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Mertes H, Rezende AM, Brosius I, Naesens R, Michiels J, deBlock T, Coppens J, Van Dijck C, Bomans P, Bottieau E, Van Esbroeck M, Ariën KK, Liesenborghs L, Vercauteren K. Tecovirimat Resistance in an Immunocompromised Patient With Mpox and Prolonged Viral Shedding. Ann Intern Med 2023; 176:1141-1143. [PMID: 37487213 DOI: 10.7326/l23-0131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Helena Mertes
- Department of Internal Medicine and Infectious Diseases, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - Antonio Mauro Rezende
- Clinical Virology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Reinout Naesens
- Department of Medical Microbiology and Infection Prevention & Control, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - Johan Michiels
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tessa deBlock
- Clinical Virology Unit and Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jasmine Coppens
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Bomans
- Department of Pneumology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Vercauteren
- Clinical Virology Unit and Clinical Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Mertes H, Harper J, Boivin J, Ekstrand Ragnar M, Grace B, Moura-Ramos M, Rautakallio-Hokkanen S, Simopoulou M, Hammarberg K, International Reproductive Health Education Collaboration (IRHEC) OBOT. Stimulating fertility awareness: the importance of getting the language right. Hum Reprod Open 2023; 2023:hoad009. [PMID: 37082102 PMCID: PMC10112336 DOI: 10.1093/hropen/hoad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/08/2023] [Indexed: 04/22/2023] Open
Abstract
While education about fertility is not intrinsically controversial, finding the right language to communicate the topic can be challenging, as there are several risks of unintended negative effects such as dissonance, anxiety, culpability, and stigma due to social norming. In this article, we share some of our learnings from promoting fertility awareness in the hope that they will inspire further debate and research on this topic. Starting from the ethical principles of respect for reproductive autonomy, avoiding harm (in terms of stigma or anxiety) and inclusivity, we have formulated five recommendations: (i) frame fertility awareness messages with (reproductive) autonomy in mind and aim to be inclusive of those who do not represent the traditional nuclear family; (ii) be empathetic and steer clear of blame; (iii) avoid scaremongering and offer a positive angle; (iv) give due consideration to both women and men in fertility health messaging; and (v) tailor the messages to particular contexts and audiences and develop resources in close collaboration with the target groups.
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Affiliation(s)
- H Mertes
- Correspondence address. Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000 Gent, Belgium. E-mail:
| | - J Harper
- EGA Institute for Women’s Health, University College London, London, UK
| | - J Boivin
- Cardiff Fertility Studies Group, School of Psychology, Cardiff University, Cardiff, UK
| | | | - B Grace
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women’s Health, University College London, London, UK
| | - M Moura-Ramos
- Centro Hospitalar e Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | | | - M Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Hellinckx H, Mertes H, Vanreusel I, Demedts I, Dutré J. Clostridium perfringens splenic abscess treated with percutaneous drainage and antibiotic therapy: a case report. Acta Clin Belg 2022; 77:688-692. [PMID: 34151751 DOI: 10.1080/17843286.2021.1940606] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Splenic abscesses are a rare medical entity with high mortality, with Clostridium perfringens being an exceptional pathogen. We present the first case describing an abscess of the spleen in a patient undergoing treatment with adalimumab, an anti-tumour necrosis factor commonly used in inflammatory bowel diseases. PATIENT We describe the case of a 73-year-old woman, treated with adalimumab therapy, who was found to have a splenic abscess, caused by C. perfringens. RESULT After antibiotic treatment and percutaneous drainage, the patient recovered both clinically and radiographically. DISCUSSION We reviewed literature about C. perfringens splenic abscesses. In all cases identified, a splenectomy was performed. This is the first case description of splenic abscess caused by C. perfringens where a percutaneous drainage was performed, leading to complete recovery in our patient. This seems to indicate that a splenectomy is not necessary in all C. perfringens splenic abscesses.
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Affiliation(s)
- Hanne Hellinckx
- Department of internal medicine, Catholic University of Leuven, Leuven, Belgium
| | - Helena Mertes
- Department of Infectiology, Jan Palfijn Merksem, Merksem, Belgium
| | - Inne Vanreusel
- Department of cardiology, University of Antwerp, Antwerp, Belgium
| | - Ingrid Demedts
- Department of Gastro-enterology, UZ Leuven, Leuven, Belgium
| | - Joris Dutré
- Department of Gastro-enterology, Jan Palfijn Merksem, Merksem, Belgium
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Naesens R, Mertes H, Clukers J, Herzog S, Brands C, Vets P, De laet I, Bruynseels P, De Schouwer P, van der Maas S, Bervoets K, Hens N, Van Damme P. SARS-CoV-2 seroprevalence survey among health care providers in a Belgian public multiple-site hospital. Epidemiol Infect 2021; 149:e172. [PMID: 34372955 PMCID: PMC8365049 DOI: 10.1017/s0950268821001497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is lasting for more than 1 year, the exposition risks of health-care providers are still unclear. Available evidence is conflicting. We investigated the prevalence of antibodies against SARS-CoV-2 in the staff of a large public hospital with multiple sites in the Antwerp region of Belgium. Risk factors for infection were identified by means of a questionnaire and human resource data. We performed hospital-wide serology tests in the weeks following the first epidemic wave (16 March to the end of May 2020) and combined the results with the answers from an individual questionnaire. Overall seroprevalence was 7.6%. We found higher seroprevalences in nurses [10.0%; 95% confidence interval (CI) 8.9-11.2] than in physicians 6.4% (95% CI 4.6-8.7), paramedical 6.0% (95% CI 4.3-8.0) and administrative staff (2.9%; 95% CI 1.8-4.5). Staff who indicated contact with a confirmed coronavirus disease 2019 (COVID-19) colleague had a higher seroprevalence (12.0%; 95% CI 10.7-13.4) than staff who did not (4.2%; 95% CI 3.5-5.0). The same findings were present for contacts in the private setting. Working in general COVID-19 wards, but not in emergency departments or intensive care units, was also a significant risk factor. Since our analysis points in the direction of active SARS-CoV-2 transmission within hospitals, we argue for implementing a stringent hospital-wide testing and contact-tracing policy with special attention to the health care workers employed in general COVID-19 departments. Additional studies are needed to establish the transmission dynamics.
