diseases were often combined and highly prevalent, including ischemic heart and valve diseases and end-stage dilatative cardiomyopathy. These patients had to be transferred to cardiac surgery. Anemia is considered to be one of the most important factors for the development of left ventricular hypertrophy. Therefore, total correction of renal anemia has to be strongly recommended in addition to other measures of our therapeutic strategy to maintain full or significant regression of left ventricular hypertrophy.
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Affiliation(s)
- H Hampl
- Medical Clinic with Emphasis on Nephrology and Intensive Internal Medicine, Humboldt University Berlin, Germany
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25
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Abstract
Early clinical results were evaluated for 22 adult patients who had undergone an open wedge tibial osteotomy by hemicallotasis (HCO) due to medial compartment osteoarthritis. The mean age at the time of the index operation was 56 (range 33-66) years. The mean duration of follow up was 16 (range 9-23) months. The median hip-knee-ankle angle (HKA) was 169 (range 162-186) deg preoperatively and 182 (range 175-191) deg at follow up. We did not observe any early collapse of the new bone wedge. The median time to fixation was 79 (range 63-125) days. Complications included two pintract infections, and two hematomas were revised. Two patients felt pain during the phase of distraction, but the procedure could be continued after a short break. We evaluated the clinical results on the HSS, Lysholm, and Tegner activity scores. At the latest follow up examination, all of the scores had improved. Our findings demonstrate that HCO requires an exact correction, is a simple technique, and appears to reduce the chance of nerve and vascular damage.
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Affiliation(s)
- H M Klinger
- Department of Orthopaedic Surgery, Kreiskrankenhaus Bad Hersfeld, Academic Training Hospital, Justus-Liebig-University, Giessen, Germany
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26
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Kahl A, Bechstein WO, Lorenz F, Steinberg J, Pohle C, Kampf D, Müller A, Settmacher U, Neuhaus P, Frei U. Long-term prednisolone withdrawal after pancreas and kidney transplantation in patients treated with ATG, tacrolimus, and mycophenolate mofetil. Transplant Proc 2001; 33:1694-5. [PMID: 11267473 DOI: 10.1016/s0041-1345(00)02645-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Kahl
- Department of Nephrology, Charité, Virchow-Klinikum, Humboldt University, Berlin, Germany
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27
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Walter Z, Szostek M, Mensah P, Lorenz F, Weglarska D, Skotnicki AB. [Methods of mobilizing hematopoietic cells, their collection using cell separation, purging--processing of pathologic cells and enrichment with CD 34+ cells--negative and positive selection]. Przegl Lek 1999; 56 Suppl 1:22-7. [PMID: 10494178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Autological transplantation of bone marrow as well as hematopoietic and precursor cells obtained from peripheral blood with the use of cell apheresis is a therapy applied in the treatment of hematological diseases and solid tumours. The mobilization of hematopoietic cells is performed by applying cytostatic drugs and/or recombinant growth factors (G-CSF, GM-CSF). The collection of CD 34+ cells is performed by using cell separators. An important role in the transplantation procedure is played by purging techniques of transplantation material from residual neoplastic cells (negative selection) or isolation of hematopoietic cells (positive selection). The considerable progress in this field is connected with the implementation of Immunoadsorbtive or magnetic methods as well as those of molecular biology. The improvement of the procedure of hematopoietic cells transplantation and its efficacy is caused by the stimulation of the hematopoiesis by using the combination of cytokines (G-CSF, GM-CSF, IL-3, SCF) and purging of the hematopoietic cells obtained from the cellular apheresis.
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Affiliation(s)
- Z Walter
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagielońskiego w Krakowie.
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28
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Lorenz F, Skotnicki AB. [Autotransplantation for solid tumors]. Przegl Lek 1999; 56 Suppl 1:101-7. [PMID: 10494190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Over the last three decades, there have been a number of advances made in the treatment of haematological malignancies including an increasingly defined role in curative therapy programmes for high dose chemotherapy (HDC) with stem cell support. This has provided an impetus for similar approaches to be tested in solid tumours. Drug resistance is one of the most important reasons for treatment failure in these diseases, and therefore attempting to overcome it with HDC is an obvious strategy to investigate. This rationale is supported by laboratory data demonstrating that dose correlates with number of cells killed, and that increasing drug doses by 5-10 fold can overcome resistance. Clear evidence of a dose-response effect in patients is provided by numerous clinical trials of chemotherapy in solid tumours. A large number of studies have investigated HDC in solid tumours, particularly in those malignancies which demonstrate initial chemo-sensitivity, but later relapse. Except for breast cancer, for other solid tumours there are no randomised trials defining the role of HDC. Many of the trials are small pilot studies in heavily pretreated patients with large volume disease and therefore any conclusions must be guarded.