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Affiliation(s)
- Reinout Naesens
- Department of Medical Microbiology, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
- Department of Infection Prevention and Control, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Helena Mertes
- Department of Infectious Disease, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Johan Clukers
- Department of Respiratory Medicine, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Sereina Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, B-2610Wilrijk, Belgium
| | - Christiane Brands
- Department of Infectious Disease, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Philippe Vets
- Department of Intensive Care and Anesthesiology, ZiekenhuisNetwerk Antwerpen, Antwerpen, Belgium
| | - Inneke De laet
- Department of Intensive Care and Anesthesiology, ZiekenhuisNetwerk Antwerpen, Antwerpen, Belgium
| | - Peggy Bruynseels
- Department of Medical Microbiology, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
- Department of Infection Prevention and Control, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Pieter De Schouwer
- Department of Medical Microbiology, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Sanne van der Maas
- Hospital and Medical Directory Board, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Katrien Bervoets
- Hospital and Medical Directory Board, ZiekenhuisNetwerk Antwerpen, B-2020Antwerpen, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, B-2610Wilrijk, Belgium
- Data Science Institute, I-BioStat, UHasselt, B-3500Hasselt, Belgium
| | - Pierre Van Damme
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, B-2610Wilrijk, Belgium
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, B-2610Wilrijk, Belgium
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Rutsaert L, Steinfort N, Van Hunsel T, Bomans P, Naesens R, Mertes H, Dits H, Van Regenmortel N. COVID-19-associated invasive pulmonary aspergillosis. Ann Intensive Care 2020; 10:71. [PMID: 32488446 PMCID: PMC7265874 DOI: 10.1186/s13613-020-00686-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Lynn Rutsaert
- Dept. of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
| | - Nicky Steinfort
- Dept. of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Tine Van Hunsel
- Dept. of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Peter Bomans
- Dept. of Pneumology, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Reinout Naesens
- Dept. of Medical Microbiology and Infection Prevention, Ziekenhuisnetwerk Antwerpen, Lindendreef 1, 2020, Antwerp, Belgium
| | - Helena Mertes
- Dept. of Internal Medicine and Infectious Diseases, Ziekenhuisnetwerk Antwerpen, Campus Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - Hilde Dits
- Dept. of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Niels Van Regenmortel
- Dept. of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
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Mertes H, Morissens M, Mahadeb B, Maillart E, Moreau A, Clevenbergh P. Serratia marcescens and other non-AACEK GNB endocarditis: A case report and review of literature. World J Clin Infect Dis 2019; 9:23-30. [DOI: 10.5495/wjcid.v9.i3.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/03/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp. (non-AACEK) gram-negative bacilli (GNBs) are an infrequent and challenging cause of endocarditis associated previously with mainly intravenous drug use. Currently, this pathology has increasingly become a healthcare-associated issue. Current guidelines do not clearly define the management of non-AACEK GNB endocarditis due to a lack of prospective trials. We review characteristics, outcomes and treatment of non-AACEK GNB endocarditis, in particular Serratia marcescens endocarditis.
CASE SUMMARY We describe the case report of a 46-year-old man who presented to the emergency department with high-grade fever and a purulent exudate on an intracardiac device site. Serratia marcescens mitral valve endocarditis as a consequence of complicated generator pocket infection was diagnosed. The patient was treated with complete device removal and a long course of broad-spectrum antibiotics for 6 wk after surgery with intravenous piperacillin-tazobactam and ciprofloxacin, which was later switched to oral ciprofloxacin and sulfamethoxazole-trimethoprim. The patient had complete resolution of symptoms and inflammatory parameters at the end of the treatment and at follow-up.
CONCLUSION Long-term dual-antibiotic therapy containing a beta-lactam is indicated for most non-AACEK GNB endocarditis, whereas valve surgery may not be necessary in all patients.