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Affiliation(s)
- F Lorenz
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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29
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Walter Z, Szostek M, Weglarska D, Raguszewska D, Jabłoński M, Lorenz F, Skotnicki AB. [Methods for freezing, thawing and viability estimation of hemopoietic stem cells]. Przegl Lek 1999; 56 Suppl 1:34-9. [PMID: 10494180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Freezing and thawing of hemopoietic stem cells (CD34+) are indispensable stages between their collection from peripheral blood or bone marrow and transfusion to the patient who has previously undergone myeloablative chemotherapy. At present there are two methods of the cells freezing: non-controlled--placing CD34+ cells directly in the final temperature and rate-controlled--gradual cooling them at programmed speed. Non-controlled freezing leads to the considerable loss of cells viability (up to 50%), but it doesn't require the expensive equipment used for rate-controlled freezing (viability loss up to 10%). In order to reduce the loss resulting from intra-cellular crystallization of water the haemopoietic cells are mixed with one of the cryopreservative substances: dimethylsulphoxide-DMSO, hydro-xyethylstarch-HES, polyvinylpyrrolidone-PVP or glycerol. The most important moment of freezing procedure is the phase transition of water. The adequate shape of the cooling curve leads to a considerable reduction of the loss of the cells viability. Further cooling is the most effective when it takes place at max. speed of 5 degrees C/min. The storage of the frozen cells is the best in very low temperatures (-170-180 degrees C-vapour phase of liquid nitrogen), but mechanical freezers (-80 degrees C) are used, too. The thawing procedure should be very fast (up to 90 degrees C/min.) and the defrosted cells must be immediately transfused to the patient because of very high toxicity of cryopreservative agents to non-frozen cells. The cells viability estimation is carried out with trypan blue or cytofluorometrically after incubation with propidine iodide.
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Affiliation(s)
- Z Walter
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
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30
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Jörres A, Ludat K, Sander K, Dunkel K, Lorenz F, Keck H, Frei U, Gahl GM. The peritoneal fibroblast and the control of peritoneal inflammation. Kidney Int Suppl 1996; 56:S22-7. [PMID: 8914050] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Jörres
- Abteilung für Innere Medizin mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Virchow-Klinikum, Medizinische Fakultät, Humboldt-Universität zu Berlin, Germany.
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31
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Abstract
Gender differences in health have been linked to gender stratification in the United States. Women's relation to production, paid and unpaid work, and their experience of this gender inequality disadvantage their self-rated health compared to men. Men's consumption or health lifestyles disfavors their comparative health. This formulation is tested in the Czech Republic with a sample of matched wives and husbands (N = 577 households). This extends previous research in the United States on gender differences in health in two ways: into post-communist Europe and by comparing paired wives and husbands. Respondents completed questionnaires in 1994 on their health and well-being, jobs and finances, non-economic life events, marriage, psychological states, opinions about the changes in the Czech Republic, and socioeconomic background. Wives and husbands filled out separate questionnaires. The relation to production (both the objective relation and its subjective experience) did not impair wives' self-reported health any more than that of their husbands, and husbands' consumption or health lifestyles did not put them at a health disadvantage. Interpretations of these findings rest on both the extension of the study into post-communist Europe and by comparing matched wives and husbands.
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Affiliation(s)
- J Hraba
- Iowa State University 50011, USA
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32
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Wilborn F, Schmidt CA, Lorenz F, Peng R, Gelderblom H, Huhn D, Siegert W. Human herpesvirus type 7 in blood donors: detection by the polymerase chain reaction. J Med Virol 1995; 47:65-9. [PMID: 8551262 DOI: 10.1002/jmv.1890470113] [Citation(s) in RCA: 36] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In order to evaluate the prevalence of human herpesvirus type 7 (HHV-7) in adult blood donors oral lavage fluid, buffy coat, and urine samples from 112 persons were examined by the polymerase chain reaction (PCR) at one time point. In addition, 11 donors were studied longitudinally over 11 weeks. When the results of the initial and the longitudinal study were combined HHV-7 DNA was found in samples from 109 of 112 (97.3%) adult blood donors. On the basis of different sensitivity levels of the first and the nested PCR differences were detected in the viral DNA load in the samples. It was found that lavage fluid regularly carried significantly higher DNA concentrations than buffy coat. Out of 112 donors, 102 (91.1%) and 8 (7.1%) were positive in the first, less sensitive PCR in lavage fluid and buffy coat, respectively (P < .0001). After nested PCR, 107 (95.5%) and 74 (66.1%) were positive in lavage fluid and buffy coat, respectively (P < .0001). Urine samples were found positive only sporadically. The longitudinal study showed that the oral lavage fluid of most of the donors consistently carried HHV-7 over up to 53 weeks, whereas buffy coat samples were positive less often. In conclusion, HHV-7 is found frequently in adult blood donors in the oral lavage fluid and buffy coat, which are, therefore, potential sources of HHV-7 transmission.
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Affiliation(s)
- F Wilborn
- Universitätsklinikum Rudolf Virchow, Abteilung für Innere Medizin mit Schwerpunkt Hämatologie und Onkologie, Freie Universität Berlin, Germany
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33
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Selbitz HJ, Lorenz F, Kühn H, Lehmann S, Mirle C. [Detection and characterization of Salmonella strains from laughing gulls (Larus ridibundus)]. Berl Munch Tierarztl Wochenschr 1991; 104:411-4. [PMID: 1786042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
25 and 17 Salmonella strains could be isolated from 429 and 423 blackheaded gulls (Larus ridibundus), respectively, during two years of examination. S. typhimurium was the most frequent serovar. All strains of S. typhimurium belonged to the biochemovar c (inosite and rhamnose negative), nearly a third of isolates caused a mannose-sensitive hemagglutination of guinea pig erythrocytes. This result is in contradiction to the literature. Furthermore the phagovars, the plasmid profiles and the resistance against chemotherapeutics were tested. The Salmonella carriage by gulls presumably reflects the contamination of the environment.
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Affiliation(s)
- H J Selbitz
- Institut für Mikrobiologie und Tierseuchenlehre, Veterinärmedizinischen Fakultät, Universität Leipzig
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34
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Koch UJ, Lorenz F, Danehl K, Ericsson R, Hasan SH, Keyserlingk DV, Lübke K, Mehring M, Römmler A, Schwartz U, Hammerstein J. Continuous oral low-dosage cyproterone acetate for fertility regulation in the male? A trend analysis in 15 volunteers. Contraception 1976; 14:117-35. [PMID: 949890 DOI: 10.1016/0010-7824(76)90081-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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35
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Koch UJ, Lorenz F, Danehl K, Hammerstein J. [Use of cyproterone acetate for fertility inhibition in the male. Morphologic changes and influences on sperm motility]. Arch Gynakol 1975; 219:581-2. [PMID: 1243497 DOI: 10.1007/bf00669258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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36
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Lorenz F, Koch UJ, Danehl K, Lübke K, Hammerstein J. [Utilization of cyproterone acetate for fertility inhibition in the male. Influence on sexual behavior and sperm biochemistry]. Arch Gynakol 1975; 219:580-1. [PMID: 1243496 DOI: 10.1007/bf00669257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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37
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Jalůvka V, Lorenz F. [Leimyoma of the rectum and gynecological laparotomy]. Zentralbl Gynakol 1974; 96:503-5. [PMID: 4837029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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38
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Karkut G, Lorenz F, Wendler H. [Serum lipid changes during pregnancy due to oral calcium administration]. Zentralbl Gynakol 1972; 94:392-6. [PMID: 5031074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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39
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Rosegger H, Lorenz F, Weikmann E. [Experiences in the rapid diagnosis of enteropathogenic coli strains using commercial fluorescence serum mixtures]. Wien Klin Wochenschr 1971; 83:905-7. [PMID: 4950783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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41
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Lorenz F. Ehlers-Danlos-Syndrom. Arch Dermatol Res 1961. [DOI: 10.1007/bf00588900] [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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42
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Hayek E, Lorenz F, Schimann H, Ude H. F�llungsvorg�nge als Ursache chromatographischer Fixierung anorganischer Ionen. Monatshefte f�r Chemie 1959. [DOI: 10.1007/bf00901131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Specht L, Lorenz F. F�r die Bestimmung des Gerbstoffs. Anal Bioanal Chem 1904. [DOI: 10.1007/bf01323318] [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: 10/25/2022]
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44
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Rosenstiehl, Lorenz F. Quantitative Bestimmung von Paratoluidin neben Orthotoluidin. Anal Bioanal Chem 1874. [DOI: 10.1007/bf01302344] [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: 11/30/2022]
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45
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