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Affiliation(s)
- Helena Mertes
- Infectious Disease Department, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerpen 2020, Belgium
| | - Marielle Morissens
- Cardiology Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Bhavna Mahadeb
- Microbiology Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Evelyne Maillart
- Infectious Diseases Department, Brugmann University Hospital, Brussels 1020, Belgium
| | - Anthony Moreau
- Intensive Care Unit, Erasmus University Hospital, Intensive Care Unit, Brussels 1070, Belgium
| | - Philippe Clevenbergh
- Infectious Diseases Department, Brugmann University Hospital, Brussels 1020, Belgium
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Mishra S, Kacin E, Stamatiadis P, Franck S, Van der Jeught M, Mertes H, Pennings G, De Sutter P, Sermon K, Heindryckx B, Geens M. The role of the reprogramming method and pluripotency state in gamete differentiation from patient-specific human pluripotent stem cells. Mol Hum Reprod 2019; 24:173-184. [PMID: 29471503 DOI: 10.1093/molehr/gay007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/10/2018] [Indexed: 12/16/2022] Open
Abstract
The derivation of gametes from patient-specific pluripotent stem cells may provide new perspectives for genetic parenthood for patients currently facing sterility. We use current data to assess the gamete differentiation potential of patient-specific pluripotent stem cells and to determine which reprogramming strategy holds the greatest promise for future clinical applications. First, we compare the two best established somatic cell reprogramming strategies: the production of induced pluripotent stem cells (iPSC) and somatic cell nuclear transfer followed by embryonic stem cell derivation (SCNT-ESC). Recent reports have indicated that these stem cells, though displaying a similar pluripotency potential, show important differences at the epigenomic level, which may have repercussions on their applicability. By comparing data on the genetic and epigenetic stability of these cell types during derivation and in-vitro culture, we assess the reprogramming efficiency of both technologies and possible effects on the subsequent differentiation potential of these cells. Moreover, we discuss possible implications of mitochondrial heteroplasmy. We also address the ethical aspects of both cell types, as well as the safety considerations associated with clinical applications using these cells, e.g. the known genomic instability of human PSCs during long-term culture. Secondly, we discuss the role of the stem cell pluripotency state in germ cell differentiation. In mice, success in germ cell development from pluripotent stem cells could only be achieved when starting from a naive state of pluripotency. It remains to be investigated if the naive state is also crucial for germ cell differentiation in human cells and to what extent human naive pluripotency resembles the naive state in mouse.
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Affiliation(s)
- S Mishra
- Ghent-Fertility and Stem Cell Team, Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - E Kacin
- Research Group, Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Brussels, Belgium
| | - P Stamatiadis
- Ghent-Fertility and Stem Cell Team, Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - S Franck
- Research Group, Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Brussels, Belgium
| | - M Van der Jeught
- Ghent-Fertility and Stem Cell Team, Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Blandijnberg 2, 9000 Ghent, Belgium
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Blandijnberg 2, 9000 Ghent, Belgium
| | - P De Sutter
- Ghent-Fertility and Stem Cell Team, Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - K Sermon
- Research Group, Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Brussels, Belgium
| | - B Heindryckx
- Ghent-Fertility and Stem Cell Team, Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - M Geens
- Research Group, Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Brussels, Belgium
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Abstract
In 2008, the Swiss National AIDS Commission issued a statement about the safety of HIV treatment in terms of reduced transmission in serodiscordant couples to reduce transmission in serodiscordant couples. This was subjected to debate until 2011 when the HIV prevention trial network 052 published the first randomized study about HIV transmission in serodiscordant couples, where no transmission was observed when the infected person was under effective antiretroviral treatment (ART). Later, the Partners of People on ART-A New Evaluation of the Risks (PARTNER) and the opposites attract studies, which first involved a large number of men who have sex with men (MSM), also showed no transmission, even in condomless receptive anal intercourse (CLAI). In this article, we first review the major studies' data showing the efficacy of ART in HIV transmission in serodiscordant couples at public health scale. Second, we discuss the implications and challenges behind the treatment as prevention strategy regarding the 90-90-90 UNAIDS targets to end the HIV epidemic.We now have strong evidence that ART reduces the risk of transmission of HIV from a positive partner to their negative partner. However, far beyond ART, combining prevention policies is crucial to avoid a new increase in the overall HIV incidence.
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Affiliation(s)
- Jean C Yombi
- Department of Internal Medicine, Infectious Diseases, and Tropical Medicine, AIDS reference Centre, Cliniques Universitaires
| | - Helena Mertes
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire Brugmann, Brussels. Belgium
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Böse-O'Reilly S, Mertes H, Schoierer J. Klimawandel hat gesundheitliche Folgen – wie können Ärzte/innen, Pflegekräfte oder andere Akteure im Gesundheitswissen fort- und weitergebildet werden? Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1639286] [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: 10/28/2022]
Affiliation(s)
- S Böse-O'Reilly
- Ludwig-Maximilians-Universität München Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin am Klinikum der Universität München, München, Germany
| | - H Mertes
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München AG Globale Umwelt-Gesundheit, München, Germany
| | - J Schoierer
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München, Deutsche Akademie für Prävention und Gesundheitsförderung, Bochum AG Pädiatrische Umweltepidemiologie, Germany
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Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically assisted reproduction: from research to clinical applications. Eur J Hum Genet 2018; 26:12-33. [PMID: 29199274 PMCID: PMC5839000 DOI: 10.1038/s41431-017-0016-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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] [Received: 04/23/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
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Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, London, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - M C Cornel
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Bologna, Italy
| | | | - I Liebaers
- Center for Medical Genetics, UZ Brussels, Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - M Morris
- Synlab Genetics, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Helsinki, Finland
| | - A P A van Montfoort
- IVF Laboratory, Department of Obstetrics & Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, Strasbourg, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University-2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
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Rombaut C, Mertes H, Heindryckx B, Goossens E. Human in vitro spermatogenesis from pluripotent stem cells: in need of a stepwise differentiation protocol? Mol Hum Reprod 2017; 24:47-54. [DOI: 10.1093/molehr/gax065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/07/2017] [Indexed: 12/15/2022] Open
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Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically-assisted reproduction: from research to clinical applications †‡. Hum Reprod Open 2017; 2017:hox015. [PMID: 31486804 PMCID: PMC6276693 DOI: 10.1093/hropen/hox015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively-parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
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Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, PO Box 720, FI-00029, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 - Box 7001. B-3000, Leuven Belgium
| | - M C Cornel
- Department of Clinical Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy
| | - K Ketterson
- Althea Science, Inc., 3 Regent St #301, Livingston, NJ 07039, USA
| | - I Liebaers
- Centre for Medical Genetics, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Blå Stråket 6, 413 45, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - M Morris
- Synlab Genetics, chemin d'Entre-Bois 21, CH-1018, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Haartmaninkatu 3, PO Box 400, 00029 HUS, Helsinki, Finland
| | - A P A van Montfoort
- IVF laboratory, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Gran Via de l' Hospitalet 199, 08908, Hospitalet de Llobregat, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Gran Via Carles III, 71-75 - 08028 Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, O&N I Herestraat 49 - Box 602, B-3000 Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, 3 rue Koberlé, 67000 Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, Prague CZ-15006, Czech Republic
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Mertes H, Defourny L, Tré-Hardy M, Lhommel R, El Khoury G, Rodriguez-Villalobos H, Belkhir L. First Robinsoniella peoriensis aortic cross homograft mycotic pseudoaneurysm: A case report and review of the literature. Anaerobe 2016; 44:23-26. [PMID: 28043924 DOI: 10.1016/j.anaerobe.2016.12.014] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022]
Abstract
Mycotic aortic aneurysm is a rare and challenging complication of aortic homografts caused by an infection and is associated with high morbidity and mortality. We report the first case of an aortic cross homograft mycotic pseudoaneurysm caused by Robinsoniella peoriensis in a 70-year-old man. Our patient underwent surgery for a recurrence of aortic cross mycotic pseudoaneurysm at the level of the aortic homograft he had had 7 years before. A clot-removal of the pseudoaneurysm was surgically carried out and the homograft was completely removed. Anaerobic culture from tissue samples yielded pure growth of a spore-forming Gram-positive rod, identified later as Robinsoniella peoriensis by 16S rRNA gene sequencing. The patient was then discharged with oral clindamycin according to the in vitro susceptibility testing. Identification of R. peoriensis might be challenging in clinical laboratories with no access to molecular methods.
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Affiliation(s)
- H Mertes
- Cliniques Universitaires St. Luc, Internal Medicine and Infectious Diseases Department, Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - L Defourny
- Cliniques Universitaires St. Luc, Clinical Microbiology Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - M Tré-Hardy
- Cliniques Universitaires St. Luc, Clinical Microbiology Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - R Lhommel
- Cliniques Universitaires St. Luc, Nuclear Medicine Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - G El Khoury
- Cliniques Universitaires St. Luc, Cardiovascular Surgery Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - H Rodriguez-Villalobos
- Cliniques Universitaires St. Luc, Clinical Microbiology Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - L Belkhir
- Cliniques Universitaires St. Luc, Internal Medicine and Infectious Diseases Department, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Tobollik M, Steckling N, Mertes H, Claßen T, Popp J, Paetzelt G, Conrad A, Plaß D, Hornberg C, Wintermeyer D. Summary of environmental burden of disease and health care costs analyses for policy advising. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.098] [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: 11/13/2022] Open
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15
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Mertes H. The portrayal of healthy women requesting oocyte cryo-preservation. Facts Views Vis Obgyn 2013; 5:141-6. [PMID: 24753939 PMCID: PMC3987355] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The possibility to cryopreserve oocytes to be used in IVF treatment later in life has not only enlarged the reproductive options of cancer patients who are faced with gonadotoxic treatments, but also holds the promise of enlarging the reproductive options of healthy women whose personal circumstances (most often the absence of a partner) do not allow them to reproduce in their most fertile years. Opinions for and against this application of the cryopreservation technology are often based on different portrayals of the women who might use it. Three different portrayals can be discerned in the debate about the ethics of so-called 'social egg freezing' or 'non medical egg freezing'. First, these women have been portrayed as selfish career-pursuing women. Second, healthy women who might benefit from oocyte cryopreservation have been portrayed as victims of a male-oriented society that makes it difficult for women to combine motherhood with a good education or professional responsibilities. Third, healthy women -opting to cryopreserve oocytes have been portrayed as wise, proactive women who will not have to depend on -oocyte donors should they suffer from age-related infertility by the time they are ready to reproduce. Each of these three portrayals has its own shortcomings that one should be wary of, as they lead to an oversimplification of the ethical debate.
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Affiliation(s)
- H Mertes
- Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000 Ghent, Belgium
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Hamm D, Anton J, Mertes H, Pennings G, Dondorp WJ, de Wert GMWR, Svitnev K, Raes I, Ravelingien A, Pennings G, Provoost V, Pennings G. SESSION 21: ETHICS OF DONATION AND SURROGACY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.21] [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: 11/14/2022] Open
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Mertes H, Pennings G, Choudhary M, Shaw C, Nesbitt M, Murdoch AP, Gudipati M, Redhead G, Hemingway V, McEleny K, Prakash A, Stewart J, De Wert G, Dondorp WJ, Liebaers I, Geraedts JPM, De Die-Smulders CEM. SELECTED ORAL COMMUNICATION SESSION, SESSION 16: ETHICS AND LAW, Monday 4 July 2011 14:00 - 15:00. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.16] [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: 11/13/2022] Open
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Hüttemann M, Mertes H, Schmalz W, Roth E, Limbourg P. Interventionelle Behandlung von Carotisstenosen. Dtsch Med Wochenschr 2008. [DOI: 10.1055/s-2008-1047802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The future success of stem cell research by means of somatic cell nuclear transfer (SCNT) depends on a sufficient supply of human oocytes. However, oocyte donation presents certain risks for the donor, and concerns for women's welfare are rightly vocalized. At the same time, these risks are comparable with the risks faced by other healthy research subjects. Thus, research donation can withstand ethical scrutiny if it fulfils the same conditions as other research involving healthy human subjects. Specifically, this means that the benefits of the research project need to outweigh the harms, that risks must be minimized, that informed consent has to be guaranteed by averting undue inducement and the recruitment of vulnerable women and that donors can and should be reimbursed for their research participation.
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Affiliation(s)
- H Mertes
- Centre for Environmental Philosophy and Bioethics, Ghent University, Ghent, Belgium.
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Purucker P, Mertes H, Goodson JM, Bernimoulin JP. Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis. J Periodontol 2001; 72:1241-5. [PMID: 11577957 DOI: 10.1902/jop.2000.72.9.1241] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP. METHODS After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group). RESULTS In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG). CONCLUSIONS These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.
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Affiliation(s)
- P Purucker
- Department of Periodontology and Synoptic Dentistry, University Hospital Charité, Humboldt-University at Berlin, Germany.
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Nixdorff U, Erbel R, Wagner S, Buck T, Mertes H, Mohr-Kahaly S, Meyer J. Dynamic stress echocardiography for evaluating anti-ischemic drug profiles in post-MI patients. Int J Card Imaging 1997; 13:485-91. [PMID: 9415850 DOI: 10.1023/a:1005882829544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Exercise ECG is an established method of evaluating the anti-ischemic properties of drugs. However, there are considerable methodologic limitations to this procedure and its use is restricted to patients with exercise-provoked ECG alterations which can be interpreted as ischemia. The principal, earlier onset of wall motion abnormalities according to the ischemic cascade can be detected by stress echocardiography and might be utilized as a pharmacological stress testing modality. Sixteen consecutive patients (15 men, one woman; 53 +/- 9 years old) with angiographically proven coronary artery disease (8 with one-, 5 with two-, and 3 with three-vessel disease) and exercise-induced wall motion abnormalities were examined by dynamic stress echocardiography (50 watt followed by 20-watt increases/min). Anti-ischemic drugs were withdrawn prior to and on day 1; on the following day 2, 0.2 microgram/kg/min nisoldipine was infused intravenously during the test after a 3 micrograms/kg bolus was given. At maximum comparable workload 15/16 patients showed an improved wall motion score on treatment (day 1: 22.9 +/- 4.9 vs day 2: 20.0 +/- 3.9; normal score: 12; one-sided binomial test: p = 0.0003). Eight of 16 patients demonstrated ST-segment deviations on day 1 and day 2. The double product did not differ at any workload stage until the maximum of 130 watt (day 1: 14,101 +/- 3140 vs day 2: 13,365 +/- 2865; n.s.). Dynamic stress echocardiography seems to be a valuable tool in pharmacologic stress testing and in terms of accuracy is supposed to be superior to conventional exercise ECG. Nisoldipine reduces exercise-induced wall motion abnormalities in patients with and without exercise-induced ECG alterations. The data result from a controlled pilot study, and further studies are required to confirm these promising methodological and therapeutic findings.
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Affiliation(s)
- U Nixdorff
- II. Medical Clinic, Johannes Gutenberg-University, Mainz, Germany.
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Kumle B, Döring B, Mertes H, Posival H. [Resuscitation of a near-drowning patient by the use of a portable extracorporeal circulation device]. Anasthesiol Intensivmed Notfallmed Schmerzther 1997; 32:754-6. [PMID: 9498097 DOI: 10.1055/s-2007-995151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report on a 21-year old patient who nearly drowned in cold water under inexplicable circumstances. About 1/2 hour later he was found with cardiac arrest. Immediate cardiopulmonary resuscitation remained unsuccessfully but was continued. After transportation to the nearest hospital a core temperature of 26.1 degrees C was recorded. A team of our hospital arrived 2 1/2 hours after start of cardiopulmonary resuscitation. After introducing a femo-femoral bypass the patient was rapidly rewarmed and oxygenated using a portable extracorporeal circulation and membrane oxygenation. Defibrillation succeeded at a core temperature of 34.4 degrees C. A severe ARDS developed the same day which was successfully treated by membrane oxygenation. 41 days later the patient left the hospital fully recovered.
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Affiliation(s)
- B Kumle
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinkum der Stadt Ludwigshafen
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Mertes H, Schmalz W, Hüttemann M, Roth E, Limbourg P. [Ultra-high dosage streptokinase lysis in dysfunction of a St. Jude aortic prosthesis]. Dtsch Med Wochenschr 1996; 121:442-6. [PMID: 8665819 DOI: 10.1055/s-2008-1043024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
HISTORY AND CLINICAL FINDINGS A 64-year-old man was hospitalised because of progressively worsening dyspnoea over the preceding few months. Three years previously he had undergone aortic valve replacement (St. Jude Medical bileaflet valve) for severe aortic stenosis and some regurgitation. He was much improved postoperatively and one year after the operation echocardiography demonstrated a well functioning prosthetic valve and a transvalvar pressure gradient (by Doppler echocardiography) of 28 mm Hg. On admission the patient reported to have stopped phenprocoumon 9 months before admission. The patient was in cardiac failure, grade III (NYHA classification). On auscultation there was a 4/6 crescendo-decrescendo systolic murmur and a 2/6 early diastolic decrescendo murmur maximal over the second right ICS. INVESTIGATIONS Echocardiography confirmed the suspected diagnosis of dysfunction of the prosthetic valve, one leaflet being immobile, with severe outflow obstruction (peak transvalvar pressure gradient 101 mm Hg) combined with severe regurgitation. At fluoroscopy one leaflet moved normally, the other one being fixed between opening and closing positions. TREATMENT AND COURSE As thrombosis was the most likely cause of the prosthetic valve dysfunction, thrombolysis treatment was started. After administration of 9 mill. IU streptokinase both leaflets showed normal movement. The peak transvalvar gradient (by echocardiography) was now 40 mm Hg and there was only slight regurgitation. No complications were noted. After oral anticoagulation for 6 months the prosthetic valve was functioning normally with unchanged movement pattern of both leaflets. CONCLUSION Thrombolysis may be successful in thrombotic dysfunction of a prosthetic valve. If there are no contraindications, this form of treatment should be tried before reoperation is undertaken.
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Affiliation(s)
- H Mertes
- Klinik für Innere Medizin I, Abteilung für Kardiologie und Angiologie, Stadtkrankenhaus Worms
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Abstract
OBJECTIVES The purpose of this study was to 1) develop an animal model of hibernating myocardium, and 2) evaluate the ability of dobutamine stimulation to detect hibernating myocardium using both qualitative and quantitative assessment of regional myocardial function. BACKGROUND Left ventricular dysfunction may be due to chronic ischemia with or without myocardial infarction and may improve after coronary blood flow is enhanced by revascularization procedures. This condition has been coined "hibernating myocardium" and variably defined in recent years. The results of recent clinical studies suggest that dobutamine echocardiography may be useful for detecting viable myocardium in patients with left ventricular dysfunction. METHODS Twenty-one dogs underwent initial operation. Sonomicrometer crystals were implanted, and baseline measurements of segment shortening and wall thickening (by echocardiography) were made. A coronary artery was ligated; the chest was closed; and measurements were repeated. Dobutamine was incrementally infused with determination of wall thickening and segment shortening at baseline and on days 3 and 7 and weeks 2 and 4 after coronary artery occlusion. Finally, the chest was reopened; the ligated vessel was bypassed; and measurements were repeated. RESULTS Of the 10 dogs that completed the entire protocol, 7 had varying degrees of nontransmural myocardial infarction (group 1), and 3 had complete transmural myocardial infarction (group 2). In group 1, baseline function was significantly impaired compared with preligation function but increased during dobutamine infusion. When reperfused after 4 weeks, both wall thickening and segment shortening increased significantly. In group 2, significant changes were not seen during the dobutamine studies or after reperfusion. Myocardial perfusion during dobutamine infusion increased in group 1 but did not change in group 2. CONCLUSIONS We demonstrated improvement in chronically dysfunctional myocardium after restoration of previously interrupted myocardial blood flow in dogs after nontransmural myocardial infarction, thus validating a canine model of hibernating myocardium. As assessed by two independent methods, dobutamine infusion identified hibernating myocardium in an animal model.
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Affiliation(s)
- H Mertes
- Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-4800, USA
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Mertes H, Sawada SG, Ryan T, Segar DS, Kovacs R, Foltz J, Feigenbaum H. Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients. Circulation 1993; 88:15-9. [PMID: 8319327 DOI: 10.1161/01.cir.88.1.15] [Citation(s) in RCA: 240] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The use of dobutamine stress echocardiography for the evaluation of coronary artery disease is rapidly expanding. New applications of the technique are being investigated in a wide variety of patients including those with advanced coronary artery disease. Despite its widespread use, the safety of dobutamine stress echocardiography has not been sufficiently documented. METHODS AND RESULTS A consecutive series of 1118 patients undergoing dobutamine stress echocardiography for evaluation of known or suspected coronary artery disease form the basis of this report. Dobutamine stress testing was performed for evaluation of chest pain, risk assessment before noncardiac surgery, after recent myocardial infarction, or as a part of ongoing research protocols. Over the study period, the maximal dose of dobutamine used was increased from 30 to 50 micrograms/kg per minute, and atropine was used in 420 (37%) patients. There were no occurrences of death, myocardial infarction, or episodes of sustained ventricular tachycardia as a result of dobutamine stress testing. The major reasons for test termination were achievement of target heart rate in 583 patients (52.1%), maximum dose in 255 (22.8%), and angina pectoris in 142 (13%). The test was terminated in 36 (3%) patients because of noncardiac side effects including nausea, anxiety, headache, tremor, and urgency. Angina pectoris occurred in 216 (19.3%) patients. Sublingual nitroglycerin, a short-acting beta-blocker, or both types of medication were administered in 80 of these patients for relief of angina pectoris. None required intravenous nitroglycerin. A total of 736 (65%) patients had stable sinus rhythm throughout the test. The most common arrhythmias were frequent premature ventricular complexes (six or more per minute) in 172 patients (15%), and frequent premature atrial complexes in 86 (8%). There were 40 patients with nonsustained ventricular tachycardia. None had symptoms associated with the tachycardia, and only one received specific pharmacological treatment to prevent recurrence of the arrhythmia after the test was terminated. The patients who were evaluated after recent myocardial infarction and those who received atropine did not have a higher frequency of ventricular tachycardia compared with those without recent infarction and those not receiving atropine. CONCLUSIONS Dobutamine stress echocardiography was safely performed using supplemental atropine and an aggressive dosing protocol. Noncardiac side effects were usually minor. Arrhythmias were well tolerated and rarely required treatment. In this study, serious complications from myocardial ischemia did not occur. Symptomatic ischemia was effectively treated with test termination, sublingual nitroglycerin, or short-acting beta-blockers.
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Affiliation(s)
- H Mertes
- Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis
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Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Krüger S, Meyer J. Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization. J Am Coll Cardiol 1993; 21:1087-93. [PMID: 8459062 DOI: 10.1016/0735-1097(93)90229-t] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [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: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. BACKGROUND The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for the detection of recurrent ischemia. METHODS Bicycle stress echocardiography was performed in a series of 86 patients 6.5 +/- 1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. RESULTS Digital analysis achieved a sensitivity of 83% for the entire group and a specificity of 85% for stress echocardiographic detection of significant coronary artery disease. Sensitivity was greater in patients with (88%) than in those without (75%) prior myocardial infarction, but this difference did not reach statistical significance. Additional analysis using an increase in end-systolic volume index or a decrease in ejection fraction during stress as an additional marker for ischemia tended to enhance sensitivity (90% for the entire group and 93% for the subgroup with prior myocardial infarction). CONCLUSIONS Stress echocardiography is a useful and sensitive method for the follow-up of patients undergoing nonsurgical revascularization procedures. The addition of volume determination to routine wall motion analysis may be helpful in patients with prior infarction who have scar tissue that may be difficult to distinguish from an adjacent exercise-induced wall motion abnormality.
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Affiliation(s)
- H Mertes
- Second Medical Clinic and Policlinic, Johannes Gutenberg University, Mainz, Germany
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Mertes H, Treese N, Wittlich N, Mohr-Kahaly S, Erbel R, Meyer J. [Left ventricular inflow behavior in dual chamber stimulation with differential atrioventricular conduction: an echocardiography study]. Z Kardiol 1991; 80:637-44. [PMID: 1771963] [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
The influence of the AV interval on early passive (E) and late active diastolic filling (A) during transmitral flow was analyzed in patients with AV sequential pacing. In 16 patients with dual-chamber pacemakers at the age of 25 to 76 years CW- and color Doppler echocardiography was used to determine inflow time (t), flow velocity (Vmax), the E/A ratio, the time-velocity integral (TVI), and the inflow jet at constant AV sequential pacing (80 bpm) with various AV interval settings (50-100-150-200-250 ms). The inflow pattern was compared to findings in 16 normals (age 26 +/- 7 years). The prolongation of the AV interval from 50 to 250 ms resulted in the following changes: 1) Decrease of tE: 220 +/- 30 ms to 170 +/- 40 ms (p less than 0.05), of VmaxE: 78 +/- 12 to 68 +/- 14 cm/s) (ns) and of TVI-E: 8.5 +/- 2.1 to 5.6 +/- 1.7 cm (p less than 0.001); 2) Increase of tA: 140 +/- 30 to 270 +/- 60 ms (p less than 0.001), of VmaxA: 48 +/- 18 to 73 +/- 24 cm/s (p less than 0.001) and of TVI-A: 2.4 +/- 1.1 to 6.1 +/- 2.9 cm (p less than 0.001); 3) Decrease of the E/A ratio from 1.6 +/- 05 to 0.85 +/- 02. Longer AV intervals shortened the total diastolic filling period and produced more diastolic aliasing without change of the relative diastolic inflow jet. The AV interval of 150 ms was associated with an abnormal high atrial component of transmitral inflow, as found with abnormal diastolic LV function.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Mertes
- II. Medizinische Klinik, Johannes-Gutenberg-Universität, Mainz
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Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Wölfinger D, Meyer J. [Stress echocardiography: a sensitive method in diagnosis of coronary heart disease]. Herz 1991; 16:355-66. [PMID: 1757061] [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: 12/28/2022]
Abstract
Prevalence of coronary artery disease requires sensitive diagnostic methods for screening and follow-up. The sensitivity of stress-ECG is low, 201-thallium scintigraphy is more sensitive but has the disadvantages of radiation and costs. Improved echocardiographic resolution with better identification of endocardial border as well as digital imaging technique have increased the interest in stress echocardiography as a diagnostic tool in coronary artery disease since a decade ago the clinical usefulness of stress echocardiography has been demonstrated. For stress echocardiography a semisupine bicycle position for continuous recording of echocardiographic images from the apical position in the two-chamber- and RAO-view was developed. Echocardiographic images were digitized with a frame rate of 30/s and stored on optical discs with a storage capacity of 1 Gbyte. Rest and exercise images were analysed simultaneously for newly-occurring wall motion abnormalities or deterioration of already present hypokinesia or extension of existing wall motion abnormalities. Segmental wall motion was scored according to the scheme in Figure 2. In addition end-diastolic, end-systolic volume, and ejection fraction were calculated. In a patient population of 150, 30 female and 120 male, age 56.6 +/- 8.3 years, we could confirm the results reported by other working groups and demonstrate a high sensitivity in the diagnosis of single vessel disease. Our technique with the patient cycling in semi-supine position allows continuous echocardiographic registration during exercise and offers adequate image quality. The mean workload at peak stress was 127 +/- 30 watts, the maximal heart rate 137 +/- 18 bpm. Digital cine-loop imaging allowed evaluation of the examinations in about 90% of the cases. The sensitivity in the whole study group was 87%, the specificity 80%. Under full antianginal medication, 43% of the patients developed angina pectoris during exercise and 58% had a positive stress-ECG. The sensitivity in single-vessel coronary artery disease was 93% for the left anterior descending, 80% for the left circumflex, and 83% for the right coronary artery. These results in single-vessel disease were superior compared to findings of other authors using different techniques of stress echocardiography. In addition to the qualitative analysis, quantitative measurement of end-systolic volume and ejection fraction seems to be important. We found a significantly more pronounced decrease of ejection fraction at peak exercise in patients with multivessel disease compared to those with single-vessel disease. In single-vessel disease ejection fraction was 61 +/- 12% at rest and 57 +/- 17% during exercise, this difference was not significant.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- H Mertes
- II. Medizinische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz
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Mertes H, Nixdorff U, Erbel R, Meyer J. [Reference values of global and regional myocardial function for stress echocardiography]. Z Kardiol 1991; 80:529-36. [PMID: 1950076] [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: 12/29/2022]
Abstract
Two-dimensional echocardiography has become a sensitive method to differentiate between normal and pathological myocardial function during exercise. Examining 50 healthy volunteers we determined normal values for global and regional left-ventricular function during bicycle exercise. Ejection fraction increased from 59 +/- 10% at rest to 85 +/- 7% at 210 watts workload, endsystolic volume decreased from 22.1 ml/m2 at rest to 7.1 ml/m2 at 210 watts. Enddiastolic volume showed a tendency to decrease from 55 +/- 21 ml/m2 at rest to 45 +/- 23 ml/m2 at 210 watts. Quantitative analysis showed an extended distribution both for Centerline- and Radiant-Method, during exercise Centerline-Method was superior. Two-dimensional echocardiography is useful for assessment of global and regional myocardial function during exercise. Decrease of ejection fraction or increase of endsystolic volume seems to be a pathological marker. Enddiastolic volume is a less useful parameter for evaluating left-ventricular function during stress. Quantitative analysis of left ventricular wall motion can be applied with restrictions.
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Affiliation(s)
- H Mertes
- II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz
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Schermann G, Schmidt R, Völcker A, Brauer HD, Mertes H, Franck B. POTENTIAL PHOTOSENSITIZERS FOR PHOTODYNAMIC THERAPY—II. PHOTOPHYSICAL PROPERTIES OF [26] PORPHYRIN. Photochem Photobiol 1990. [DOI: 10.1111/j.1751-1097.1990.tb08675.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Breter HJ, Mertes H. The quantitative determination of metabolites of 6-mercaptopurine in biological materials. VII. Chemical synthesis by phosphorylation of 6-thioguanosine 5'-monophosphate, 5'-diphosphate and 5'-triphosphate, and their purification and identification by reversed-phase/ion-pair high-performance liquid chromatography and by various enzymatic assays. Biochim Biophys Acta 1990; 1033:124-32. [PMID: 2306458 DOI: 10.1016/0304-4165(90)90002-e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A fast and reliable two-step method has been established for the chemical synthesis of 6-thioguanosine 5'-monophosphate, 6-thioguanosine 5'-diphosphate and 6-thioguanosine 5'-triphosphate starting from the ribonucleoside. In the first step, 6-thioguanosine dissolved in triethyl phosphate, at high yield reacts with phosphorus oxide trichloride to 6-thioguanosine 5'-monophosphate which is purified by anion-exchange chromatography on DEAE-Sephadex using a step gradient of hydrochloric acid. In the second step, 6-thioguanosine 5'-monophosphate dissolved in water, reacts with phosphoric acid in the presence of pyridine/dicyclohexyl carbodiimide and is converted to 6-thioguanosine 5'-diphosphate and 6-thioguanosine 5'-triphosphate which are separated from each other and from the 6-thioguanosine 5'-monophosphate by anion-exchange chromatography on DEAE-Sephadex using a gradient of ammonium bicarbonate. Material from each step of the preparation procedure is separated by reversed-phase HPLC chromatography and analyzed for its free ribonucleoside content, 5'-monophosphate, 5'-diphosphate, 5'-triphosphate and small amounts of unidentified phosphorylated compounds. The purity of the final preparations and the identity of each 6-thioguanosine 5'-phosphate are proven by highly specific enzymatic peak-shifting/HPLC analyses using alkaline phosphatase, 5'-nucleotidase, pyruvate kinase, nucleoside diphosphate kinase and combined hexokinase/glucose 6-phosphate dehydrogenase.
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Affiliation(s)
- H J Breter
- Institut für Physiologische Chemie, Johannes Gutenberg-Universität, Mainz, F.R.G
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